By early August in recent years, Luis Torres was in the midst of a health care blitz, meeting weekly with the Department of Health and Human Services (HHS) and the White House to prepare for the start of the Affordable Care Act’s open enrollment period on Nov. 1.
As the policy director for the League of United Latin American Citizens (LULAC), Torres was a key member of the Latino Affordable Care Act Coalition—a group of local and national organizations that since 2013 has worked with HHS and the White House to develop outreach and education campaigns specifically aimed at helping millions of Latinos sign up for health insurance.
But this year, Torres told TPM, that flurry of activity came to an abrupt halt.
“We haven’t had any of those discussions. It almost completely stopped as soon as the new administration came in,” he said.
President Donald Trump has repeatedly announced his intention to “let Obamacare implode,” and has already taken several concrete steps to undermine the health care reform law. But with the fate of the Affordable Care Act’s delicate individual markets in jeopardy, inaction could be as just as damaging as active sabotage.
The major organizations that were part of the Latino Affordable Care Act Coalition tell TPM that HHS has made no effort to reach out to them this year as open enrollment approaches, and there is no sign the partnerships will continue.
HHS did not respond to TPM’s inquires about the status of the Latino Affordable Care Act Coalition and Latino outreach in general.
A Strategic Alliance
Since Obamacare’s exchanges launched in 2014, a massive amount of work happened behind the scenes to spread the word to millions of uninsured Latinos so they could take advantage of the new coverage and to convince enough people to sign up to keep the insurance markets afloat.
Much of that work happened in partnerships between the White House, HHS, and hundreds of partner groups. Latinos, who disproportionately lacked health insurance, were a key target of the Obama administration, which poured federal resources into education and outreach specifically aimed at Latinos.
“Ensuring the success of open enrollment was an all-hands-on-deck enterprise in the Obama administration,” former Labor Secretary and current DNC Chair Tom Perez told TPM. “It was a labor of love.”
Partnering with national legacy Latino civil rights groups like LULAC and National Council of La Raza (recently renamed Unidos), the Obama administration created materials in Spanish, sent its cabinet members around the country to promote enrollment, solicited feedback from grassroots groups about how to best message to Latinos young and old, responded in real time when those groups flagged problems on the ground, participated in health care town halls on Univision that reached millions of people, launched social media campaigns, and organized summits on health care.
Steven Lopez, the associate director of health policy at Unidos, told TPM that all this effort was necessary to reach a historically underserved demographic.
“For a number of folks, this was their first time ever having insurance,” he explained. “There was a lot of confusion and misinformation about what insurance is and who is eligible. We were also working with people disproportionately impacted by limited English proficiency. So we worked closely with HHS in identifying and addressing enrollment barriers, finding out what was impeding folks’ ability to get enrolled.”
In particular, Lopez said, the line of communication the groups had with the federal government was “incredibly important.”
“It was of enormous value to be able to pick up the phone and talk to HHS and have them address problems in real time,” he said. “It helped us quickly remove barriers and enable people to get covered. [HHS] also asked us for feedback on materials they were developing, to make sure they were culturally and linguistically appropriate.”
Perez, one of several Obama administration officials who flew around the country to stump for the ACA and reach out specifically to Latino communities, told TPM that the partnership was equally valuable from the government’s perspective.
“The grassroots community organizations enjoy the trust of the community. They’re trusted partners,” he emphasized. “So when we can walk in with them, we succeed.”
These partnerships paid off. Though Latinos still experience much lower rates of insurance than white people, 4 million Latino adults have gained coverage since the launch of the Affordable Care Act, and the Latino uninsured rate has dropped faster than that of any other ethnic group.
Over the past four years, every summer was a flurry of activity for the Latino Affordable Care Act Coalition, with intense preparation and regular meetings with HHS and the White House in the months leading up to the start of open enrollment. Since the Trump administration took office, the groups said, they’ve have not been contacted at all.
“In past years, our Latino Coalition existed throughout the year and was a very collaborative effort,” Lopez said. “That’s something that has now sort of dissolved, and we haven’t seen any sort of indication it will be revived.”
Several major groups that used to partner with HHS to promote open enrollment—including LULAC, Unidos, The National Hispanic Medical Association, the Hispanic Federation, Voto Latino, the National Latina Institute for Reproductive Health and Concilio—confirmed to TPM that they have not yet heard from the Trump administration and do not believe the partnership will continue.
“By this time last year we had already had various coalition meetings about how we can support the government’s communications about open enrollment,” Torres said. “We were strategizing in person and in phone calls. We were coordinating best practices and trying to leverage community infrastructure, working hand in hand with HHS officials and the White House. But as far as we can tell, that aspect of the ACA seems to have just stopped.”
Ann Marie Benitez, the senior director of government relations for the National Latina Institute for Reproductive Health, described a similar drop off.
“We would normally be having sessions by now about what worked and didn’t work in terms of strategy last year to start preparing for this year’s open enrollment,” she said. “But I haven’t heard anything in regards to enrollment from HHS or the White House, and the group hasn’t met at all since the new administration has come on board.”
Several of the organizations also confirmed to TPM that a newsletter called “Get Covered” that the partner groups used to receive regularly with information on open enrollment promotion strategies has ceased.
“We used to get emails. I used to get stuff every week: sample tweets, tips, reports, enrollment deadlines, different things we would then blast out to our partners,” said Torres. “I was just checking my email to see if I’d maybe missed something, but there’s been none of that this year.”
Additionally, the groups noticed that a report prepared by HHS last year titled “The ACA is Working for the Latino Community” that they frequently linked to, was removed from the agency’s website. An HHS spokesperson insisted the report was still “publicly accessible” because an archived version can still be found using the Wayback Machine.
Perez told TPM he sees the Trump administration’s silent rollback of the Latino partnerships and removal of information as a form of sabotage.
“Look, we took an oath of office and swore we would faithfully implement the laws of the United States, and the ACA is one of the most important of those laws,” he said. “We now have an administration that took the same oath, but in practice is working to sabotage a law they do not like. That’s unconscionable.”
Going It Alone
The Latino organizations all told TPM they plan to promote open enrollment this fall with or without the White House. LULAC, for example, will host a health fair in Los Angeles in September. Unidos plans to hold Facebook Live chats in English and Spanish to explain the failed effort in Congress to repeal the ACA and what it means for the law’s future.
But the groups stressed that they alone cannot reach as many people as effectively as they could with the full support of the federal government.
“We worked with the previous administration. We are ready to work with the current administration,” Lopez told TPM. “The ACA remains the law of the land and it’s the administration’s responsibility to make sure that law is implemented successfully rather than undermining it.”
The groups will face other new hurdles as well. The Trump administration has cut the length of the open enrollment period in half, leaving groups with a much shorter window to get the word out and less time for millions of people to consider their options and enroll. HHS also decided this spring to cancel $22 million in contracts that funded programs at local libraries that assisted people in signing up for insurance.
Because the administration has redirected funds meant for promoting the ACA towards messaging against it, the groups that once partnered with HHS also told TPM they see signs they’ll be working with a population even more misinformed than in previous years.
“People are unsure. People don’t feel like they can trust that the government is fully supporting the exchanges,” Torres said. “When you have the president saying he wants to let the ACA implode, people get worried. They ask: ‘Why should I sign up if it sounds like the president is going to shut down the program?’ So we have to work even harder to dispel these things.”
Benitez echoed these concerns.
“People were already asking in January if they should still enroll,” she said. “People are most likely even more confused now.”