There’s football season, hunting season, and the holiday season. Overlapping all of these is something decidedly less fun and sexy: open enrollment season for health insurance.
“We’ve been busy this past month,” says Iris Galvez, a health insurance navigator with the Houston social services agency Change Happens!
Galvez helps people navigate the Healthcare.gov website and enroll in health plans offered through the Affordable Care Act marketplace.
“It’s the holidays, that makes it hard. Because people are like ‘Well, we’ll just put it off,’ ” Galvez says with a laugh. “But now we’re getting very busy.”
Earlier this month, Galvez helped Elisia and Cipriano Saenz, a couple from north Houston, select a plan with Molina.
“You’ll have to pay this much per month to Molina,” Galvez explains in Spanish, before handing over a summary sheet listing the couple’s monthly premium payment ($363), the federal subsidy ($691), deductible ($2,000), and copays ($20 for the primary care doctor, $55 for a specialist).
“They’re pretty good, reasonable,” Saenz says of the amounts. “We’ll be able to afford it.”
Elisia Saenz thanks Galvez for her assistance.
“You made our day,” she says. “Because we were having a hard time getting in to it.”
Last year, her husband Cipriano Saenz did try to sign the couple up, but he was confused, and then suspicious when a government worker requested more paperwork and asked him to confirm his Social Security number.
“Sometimes we have to be careful who we talk to, give our Social Security, ID number,” Saenz explains. “He told them ‘I’m very sorry. I can’t give my information to you all through phone.’ ”
Elisia Saenz says he never followed up, and the insurance lapsed.
“Something had gone wrong, or maybe he didn’t understand,” she says.
Signing up can be a chore. You need to gather financial documents and set aside money for the monthly premium. Not only that, it’s just unpleasant to think about risk and injury and disease.
Galvez noted that some of her returning clients were angry this year because the insurance networks had become narrower. Almost all the coverage plans on the exchange in Houston are now HMOs.
“This year they have taken away the PPO. So a lot of people are not pleased with that,” Galvez said.
That means they have fewer choices of doctors and hospitals. Still, she tries to focus on the positives – not only avoiding the federal tax penalty for not being covered (which is either $695 for each adult without coverage or 2.5% of household income), but also the peace of mind that insurance will bring.
“You never know, you know? You fall and slip and break your leg, that’s a big bill from the hospital,” she says.
Elisia Saenz is 56 and Cipriano Saenz is 62. They work as janitors at a charter school, where Elisia also works in the kitchen. She says they can’t afford the insurance offered at the school.
“It’s been years that I haven’t been to a doctor,” Elisia says. “Thank God that I haven’t gotten sick. Now I can just go and get a whole physical, and he can do the same. So we’re happy that we got this.”
The Obama administration has increased its outreach this year to Hispanics, running special ads and targeting cities like Houston, Miami and Dallas with big Hispanic populations.
Across the country, 20.9 percent of Hispanics are uninsured in the U.S., compared to 12.7 percent of blacks and 9.1 percent of whites, according to the Kaiser Family Foundation.
There are lots of reasons why. Hispanics are more likely to work in jobs that don’t offer health benefits. Many are ineligible for the Affordable Care Act, or just don’t know about the options available.
Of the three states with the biggest Hispanic populations, only one, California, has chosen to expand Medicaid to low-income, uninsured adults. Florida and Texas have not expanded Medicaid, and that’s affected many low-income Hispanic adults.
In surveys, Hispanics explain the main reason they are uninsured is cost. Health coverage just seems too expensive to fit into a budget.
“They don’t make enough money where they work, or they work self-employed, cutting yards and stuff,” says Elisia Saenz, describing some of her neighbors.
“Sometimes they can barely, probably make it to pay the rent, feed their kids, clothe them. I know it’s kind of hard for them, if it’s just one person working in the household.”
Federal officials counter that’s an outdated perception for some Hispanics – because under the new law, many would qualify for subsidies to buy insurance, just like the Saenzs did.
Enrollment in most states for 2016 ends Sunday.
This story is part of a reporting partnership with NPR, Houston Public Media and Kaiser Health News.