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By Karen E. Klein

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?
The answer to both of these is: No. First, Obamacare (as the Affordable Care Act is colloquially known) requires only businesses with 50 or more employees to provide health coverage, so the five-person company owner needn't worry. In any case, that part of the law has been delayed until 2015 for all employers and until 2016 for those with from 50 to 99 employees.

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.

"There is a clear distinction in that Hispanics are less aware of the insurance issue and they're enrolling at lower levels," says Sharon K. Long, one of the study's co-authors. "The ads haven't been targeted in a way that resonates with them, so many people are missing the boat."

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."

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75 Comments

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jdykbpl45

Why are Moocha and the Obama girls in china, on our dime?

March 24 2014 at 3:20 PM Report abuse rate up rate down Reply
1 reply to jdykbpl45's comment
teapartyisdying.uall

It's okay if Bush and his wife and daughters traveled on taxpayers dime. I just love the hypocrisy from the right.

March 25 2014 at 11:11 AM Report abuse +1 rate up rate down Reply
scottee

why is there a deadline?
why are policies not portable across state lines?
why was the ACA passed before it was written?
why did it cost $600 million to start up?
how many plans could that money have purchased?
why not cut all foreign aid and non essential government spending and give everyone the same health plan seniors and congress have?

March 23 2014 at 9:09 AM Report abuse +1 rate up rate down Reply
COMMON SENSE

How to create a social state

There are eight levels of control that must be obtained before you are able to create a social state. The first is the most important.

1) Healthcare– Control healthcare and you control the people
2) Poverty – Increase the Poverty level as high as possible, poor people are easier to control and will not fight back if you are providing everything for them to live.
3) Debt – Increase the debt to an unsustainable level. That way you are able to increase taxes, and this will produce more poverty.
4) Gun Control– Remove the ability to defend themselves from the Government. That way you are able to create a police state.
5) Welfare – Take control of every aspect of their lives (Food, Housing, and Income)
6) Education – Take control of what people read and listen to – take control of what children learn in school.
7) Religion – Remove the belief in the God from the Government and schools
8) Class Warfare – Divide the people into the wealthy and the poor.
This will cause more discontent and it will be easier to take (Tax) the wealthy with the support of the poor.

March 22 2014 at 9:21 AM Report abuse +1 rate up rate down Reply
1 reply to COMMON SENSE's comment
republicanslostagain

You forgot tax cuts for the rich which causes more income inequality. Destroy Unions which built the middle class. It's much more profitable for the rich to have a two class society , the rich and the poor. Now that the middle class has been in decline for the past 30 years corporations don't have to pay living wages or provide any kind of benefits. This is why Corporate America now is making record profits. What do you say we give them more tax cuts ? Mitt Romney was going to give them a trillion dollar tax cut.

March 22 2014 at 10:42 AM Report abuse rate up rate down Reply
jrb359

If you noticed, this is the ONLY thing other than vacations and golf, that this president has focused on. Not the debt, jobs, the economy, or telling the truth. For the first time Americans are forced to buy something because the government tells them to. There are many failures in this law that have a negative impact on people. Yet this president has NO intention of trying to make it fair for everyone. His 31 illegal changes only benefit his chosen supporters. Americans are getting hurt by this law, yet there are those that support it and show NO concern for the negative impact it has on others. This once was a country that helped and supported it's neighbors. Today it's all about 'gimme'.

March 21 2014 at 6:16 AM Report abuse -7 rate up rate down Reply
Tom

It is strange that how something that is called "affordable" has raised the costs for most WORKING Americans. It is only affordable for the same folks that live off of the back of the tax payer. And if your costs have gone up please get out and vote in November and let those that had shoved this garbage down our throats know that we are unhappy.

March 21 2014 at 5:29 AM Report abuse rate up rate down Reply
hotrimer

zzzzz Wake me up when this scam is repealed., zzzzz

March 21 2014 at 1:47 AM Report abuse -1 rate up rate down Reply
tpglynn1

the reason there is "confusion" about ACA is that it DOES cost more, limits choices of doctors, makes you pay for 10 core benefits and is run thru the IRS as oart of a new tax revenue stream. this article is essentially a free commercial by a "state certified" educator, what the hell is that? this person is part of a non profit? do you think they will be audited? I doubt it. They are part of Obama's effort to hook hispanics into the plan. if this was such a good plan why delay it untiil 2016 how can people exist with all these "substandard" plans until then? Why is there no mention of the 6 million who lost health coverage? How do we know "over" 5 million have "signed up?" Kathleen sebelius never seems to know any figures. How many are medicaid? how many are formerly non insured? there are no numbers whatsoever to back up the claims in this article and no attempt to investigate or even comment on "misconceptions" about keeping your health plan and your doctor without adding a dime to the deficit. Any CEO would be tried for fraud based on these statement alone. That should be the headline.

March 21 2014 at 12:01 AM Report abuse +1 rate up rate down Reply
wbearl

6.3 million people loose their insurance so that 5 million can have Obamacare. Only a Liberal would find those numbers exciting. That doesn't even take into consideration the other problems Obamacare has created. One of my wife's Doctors has dropped her because we are on Medicare and he is going to a No Insurance Practice. Our Family Clinic has lost a couple doctors to the same thing. What is truly tragic is that Obama destroyed what we had when he started his nightmare, so there is no going back. God help us.

March 20 2014 at 10:56 PM Report abuse -1 rate up rate down Reply
1 reply to wbearl's comment
clwgeorgetownlaw

Looks like you need to start praying to your FOX news God.............Ugh

March 20 2014 at 11:58 PM Report abuse +2 rate up rate down Reply
norky1995

Was this article written by Jay Carney?

March 20 2014 at 10:54 PM Report abuse -1 rate up rate down Reply
dm2473

I enrolled in December.
My rates are much higher than they were in 2013, and my deductible is $5000 per person, which is also more than the plan i had last year.
The only way to really save a few bucks was to buy a lesser plan, but too many doctors and hopsitals don't want to particpate in those plans.
But even those lesser plans that many doctors and hopsitals reject, come saddled with burdsensome deducibles.
Avoiding those high deductilbes means buying a plan that is exorbitantly priced.

March 20 2014 at 10:14 PM Report abuse +5 rate up rate down Reply