Health care coverage for Latinos lowest in North Carolina

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Health care coverage for Latinos lowest in North Carolina
Thursday, 01 May 2008
Amy Eagleburger

uana Martinez, 54, was diagnosed with diabetes three years ago. Like most diabetics she must be diligent in checking her blood sugar and monitoring her diet.

But she also has to be resourceful in finding ways to afford the medicine she so desperately needs. Juana, like more than 270,000 other Latinos in North Carolina, is uninsured.

Originally from Michocan, Mexico, she immigrated to the United States five years ago. First entering in Florida and then moving to North Carolina. Her husband works as a dishwasher at a local restaurant. The restaurant provides him with health care but it does not extend to Juana or her two daughters who still live at home.

The situation is similar for Enrique, 33, and Leonor Ruiz, 36, who are originally from Guanuato, Mexico. Enrique has been in North Carolina for the past 14 years working in construction but he has never been offered health care for himself, let alone his wife and three kids.

His wife, Leonor, joined him in North Carolina four years ago. She remains at home to care for their three children, ages 11, 10 and 7. Neither the Ruizs or the Martinez family had health insurance when they lived in Mexico.

In North Carolina, 52.6 percent of the more than 517,000 Latinos that live in North Carolina are uninsured. That number is significantly higher than the 19.9 percent of blacks and 13.4 percent of whites who are uninsured, according to the State Center for Health Statistics and the Office of Minority Affairs.

Some are like Enrique, employed but without being provided insurance. Some are like Juana, who stay home to care for children but cannot afford the costly policies. In Juana’s case, a policy that would cover herself and her two daughters still living at home, with a $10,000 deductible would cost $3,027 per year. She would still have to take care of co-pays. The quote does not take into account her diabetes which likely would increase the rate.

Groups in North Carolina are trying to change these statistics on three fronts – by educating Latinos about the importance of health insurance, by filling in the gaps with free and reduced rate clinics and by combating the substantial barriers to both.

In most Latin American countries it is rare for individuals to have private health care insurance. Even then it tends to be only the wealthiest of citizens. There is almost no concept of preventative care.

“If you see an Hispanic male in their 20s, 30s, 40s, 50s and you ask them when is the last time you’ve had a physical, they would respond ‘Oh, I haven’t had one in 10 years.’ That’s pretty common,” said Rudy Rivas, president and CEO of Hispanic Insure, which sells health insurance policies to Latinos and Latino-owned businesses in California and Florida.

Walking Time Bomb

The results of waiting for treatment can be disastrous. For un-diagnosed diabetics, living with the disorder for a decade can result in heart and blood vessel disease, blindness, kidney failure and foot ulcers, sometimes requiring amputation.

“If you haven’t been to the doctor in 10 years you’re a walking time bomb,” Rivas said.

The process of marketing to Latinos and Latino business owners is vastly different from marketing to the general population, Rivas said.

Selling to Americans, most insurance salesman are taught to close the sale as soon as possible. Latinos require a bit more patience, he said.

“You don’t push them,” he said. “You come in, you explain everything and then you leave.”

Often he will give someone a quote, but they will not decide to buy the policy until a year down the road.

“The first-generation immigrants, the goal is to just get here,” Rivas said, adding that health care becomes a priority for their children. He is a second-generation immigrant from Cuba.

“All my mom talked about was getting an education, getting health insurance,” Rivas said.

Convincing Latinos that health insurance is a good investment is one of the goals of the Líderes de Salud (Health Leaders) program run by El Pueblo, a Raleigh-based advocacy group that works to promote Latino issues in Wake County.

Started three years ago, Líderes de Salud is a program that trains Latinos to be lay health advisors to others in their community. About 90 promotores de salud (health promoters) have been trained since the program started, and between 20 and 25 will graduate in May from the most recent training session, said Florence Simán, Health and Human Service adviser for El Pueblo.

“We train folks on how to advocate on their own behalf,” she said.

Door-to-door sales

Promotores spend most of their time going door to door in Latino communities providing information to residents, many of whom they already know as neighbors. They also work outside of clinics and health care centers, insuring that Latinos know what they can expect.

To become a promotore, volunteers must commit to attending a class once a week for eight weeks. There are two groups now, one that meets in the mornings for those who are unemployed and one that meets in the evenings for those that have jobs during the day.

The course includes information about buying insurance but most importantly how to use the insurance and the available medical facilities effectively. Promotores are also given tours of local medical facilities so they will be more comfortable working in that environment in the future.

“Most of them are first generation,” Simán said of the promotores. “Most of them are Spanish language dominant and I would say some of them, maybe about 10 to 20 percent, have had some kind of health or health care training in their country of origin.”

The position is voluntary, but they are able to receive a $150 stipend per year, basically a mileage reimbursement, Simán said. This year El Pueblo likely will have enough funding to increase the stipend to $300.

Some promotores even decide to pursue further education in the medical fields – getting a GED and then working to be certified as health professionals, Simán said.

Blue Cross and Blue Shield of North Carolina is also reaching out to the Latino community through the creation of a bilingual Hispanic relations team, participating in about 13 Latino health fairs per year across the state and also creating an internal minority affairs council.

“We have people from different countries within the company that have helped us identify what the main differences are between the majority of the Latin American countries and the U.S.,” said Teresita Hoffman, a bilingual program manager for the Hispanic relations team at BCBSNC.

“We have noticed that during our outreach events we usually don’t have only uninsured, we may have people who have insurance but they don’t know how to use it,” she said.

A major problem in receiving information is the language barrier. BCBSNC now makes sure that all materials are available in Spanish. It’s also important that the design is culturally relevant by having pictures of Latino families in brochures, people playing soccer and other images that would resonate with Latinos, Hoffman said.

Some hospitals in and around North Carolina’s urban centers have also moved to create bilingual signage and information packets. But signs in Spanish do not solve the problem of how patients and doctors communicate with each other once they are in the examining room.

“The thing is right now the Latinos in North Carolina, this group is still pretty new here so it’s hard for us to compare to states like Texas or California or Florida,” Hoffman said of services provided in North Carolina.

Emergency room treatment

A major misconception in the Latino community is that the emergency room is the best place to seek treatment, even for minor illnesses, she said. In most Latin American countries, medical facilities are large hospitals. When Latinos think of receiving medical care, they think about such buildings rather than the smaller clinics that exist in the United States.

Disease does not discriminate based on possession of health insurance. For uninsured Latinos who need health care, the 75 free clinics and pharmacies across the state form an important line of defense in case of illness.

The North Carolina Association of Free Clinics website offers a complete list of free clinics along with contact information for the clinics. However, the Web site is in English only.

These clinics are either completely free or operate on a sliding scale payment system. The Student Health Action Coalition is a free clinic on Wednesday evenings, run from the offices of the Carrboro Community Health Center.

The clinics depend on grants, donations and hours of volunteer work by students from all of the allied health schools, professional physicians and translators to provide the best care possible for the uninsured, many of whom are Latino.

SHAC began in 1968 as a project of the University of North Carolina at Chapel Hill’s allied health schools. A few years ago the university decided to divest from the clinic to see if it could be self-sustaining. Happily it is, said Lindsey Bach, a first-year nursing student at UNC-CH and the current director of SHAC.

“We have an endowment that we’re building and trying, hopefully, within the next four or five years or so, to have enough so that we can operate of the interest and then we won’t have to apply for any more grants.”

But clinics cannot provide all the services of a regular clinic where a patient has a primary physician.

“We don’t do chronic care here. It’s really not feasible,” Bach said. “We don’t have regular attendings – professional physicians to monitor the medical students – who come in so it’s really difficult to follow patients through chronic care. We really try hard to refer people, get people to other sources.”

One source is the day clinic, Carrboro Community Health, which allows patients to pay on a sliding-scale based on what they can afford.

“It’s just important for them to have these walk-in clinics where they can get information without signing up for something,” said Lisa Wiese, a first-year medical student at UNC-CH and a Spanish-speakers Assisting Latinos Student Association (SALSA) volunteer translator at SHAC.

She said the clinic also has a reach out and read program. While parents or siblings receive medical treatment there is usually an impromptu reading session in the corner, led by a volunteer.

The North Carolina Area Health Education Centers Program has also attempted to reach out through the creation of a health resources Web site. The site is currently only in English and offers a few links while the organization waits for the site to be redesigned and re-launched.

Running contrary to the community push to provide better health care to Latinos, new law enforcement regulations are making it more difficult for Latinos to get to the clinics.

Immigration issues

The North Carolina Office of Minority Health has reached out to address disparities. Sheriffs using new powers found in line 287 (g) of the 1996 Immigration Reform bill however might be preventing Latinos from accessing health care.

Clause 287(g) allows for Sheriffs Office deputies to work with authorities from Immigration and Customs Enforcement to ensure immigration statues are being upheld. And amendment to the bill in March of 2008 provided an additional $75 million for the program.

Mecklenburg, Alamance, Gaston, Cabarrus and most recently Durham counties already have officers who are now immigration officers and sheriff’s deputies. Eighteen other counties have applied for the program.

“What’s happening is in some counties the sheriff’s department has a car a block away from the health department and they’re doing a checkpoint,” Simán said. “That’s scaring people from driving to the health department.”

While it is rare for stops to be set up deliberately near a health center, Simán said the new laws are making Latinos afraid to be out on the roads in general, making them less likely to seek medical attention even in emergencies.

Marie Miranda, a public health consultant and training coordinator at the Office of Minority Health, said blocking health care because of immigration status doesn’t just effect the health of the immigrant but also the health of the entire community.

“No matter what color, where someone is from, what language they speak, if it’s a communicable disease, like TB, they can transmit that,” Miranda said. “Do we really want to sit around and decide if they’re eligible for treatment?”

She also rejects the idea that Latinos receiving health care is a drain on public funds. They do pay taxes every time they buy food at a grocery store and, even if they use a fake Social Security number, they pay taxes on it.

“We have a lot of Russians here illegally but because they’re lighter skin, green eyes, blonde, no one really pays attention,” Miranda said.

Amy Eagleburger is a senior at the School of Journalism and Mass Communication at UNC-Chapel Hill. She is interning this summer at the Phoenix Business Journal in Arizona.