Published January 13, 2014
Many Latinos are being left out of the first wave of coverage under the new health insurance program because multiple glitches in the Spanish version of the website have made it difficult, or impossible, to enroll, experts say.
The site, CuidadoDeSalud.gov, launched more than two months late.
A Web page with Spanish instructions linked users to an English form.
And the translations were so clunky and full of grammatical mistakes that critics say they must have been computer-generated — the name of the site itself can literally be read "be careful of health."
"When you get into the details of the plans, it's not all written in Spanish. It's written in Spanglish, so we end up having to translate it for them," said Adrian Madriz, a health care navigator who helps with enrollment in Miami.
The issues with the site underscore the halting efforts across the nation to get Spanish-speakers enrolled under the federal health care law. Critics say that as a result of various problems, including those related to the website, many people whom the law was designed to help have been left out of the first wave of coverage.
Slightly more than 30 percent of Latinos – who number 53 million in the United States – lack health care coverage. In surveys of Latino adults, a majority indicate support for the Affordable Care Act.
Federal officials say they have been working to make the site better and plan further improvements soon. Also, administrators say they welcome feedback and try to fix typos or other errors quickly.
"We launched consumer-friendly Spanish online enrollment tools on CuidadoDeSalud.gov in December which represents one more way for Latinos to enroll in Marketplace plans," said Health and Human Services Department spokesman Richard Olague in an email to The Associated Press. "Since the soft-launch, we continue to work closely with key stakeholders to get feedback in order to improve the experience for those consumers that use the website."
Still, efforts to enroll Spanish-speakers have fallen short in several states with large Hispanic populations, and critics say the translated version of HealthCare.gov could have helped boost those numbers.
In California, officials have acknowledged the need for improvements, saying fewer than 5,500 people signed up for health care in Spanish in October and November, the most recent period for which records are available. About 4.3 million California residents speak only Spanish, according to census data. It's not clear how many of these residents are without health insurance, but observers say few groups are more vulnerable.
"Spanish speakers are typically the ones who need to sign up for health insurance," said Veronica Plaza, a professor who teaches medical Spanish at the University of New Mexico. "They are the ones who could use the support."
In New Mexico, the state with the nation's highest percentage of Latino residents and where more than 20 percent of the state's population goes without health insurance, fewer than 1,000 people total signed up for coverage in October and November.
In Florida, federal health officials have not said how many of the state's nearly 18,000 enrollees for October and November were Latino, but that group accounts for about one-third of the roughly 3.5 million uninsured people in the state. About 1.2 million people in the state speak only Spanish.
Across the U.S., about 12 percent of the 317 million people in the country speak only Spanish, but federal officials have said less than 4 percent of calls to a national hotline were Spanish-only as of last month.
Many blame at least some of the enrollment problems on the trouble-plagued site.
"In my opinion, the website doesn't work," said Grettl Diaz, a 37-year-old Miami gas station cashier who is originally from Cuba.
Diaz said she tried to sign up at home using CuidadoDeSalud.gov. After she couldn't get the website to accept a scanned document, she called the government's Spanish hotline seeking help. However, she was repeatedly told to call back because the site was down. She got through days later and waited over an hour for an operator before she was ultimately disconnected.
"I'm very frustrated," she said through a translator this month. "I've spent at least one week on the phone, and I couldn't get it done."
Diaz, who speaks very little English, finally went to a counselor for help and is now waiting for an email from health officials saying she can proceed with her application.
Diaz hasn't had insurance since moving to Florida two years ago. She will likely qualify for a tax subsidy to help pay her monthly premiums and has said she wants insurance mostly for peace of mind.
"Now, I am healthy," she said. "But I don't know what will happen tomorrow."
Such stories have frustrated Latino advocates, especially since the problems with the site come after an unprecedented collaboration between competing Spanish-language media outlets and Latino businesses, urging members of their communities to sign up for health care on Oct. 1. But advocates say despite promises from federal officials, the Spanish-language site was not up until Dec. 6.
"In many states, groups were cooperating and ready to go," said Patricia Perez, a partner of the VPE Public Relations, a Pasadena, Calif.-based firm that focuses on U.S. Latinos. "It was a missed opportunity."
Univision Communications Inc., which runs the largest Spanish-language media network, has been airing daily public service announcements about the health care overhaul. It hosted and aired a live town hall meeting out of Los Angeles last month to discuss the law, and another such event has been planned for February.
The network frequently airs segments about the Affordable Care Act on its weekend health shows, and it produced a documentary exploring obstacles Latinos face signing up for health insurance, network spokesman Jose Zamora said.
The film, featuring a 19-year-old Mexican-American whose father suffered three heart attacks with no insurance aired Dec. 1 — five days before CuidadoDeSalud.gov went live.
Since the site has been active, users have reported disappointment and frustration in both the functionality and language.
For example, links comparing insurance plans took users to the English version of the options. That glitch was fixed last week after The Associated Press contacted Health and Human Services to ask about the problem.
As for the language, Plaza, the New Mexico professor, said a recent examination by her research students concluded that the translations were done "by a computer-generated process" and came across as awkward.
"There are problems with the verbs and word order that make sentences hard to understand," said Plaza, who helped develop an audio version to help residents in New Mexico sign up.
"Sometimes," she added, "it's just the terms they use."
The website translates "premium" into "prima," but that Spanish word is more commonly used to mean a female cousin, Plaza said. A more accurate translation, she said, would be "cuotas," ''couta mensual" or "costo annual."
According to Health and Human Services, the website was translated with the same methods and team used to translate content into Spanish for the Centers for Medicare & Medicaid Services.
But health care workers in Miami also have reported technical problems that don't exist on the English version of HealthCare.gov.
Nini Hadwen, a health care navigator, said she also prefers to use the English website even when she's enrolling Spanish-language applicants. CuidadoDeSalud.gov "doesn't navigate as smoothly from page to page," she said. "It takes longer."
Also, navigators say Spanish-language applicants must provide income and immigration documentation. Frequently, applicants are required to scan and fax supplemental documents, which can also be challenging, as Diaz's case shows.
However, Jane Delgado, president and CEO of the National Alliance for Hispanic Health in Washington, D.C., defends the site, saying Friday that delays were merely "part of the process" and that she was confident federal officials would get it running better soon.
"Insurance is way complicated. It's not like paying for a cellphone," she said. "Technology is only part of the answer."
Overall, Delgado said Spanish-speaking Latinos will benefit from the federal overhaul in the long-term because the population is less likely to be insured compared with other groups.
Still, Gabriel Sanchez, a political science professor at the University of New Mexico, said the problems hurt the credibility of federal officials and reinforce the belief held by some that authorities are indifferent to the plight of Latinos.
Sanchez said, "They will look at this, and think, 'Man, they really don't care about us.'"
Based on reporting by The Associated Press.