HealthCare.gov's simpler online application is being touted as a big win for consumers. But it can't be used by immigrants in the United States legally and naturalized U.S. citizens, who represent millions of potential new health insurance customers.
That's prompting worries that many Hispanics and Asians will end up in long enrollment queues when the second sign-up season for coverage under President Barack Obama's health care law gets underway next month.
The administration says immigrants are not being overlooked, and points to other improvements in the application process. Officials say what they can do is limited by the law's requirements.
Advocates aren't buying that explanation.
"The whole idea was that HealthCare.gov was going to be a seamless and easy process, but that doesn't seem to be the case for immigrants," said Alvaro Huerta, an attorney at the National Immigration Law Center in Los Angeles. "I think this is happening because the federal government hasn't taken the steps necessary to resolve issues with their verification system."
The White House wants more Latinos to sign up under the health care law for 2015. As the nation's largest minority group, Hispanics tend to be younger and more likely to be uninsured.
The law offers taxpayer-subsidized private health insurance for people who don't have access to coverage on the job. Open enrollment for 2015 starts Nov. 15. It's estimated that 6 million more people will sign up for next year, bringing the total to about 13 million.
The federal HealthCare.gov website will be the sign-up platform in 38 states, two more than it served last year. States in the federal marketplace include immigrant-rich Florida, Texas, and Nevada. The remaining states are running their own insurance exchanges.
While immigrants living in the country illegally cannot get coverage through the law, millions who are lawfully present are entitled to benefits, as well as people who were born overseas and later became U.S. citizens.
The new easy online application for most consumers will feature 16 screens, instead of the 76 that people muddled through last year. But immigrants and naturalized citizens are a major exception, a category the administration calls "complex cases."
Andy Slavitt, the official who oversees HealthCare.gov operations, said there have been several improvements to help immigrants, including expanding the list of documents that people can use to establish eligibility and updating the computer system so it won't get hung up on special characters used in some names.
"I wouldn't say by any means that we have achieved the best we can, but I do think we have taken appropriate steps across the board," Slavitt said. "I would suspect in future years we will be able to do more and more electronically."
Consumers navigating the new HealthCare.gov will encounter early on a screen with a series of questions, the gateway to the streamlined application. But legal immigrants, naturalized citizens, and families in which someone is an immigrant or naturalized citizen will have to work through more screens and answer more questions.
About half of Latino adults were born abroad, according to research from the Pew Hispanic Center. Of those who have become U.S. citizens, 21 percent lack health insurance. That's well above a 15 percent uninsured rate among naturalized U.S. citizens who are not of Hispanic origin. Latinos are also more likely to be married to an immigrant.
"Immigrants could be unjustly excluded even though they are eligible," Huerta said.
Asian-American groups are also concerned.
"The problems will persist for our communities," said Bonnie Kwon, health law program manager for the Asian & Pacific Islander American Health Forum in San Francisco. "It shows a lack of commitment to provide adequate access for immigrants."
Many immigrants need help to get through the application, said Kwon. Trained helpers are in short supply. So the more time it takes to finish one application, the fewer uninsured people can be helped.
Slavitt disagreed that the administration has overlooked immigrants. The law's requirements mean that some people have to answer more questions and supply more documentation. He also said immigrants will benefit indirectly from the EZ application because it may free call-center operators from handling routine cases.
"The immigrant community has been a particular thrust, and more of a passion, for us," Slavitt said. "These are the people our team spent time with all of the year. If we don't make it easier for them on the front end, it will mean spending more time with them on the back end."
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