Latinos important constituency in health care overhaul

Translator Samuel Alcocer
Spanish-language interpreter Samuel Alcocer, right, helps a patient communicate with diabetic nurse educator Michele Kimber Thursday, June 13, 2013 at NorthPoint Health and Wellness Center in Minneapolis.
MPR Photo/Jennifer Simonson

When Samuel Alcocer arrived at the reception desk of a north Minneapolis clinic with a swollen cheek in 1996, he was desperate for relief.

One of his wisdom teeth had erupted into a throbbing, painful ache.

At the time, Alcocer, a native of Santa Cruz in the Mexican state of Guanajuato, spoke no English. No one at the clinic spoke Spanish. So he and the receptionist resorted to gestures, to little avail.

"[I was] pointing hands to my face," said Alcocer, who remembers the day vididly. "And the lady at the front desk [was] just moving her arms, like 'What do you want me to do?'"

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Seventeen years later, he helps to make sure others don't have a similar experience, working as a Spanish interpreter at the same clinic in Minneapolis, now called NorthPoint Health and Wellness Center.

While Latinos comprise only about 5 percent of Minnesotans -- a small fraction of the state's population -- they are a big part of the uninsured population. One in eight Latinos lacks health insurance.

That makes Latino communities a likely focus for efforts to reduce the number of Minnesotans lacking health coverage.

"It was like, 'Why cannot I go over there and open the doors that was one time shut in my face?'"

For Acolcer, interpreting for Spanish-speaking patients and English-speaking health care workers has been a calling.

"To me," he said, "it was like, 'Why cannot I go over there and open the doors that was one time shut in my face?'"

Alcocer's tenure as a NorthPoint onterpreter began 10 years ago as temporary project with funding for six months. On his first day, he was given an office, a desk, a computer, and a phone and told he'd get a call if needed. But instead of sitting in his office and waiting Alcocer did what he wished someone else had been doing when he arrived there the first time.

"I went and sat in the lobby waiting for anybody to show up and say, 'Welcome; thank you for coming. How can I help you?'" Alcocer said.

In the first month, 25 Spanish-speaking patients arrived. Their family members and friends followed in subsequent weeks. By the sixth month, Alcocer was interpreting for 700 patients. Today, NorthPoint sees close to 1,000 Spanish-speaking patients each month. Alcocer attributes that growth to word-of-mouth, not advertising or marketing.

The funding for his position was extended, and after eight months, Alcocer needed help, so the staff expanded. There are now eight full-time and five part-time Spanish-speaking interpreters at NorthPoint.

Alcocer said that kind of one-to-one interaction is what many Spanish-speaking people will need to understand the new federal health care law's requirements and benefits. Radio, TV or newspaper ads in English, he said, won't be enough.

Eva Sanchez of Portico Healthnet agrees. Sanchez, a native of Morelos, Mexico, has been working in Minneapolis helping Spanish-speaking families navigate the health insurance landscape for more than five years. She has an office in the Andersen United Community School located in the heart of one of Minneapolis' most vibrant Latino communities.

Sanchez said health insurance itself can be a foreign concept for Latino immigrants, particularly if they grew up in a small town as she did. They often have no experience filling out health insurance forms, because where they lived there was no health insurance. Patients pay the doctor at the visit.

"If it's already difficult for people from here," Sanchez said. "Imagine how hard it will be for other people."

Other immigrant advocates say the new federal health care law has a mixed message for immigrants that make it harder to convince some Latinos to enroll in health plans.

The law includes a variety of restrictions on immigrants. Even people who are legally entitled to be in the United States are subject to a five-year waiting period before they're eligible to enroll in Medicaid. In addition, the law bars anyone who entered the country without authorization from receiving the health care law's benefits.

People who work with immigrants say the law's mingling of health and immigration policy can stoke fears about being deported.

"There's no question that the politics that has mixed immigration policy with what I think should be public health policy has made the job much harder," said Daniel Zingale, senior vice president of the Los Angeles-based private health care foundation, The California Endowment.

California, which has more uninsured residents than many states have people, started trying to navigate those crosscurrents before most states. Latinos make up 59 percent of its uninsured.

The California Endowment has partnered with Spanish-language media giants such as the Telemundo and Univision networks to explain the new law. The campaign also includes Cuban-born psychologist Isabel Gomez-Bassol, known to millions as "Dr. Isabel," explaining the law's benefits and limits. It's important, Zingale said, to have trusted personalities delivering those key messages.

"That Latinos are welcome, that new immigrants are welcome, and that enrolling in Obamacare is not going to trigger any punitive immigration action from the government against your family," Zingale said. "But I think it's going to be a constant endeavor to get that across.'"

Two field polls of Californians appear to bear that out. Latino support for the federal health care law in California rose from 46 percent in April 2010 to 70 percent in Jan. 2013.

2010 Field Poll of 1,522 Californians
2013 PPIC Poll of 1,704 Californians

Officials with MNsure, Minnesota's new health insurance marketplace, say they are working on an outreach plan specifically aimed at Latinos, but they won't provide details.