Advocates Prepare for Confusion and Resistance to Obamacare Among Asians

By Mina Kim, KQED

There's talk the Obama administration will try to enlist the help of NBA players to sell the federal health law to young men. For its part, Covered California, the state’s new health insurance marketplace, plans to spend millions on an ad blitz and social media strategy. But in a state as diverse as California, one of the toughest challenges will be reaching ethnic communities where English is a second language.

In Orange County's Little Saigon neighborhood where suburban-style strip malls fill with Vietnamese storefronts, the Affordable Care Act isn’t top of mind.

“[Vietnamese] know that whatever they think (about health reform), it will turn out to be different,” primary care physician Dr. Dean Ngo said with a laugh. “So they decide not to waste their thinking.”

His colleague, Dr. Mai-Phuong Nguyen, has a different take.

“A lot of ethnic communities have great hesitancy to be accepted as part of the mainstream because our collective experience is that we've always been in the margins,” Nguyen said. “ACA is different in that it's saying we do care about you,”

Nearly one in five Vietnamese Americans in California is uninsured, and more than half aren’t proficient in English. Researchers at UC Berkeley and UCLA estimate 110,000 eligible Californians will miss out on health reform because of language barriers. Nguyen said suspicion about the law will play a role, too.

At the busy primary care office where Nguyen works, patient Nikki Dong's opinion on the health law is pretty negative. Dong worries about the cost to taxpayers of covering more people.

“It means we have to pay more taxes, we have to work harder,” Dong said. “That's why I think it's kind of a little unfair.”

Little Saigon small business owner and former City Councilman Tyler Diep said the Vietnamese business owners he knows are planning to get out of the health law's requirements by laying off staff. Businesses with more than 50 full-time employees are subject to penalties under the Affordable Care Act.

“It's not that they don't want to provide health care,” Diep said. “It's just that in order to stay above water, they cannot afford the additional cost.”

Grassroots Outreach and Education

The goal of health reform --  to insure more people and keep insurance premiums affordable -- depends on lots of people signing up for coverage. But the Vietnamese community isn't the only Asian community where health reform advocates are expecting to encounter confusion and resistance.

“It is overwhelming when we think about how much we need to do,” Doreena Wong said.

Wong is with the Asian Pacific American Legal Center in Los Angeles, and is leading an effort to get the state's Asian populations aware of a key piece of health reform: the state-run insurance marketplace Covered California.

Wong will use a $1 million grant to educate communities from Sacramento to San Diego on Covered California's health plan options and available tax credits. She'll work with 21 community-based groups to fan out in dozens of neighborhoods, including Chinese, Indian, Thai, Pakistani and Samoan. In many cases outreach workers will teach people about premiums and co-payments.

“A lot of our community are immigrants, and so that means that they're not familiar with our health care system,” Wong said. “It's crazy enough for us to navigate our system when we grew up with it, but for somebody coming over from another country, they don't understand what a managed care plan is or why (they) have to get permission to go see a doctor.”

Complicating matters, Covered California's online insurance application will be available in English and Spanish. Wong said she and others have been trying to get Covered California officials to change that,  but with enrollment opening Oct. 1, they can’t delay outreach. Wong is anxious to get started for other reasons. Immigrant communities are vulnerable to scams.

“We want to get the word out and tell them where to go,” Wong said. “Not that little store with the little shingle out there that says ‘I have cheap health insurance,’ which you know will spring up.”

Pent-up Demand for Health Insurance

But Little Saigon community health educator Lucy Huynh thinks federal health reform might not be such a tough sell. Huynh is with Orange County Asian and Pacific Islander Community Alliance, one of the groups involved in outreach. The Vietnamese community has long suffered from high rates of lung and liver cancer, and over the years Huynh has been approached many times by people who were rejected by private insurers because they were sick.

“They ask me again and again, and I always say someday, someday, I hope that everyone can get health insurance.”

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