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e i g h t Eligibility, Enrollment, Utilization Barriers to Public Insurance Access among Latino Families in the Age of Welfare and Health Care Reform A d e l a d e l a T o r r e , J e s s ic a N u ñ e z d e Yb a r r a , M a r i s o l C o r t e z , a n d E m i l y P r i e t o In a study examining the differential impact of Medicaid expansions on the health status of children by race and ethnicity, Lykens and Jargowsky (2002) have pointed out that access to public health insurance programs depends on three distinct realms of action. To benefit from public health insurance programs, such as Medicaid and the State Children ’s Health Insurance Program (SCHIP), an individual must first qualify for, enroll in, and ultimately take advantage of the care plan available (Lykens and Jargowsky 2002). Although this is a seemingly simple statement of fact, each of these three realms presents a unique set of difficulties for Latinos, especially in terms of their ability to benefit from public insurance programs like Medicaid and SCHIP. Furthermore , Latino immigrants in the United States face increased challenges in securing health care coverage because eligibility restrictions have become even more stringent for them (Kaiser Commission 2006). 236 Eligibility, Enrollment, Utilization ■ 237 This chapter follows the three-part approach to health care access as outlined by Lykens and Jargowsky, examining existing literature in the areas of eligibility, enrollment, and actual care as it relates to Latino citizens and non-citizens. In addition, the next chapter reviews the limited body of literature on culturally innovative interventions, particularly those that have been shown to be effective in reducing rates of under-enrollment among Latinos eligible for public health insurance programs. The goal of these chapters is thus to use existing knowledge as one basis for identifying practices that will best improve Latinos’ access to public health insurance programs in an attempt to improve their well-being and quality of life. Background and Historical Context: Insurance Status of U.S. Latinos According to United States Census 2000 data, Latinos are now the largest minority group in the United States, comprising 12.5 percent of the total population. However, this demographic growth has not led to better health care access or coverage for the population. Numerous studies have documented the various obstacles that both Latino adults and children encounter in obtaining and utilizing health care. Chief among these obstacles is access to health insurance, which is key to an individual receiving health care services (Maida 2001; Angel and Angel 1996; Schur and Feldman 2001). Barriers to acquiring health insurance can significantly lessen the amount and quality of health care received. For example, when compared to children with Medicaid coverage, children without it are 30 percent less likely to receive ambulatory care and have 50 percent fewer visits to health care providers (Marquis and Long 1996; Lykens and Jargowsky 2002). Figures 8.1 and 8.2, shown below, demonstrate the scope of the problem. As shown above in Figure 8.1, the number of uninsured Latinos increased 60 percent from 1990 to 2000, rising from 7 million to 11.2 million. According to Doty (2003), this increase in rates of uninsured has been proportional to growth in the United States Latino population during this period; so that “throughout the past decade, one-third or more of all non-elderly Hispanics have been uninsured each year—a 238 ■ De La Torre, De Ybarra, Cortez, and Prieto rate two to three times that of non-Hispanic whites” (Doty 2003). Figure 8.2 only gives us a snapshot for 2001 of the percentage of uninsured Latinos according to national origin. As is evident here, the most astonishing rates of the uninsured occur within the Mexican- and Central American-origin populations, who at 49 percent and 55 percent, respectively , are uninsured at approximately twice the rate as compared to the total U.S. population. These immense disparities in coverage speak to a health care system that requires change if we are to see parity in health care access across racial and ethnic lines. Before Medicaid was established in 1965, the likelihood of having health care insurance depended on family income level and access to an employer who offered health benefits. The Medicaid program effectively created a partnership between state and federal levels of governFigure 8.1...

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