Recently the inbox for Bloomberg BusinessWeek's Smart Answers column has been filled with questions that show how much confusion remains about the Affordable Care Act among small-business owners. Here are two examples:
- I have five employees and can't afford to buy health insurance for them. Will I have to close my doors under Obamacare?
- I have a small business and could get a subsidy for my insurance under Covered California, but I'm afraid that if I do, I could lose my home. Should I pay the total premium myself so my house won't be at risk?
As for the second point, people who take advantage of the law's subsidies aren't at risk of losing their homes. The premium subsidies available for people under certain income levels are structured as advance tax credits. If your income goes up unexpectedly and your subsidy isn't adjusted down, you might owe more than expected at tax time. But your home would not be at risk.
'Lack of Awareness and Confusion'
Since Americans began enrolling in health plans under the Affordable Care Act on state and federal marketplaces last fall, the simmering myths and misconceptions around the law seem to have reached fever pitch. If questions like these are any indication, confused small-business owners are struggling to get basic information about the law, even with the March 31 deadline to buy coverage for 2014 just days away. It's a pretty safe bet that the bungled healthcare.gov rollout and the torrent of bad press that followed made matters worse.
This means Marcia Davalos has a tough job as Southern California outreach manager for Small Business Majority, a nonprofit advocating for health-care reform, and a certified educator with the state's Covered California exchange. She has been on the road, talking to "tens of thousands" (by her estimate) of small-business owners and self-employed individuals about the Affordable Care Act since June 2013, many in the Latino community because she is fluent in Spanish.
"There's a lack of awareness and confusion about [the ACA] hurting micro-businesses, costing too much, making everyone's insurance rates much more expensive, and making it impossible to find a doctor," she says. "Unfortunately, there's a lot of misinformation out there, and a lot of it is being fueled by the media and it's not getting cleared up."
More than 5 million Americans have signed up for health insurance through marketplaces created by the health-care law, and the country's uninsured rate has dropped to the lowest levels since President Obama took office. But signups have been disappointing among certain groups, particularly where the need for insurance coverage is the greatest, including the Hispanic community. Davalos says outreach and communication aimed at that community "has not been as culturally aware and linguistically appropriate as we wanted it to be."
She uses her father, an immigrant who speaks English but mainly gets his news from Spanish-language media, as a benchmark. "My dad will tell me that Obamacare is bad and everyone's complaining about it. Then he hears about people he knows getting covered by Covered California and there's a big disconnect there," she says.
How Do You Say 'Affordable' in Spanish?
Part of the disconnect stems from a language barrier, according to a study on racial and ethnic differences in insurance literacy by researchers at the Urban Institute. While more than half of white adults reported confidence in understanding key health insurance terms, only 21 percent of Hispanic adults said the same. The gap narrows but persists, even after controlling for such factors as income and education level.
A marketing campaign that has used direct translations from English to Spanish is one problem. "It's hard enough to understand health insurance choices written in English for an English-speaking audience. It's much, much harder when the words are translated directly into Spanish," Long says. Davalos agrees, noting that even the word "affordable" -- as in Affordable Care Act -- has no good, one-word direct translation. "The closest thing is asequible, but that's a formal word that's not commonly used," she says. An idiom meaning "within the range of your pocketbook" is a better-understood, though cumbersome substitute that she uses.
The marketing campaign for Covered California has also fallen flat among Latinos for two additional reasons, she says. "Surveys show that messages that Latinos respond to the most involve people's stories. And there's been a real big lack in targeting women," Davalos says. "The people making the decisions in the community about health care and how the household money's being spent are Latinas. If we told mothers how this would impact their kids, they would communicate that message."