Progress Illinois talks to one of the local players involved in getting a key demographic enrolled in Obamacare.
She consoles a young Latina with a screaming baby by reassuring the woman that signing up for health care won't get the child deported.
A few minutes later, a middle-aged man is pounding his fist on a table, venting while declaring he hasn't been sick in years so why does he need health insurance?
Welcome to the front lines of the Affordable Care Act in Chicago, where Graciela Guzman is busy answering questions and offering a reassuring smile while enrolling the uninsured in health care; many of them obtaining coverage for the first time.
"It's absolutely critical we do this work," explains Guzman, a 27-year-old former AmeriCorps volunteer. "These are people who only see a doctor when something bad happens."
How do you teach that kind of passion for a cause? As a new leader of the Chicago Affordable Care Act Consortium, a coalition of service organizations working together to help reach the uninsured, Guzman is about to find out. Her responsibilities come with an important new challenge for 2016: Finding a way to reach and enroll the final 25 percent to 30 percent of eligible Chicago-area Hispanics who still are not participating in the ACA.
But there is a great deal at stake as the woman her colleagues call "Miss Obamacare" shapes a new Latino enrollment outreach program set to begin later this year. The success or failure of that plan may hold answers to the long-term viability of the nation's most significant health care law in 50 years.
This new push will rely heavily on Latino elected officials spreading the word, and better targeting of neighborhoods where the greatest numbers of uninsured Latinos reside.
'THE RIGHT PERSON'
Advocates at the Sargent Shriver National Center on Poverty Law, a group charged with providing "Best Practices" and training to those who conduct outreach during open enrollment, say the consortium couldn't have picked a better person to lead its new efforts.
"She knows her way around a very complicated issue," said Stephani Becker, a policy analyst at the Shriver Center. "She can debunk the myths on the ground and remove those obstacles so people can get signed up."
There is also that practical experience one can only get from working on the front lines of Obamacare, Becker said. The best training comes from staffing outreach tables, making speeches on the topic and setting up individual meetings with those who need health care.
There is a great deal at stake in this new push for Latino enrollments, both in Chicago and around the nation.
Regardless of your point of view on Obamacare, everyone can agree on one thing: Its long-term viability will remain a question until everyone who is eligible gets signed up.
Barbara Otto, CEO of Health & Disability Advocates, a health policy and advocacy organization, says reaching and then enrolling Latinos will require efforts to ease their fears and overcome some stubborn obstacles.
Some stay away because they fear deportation while others simply are uncomfortable talking about their health to anyone other than family.
But it is more than fear. Business groups and private companies haven't exactly welcomed the health care law with open arms and that makes access to low-wage and uninsured workers very difficult.
It's hard to sign up the working poor when you can't get access to them, Otto explained. "Information about the Affordable Care Act just isn't getting to them."
The national political discourse regarding immigrants, President Barack Obama's controversial policy on deportations and language issues all provide major headwinds as Guzman and her team will get to work in the neighborhoods come September.
"You have a large group of working-poor Hispanics who just do not believe this (Obamacare) was meant for them," Otto observed.
The ACA Consortium is comprised 55 groups, community organizations and social service advocacy groups located across Chicago and the suburbs. Its mission is to promote partnerships and advocate for expanding health care across the region. Some members include the Brighton Park Neighborhood Council, the Hispanic Health Coalition and larger organizations such as the United Way of Metropolitan Chicago.
What makes Guzman believe she can be successful?
Growing up the daughter of new immigrant parents who fled turmoil in El Salvador provided plenty of important lessons in survival. Guzman and her five siblings learned to make the best of life in a tough section of Los Angeles during the 1990s as the children of political refugees.
They were happy just to have food on the table. Health care seemed like a pipe dream, especially after Guzman's grandfather became so sick one afternoon he had to be rushed to a nearby emergency room. Doctors told him he had cancer that was already so far along there wasn't much anyone could do.
But the days before his death were full of health care obstacles to overcome: Fear, language, questions about the quality of his care and who would be responsible to pay his outstanding medical expenses?
It provided her with hands-on experience in translating while also learning how to relate to those so overwhelmed by the health care industry's jargon. Terms like deduction, managed care, premiums, co-pays, capitation or acronyms like PPO and HMO.
Before long, she was picking up more than a few medical terms in Spanish.
There was the eye contact with her grandfather that always seemed to provide enough energy to make it through another day. She often touched his hand, offering a reassurance that only a granddaughter can provide.
After he died, her thoughts turned to what more could have been done. It's a complex question for a child.
But she posed the question often to her mother. The response was usually silence. Followed by quiet until it became clear there was no answer.
Upon entering her teen years she discovered the grandfather's death opened a window into her own mortality. It wasn't until she began seeing a physician regularly while a freshman at Grinnell College in Iowa that those issues began to subside.
Shortly after her freshman year, all she wanted to do was read about the expansion of health care across the United States.
The failures of her own family served to drive her forward.
The Affordable Care Act is hinged upon 100 percent participation of those who are eligible, anything less will do little to keep down the cost of care.
Pew Research says Hispanics have been the key driver of the U.S. population since the 1990s. Today, there are about 55 million Hispanics across the country with a median age of about 27.
Since the population tends to be younger than other demographic groups, enrolling them in health insurance is important. Especially in plans purchased via state exchanges. That should help keep costs down because younger people tend to have fewer health problems and use insurance less.
But the latest federal government data indicates nearly one in three Latinos remain uninsured even after three years of pushing Obamacare enrollments.
Those numbers are only lightly better across the Chicago metropolitan area, home to nearly 2 million Hispanics, according to local health care experts.
The first step in growing Latino enrollments will hinge on the consortium getting its own act together. Selecting a leader, shaping a program and then implementing it sounds easy but nothing related to healthcare is ever as simple as it appears on paper.
"We are doing that now," Guzman says, a sense of urgency in her voice. "We have to try some new things. And we will."
Part of the solution will hinge on convincing elected officials of all backgrounds to take a greater role in spreading the word about Obamacare, something many of them have been reluctant to do in the six years since the health care law was passed.
Embracing the law hasn't been easy for them, because those who are eligible and do not get enrolled are subject to fines of up to 3 percent of their income. All of the hard work organizing, creating a social media campaign and shaping a message to change attitudes won't be ready until early fall.
Outreach to elected officials will begin in Chicago where new research has identified Latino neighborhoods with the greatest numbers of uninsured. For instance, in the neighborhoods of Brighton Park, New City, Bridgeport and McKinley Park, there are 3,526 individuals eligible for enrollment in Obamacare.
"We need the help of our Latino elected officials," Guzman related. "Many of them have great lines of communication open with their constituents. There is no greater service then helping individuals gain access to health care."
Each consortium group's outreach staff must be licensed by the state or federal government before they can talk to the uninsured about their health care options.
Another key to bolstering Latino enrollment is more effective outreach events. In the past, outreach workers have been stationed at neighborhood libraries or local health clinics, waiting for the uninsured to arrive with questions or to discuss their health care options.
That has to change. Not only here, but around the nation.
Bill Green, manager of Public Policy for the United Way of Metropolitan Chicago, said building relationships with the Chicago Public Schools and Chicago Housing Authority - two agencies that touch thousands of lives a day - are solid examples of partnerships that were built in recent years and served to grow health care enrollments.
"Those trusted resources in Latino communities need to be identified so new relationships can be built," Green said. "Once that is done, you have to develop trust. That's how you are going to be effective."
Ray Quintanilla is an independent writer
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