Those who primarily speak Spanish are largely being left out of the first wave of coverage under Obamacare. Many missed the late December deadline for enrollment in plans beginning Jan. 1. People must sign up by March 31 or face a penalty.
In part, the lag in sign-ups among Spanish speakers reflects a digital − and a cultural − divide. Many are hesitant about handing over personal information to strangers over the Internet, advocates say. This group tends to be less educated, and have lower incomes and less access to technology than fluent English-speakers.
When Elizabeth Gonzalez, 31, started getting migraines her doctor prescribed medicine that cost $300. She had health insurance provided through a San Mateo County program for low-income adults, but the medicine wasn't covered and she couldn't afford it.
"I guess I don't need it," she remembers thinking. Then she started wondering whether the new health law might offer a better plan.
Gonzalez, a part-time library aide, started hunting for resources to help her decipher the Affordable Care Act. Though a Los Angeles native, she was raised in Morelia, Mexico and preferred to have the law explained to her in Spanish.
California's health insurance marketplace, Covered California, has had a functioning Spanish-language website since Oct. 1 – which puts it ahead of most of the rest of the country. But Gonzalez couldn't access the site from home because she doesn't have Internet service or a smartphone.
"With my budget, I don't have access to that," she said in Spanish. "I have to limit myself to the primordial."
Instead, she relied on staff at the county's human services office, two floors up from the library where she works, to guide her.
Staff members there told her she needed to fill out an application and to wait for up to a month to hear whether she was eligible for Medi-Cal − California's insurance program for the poor. Discouraged, she made repeated telephone calls to the hotline for Covered California.
"There's no one picking up, probably because there's not enough people," she said. "We need more information in poor communities and places to help you fill out forms so you know you're doing it correctly. There's not enough [information] in Spanish."
According to the latest data released by the state, less than 5 percent of California's roughly 110,000 signups in October and November were completed in Spanish.
Spanish-speaking operators at Covered California call centers, as well as navigators who can walk people through enrollment, are in short supply. The section on the Spanish version of Covered California for requesting help with enrollment still links to an English website.
In other parts of the country, Spanish speakers are worse off.