Healthcare Reform’s Biggest Ailment: Fear

Problems with the website aren’t helping, but the worst impediment to healthcare reform for some may be fear of dealing with the medical system, writes a former healthcare “navigator.” Marina Sáenz Luna explains how rural communities like those in the Rio Grande Valley can lead the way in helping folks get covered and get well.

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I am 30 years old, computer savvy, own a laptop and even have one of those mobile hotspots on my phone. While I had everything I needed to enroll in the healthcare marketplace, I could not.

This time, I could not blame the website. I had to give myself a proper diagnosis: I was terrified of healthcare. To be more precise, I was terrified of the overwhelming process of selecting an insurance provider that I had equated with healthcare.

The last time I had the opportunity to pick my own health insurance was while working for a small non-profit organization. I avoided the process for nearly three years because I had no idea where to begin. The fear immobilized me from seeking coverage.

While in college, I took advantage of the clinic on campus when I needed mandatory physicals for employment. Aside from this, I have only had private health insurance for a combined three months in the last eight years.

When the Texas Tribune put together their report of 5.7 million uninsured Texans, I began to see my experience reflected in these numbers: 58.8% of uninsured Texans were Latinos; 80.2% of uninsured Texans are between the ages of 18 and 64. In the Rio Grande Valley, about 41% of residents were uninsured compared to only 15% nationally.

   
A portion of the Rio Grande Valley in southeast Texas. Political and geographic boundaries make the region difficult to enter and leave. Click map to enlarge.
In the Valley, being left out is the norm.

There are many physical boundaries that enclose the Rio Grande Valley – making it a hard-to-reach area. We’re the abandoned child that cannot climb the border wall. We cannot cross the Falfurrias checkpoint to head north. We try to avoid the violence to the west (namely Starr County) and can’t swim across the Gulf of Mexico to another land. In many ways, this corridor has been forgotten – leaving successive generations in survival mode.

There is, however, an incredibly affordable healthcare industry just across our border that caters to mobile retirees (better known as “Winter Texans”). Those with the privilege to cross the border are decreasing as border security gets tighter.

The cartel-related violence has also stopped quick day trips to México for more affordable health care. A recent interview with a community health worker by Kaiser Health News shows a new trend for those managing diabetes. Before, it was common to hear stories of families who would cross the border to get cheaper insulin and other types of prescription medications. Now, it’s more common to hear that family members prefer to share their insulin rather than risk crossing the border.


Spreading Fear

During the first month of the federal healthcare marketplace rollout, I had the opportunity to become a certified “Navigator” and worked for a local nonprofit to offer assistance in enrollment. In my short time helping to enroll people in the marketplace, I learned that many families in the Valley were afraid to be honest about their pre-existing conditions and immigration status for family members.

Photo provided by Marina Sáenz Luna
The author, Marina Sáenz Luna, was trained to help others navigate the health insurance marketplace. Even so, she had to overcome her own fear of dealing with the healthcare system to choose an insurance plan.
When I told my mother about my new job, the first comment I heard was “I heard we’re going to have to pay a fine.” 

Now, my mother was a federal employee for 40 years, keeps up with the news and has taught herself to use technology despite coming from a generation that grew up without it. 

My mother has had health insurance for many years and upon hearing about the Affordable Care Act, she had an intense fear. She felt threatened that her health insurance – along with the disability income that my father receives – was going to be taken away. She thought that she would have to buy health insurance that would be too expensive for her and was going to have to pay a fine if she did not choose this new mythical expensive coverage.

For Texas families, many will find themselves in a “black hole” because Governor Rick Perry rejected federal money that would have expanded Medicaid. The federal law was written with the understanding that federal funds would go to individual states to expand Medicaid to serve those who don’t make enough to cover their families through private insurance. One can only imagine how an additional $28 billion could have helped Texans receive some type of coverage.

Unfortunately, these families and individuals will most likely not be covered. The best that they can do to avoid a fine, while remaining uninsured, is to file for an exemption. 

While the online application process has been encouraged, the reality is that the website failed during its first month in two central ways. Those who are computer literate could not fathom waiting over half an hour for a page to load, and those who are not tech savvy needed over half an hour to understand what it means for a page to “load”. To add insult to injury, many of those who so desperately need health insurance are also those least likely to have Internet access and computer literacy skills. For Spanish-speakers, the paper applications were not readily available last month and the online application in Spanish was non-existent when the healthcare.gov site launched.

Photo by Marina Sáenz Luna
A healthcare navigator (facing camera) in Edinburg, Texas. When Marina Sáenz Luna was a navigator, she found that people had questions that grew out of fear and erroneous information about the Affordable Care Act.  
The bad publicity that the website received amplified the fear that people have about everything healthcare-related: the mandate, the fine and health coverage itself. 

During an enrollment event, I heard story after story from students and older adults. I got asked what would happen to their Medicaid, Medicare, their current insurance plans. They feared having their most basic coverage taken away. And they were confused by what they had heard from the media.

The problem is that fear and confusion don’t help.  With no encouragement, people will pay fines until they run out of money. They will file for an exemption before they even know about their coverage options. And more terrifying, they will not get medical attention when they need it, even when they do have coverage, because they won’t understand how to use it. 

Shifting the Conversation

This is why rural America must shift the conversation. We need to motivate people with hope and leave fear behind. 

The hope of receiving the care we need is here – whether we have been previously left out of the healthcare system because of pre-existing conditions (the Rio Grande Valley has three times the national average for Type 2 diabetes) or healthy adults who are never immune to a potential devastating accident.

For the first time, the health insurance industry cannot turn away anyone for a pre-existing health condition.

This is significant for people in the Valley who live in or near toxic areas that have been declared “superfund sites” because of a dangerous level of chemical contamination that requires a long-term plan to clean up. Those living in the Valley who have been exposed to chemicals like Agent Orange have reported numerous health issues, the most serious including miscarriages and cancer. For the first time, they will have the opportunity to get covered. Those with diabetes, heart conditions and any other untreated conditions can be covered. This kind of inclusion is indeed rare, and we should be spreading the word like it’s good chisme (gossip)

It is also important to note the government decided to leave undocumented immigrants out of the equation. While I believe that this is deplorable, families with both documented and undocumented members will still be able to apply for documented family members, and we should encourage people in our communities to do so.

Since the healthcare marketplace launched, I have met families who want health coverage so badly, they have begun to put money aside for their first payment. 

I have begun to see a younger and more computer-literate generation of healthcare recipients stepping up to help their parents, relatives and abuelitas (grandmothers) enroll. This kind of coming together is inspiring, and our media should be reporting it.

Marketplace materials have been translated to address the needs of non-English-speaking residents. Undocumented immigrants are not eligible to participate.
Now, I knew I could not write this article until I had tried my luck on the federal healthcare.gov site. To my surprise, I was able to create an account, verify my identity, browse and save health plan options in about 33 minutes. I spent more time making excuses than I did starting the process. 

I’ll be honest that some parts of the site are a bit counter-intuitive, but this experience in comparison to navigating a sea of healthcare information on my own was like night and day. I can hold my head up high and say “I actually figured it out”.

During the enrollment section, one may wonder how in the world they’ll be able to differentiate among the plans. Have no fear – there is a color code system (bronze, silver, gold, and platinum) and even an option to compare plans literally side-by-side to see what plan will work best. Some people may qualify for a “catastrophic plan” that is considered very affordable and offers the most basic coverage.

Free educational resources are essential for people who live in low-income areas with low adult literacy rates. The healthcare.gov site has informational graphics that help explain how health insurance coverage works. There are also videos that explain the sign-up process.

The hope that we can and will get covered is one that can inspire our friends, families and our neighbors to follow our example. It’s time for us to stop ignoring the symptoms and begin to heal our communities.

Marina Sáenz Luna is a Native Tejana who has been doing community work in the Rio Grande Valley of Texas for the last 15 years. She is co-author of the blog www.magicvalleyoftexas.com.

 

Topics: Health
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