PHILADELPHIA (WPVI) -- Cecilia Vizuete of Upper Darby is expecting her third child in November, but she hasn't been able to get the health care she's needed throughout her pregnancy.
Vizuete, who came to the United States two years ago to escape violence in Ecuador, is among more than 15 percent of Latino residents across the Philadelphia-Camden-Wilmington metro area who do not have health insurance. Just 3.5 percent of white residents are uninsured.
"It worries me a lot," Vizuete said. "I've had some scares where I thought that the pregnancy was at risk, and I couldn't get medical care when I needed it. I have really battled."
In her first trimester, Vizuete started experiencing severe pain and bleeding. She went to the hospital, but because she was uninsured, she was told she'd have to pay out-of-pocket for the exams she needed - an expense she could not afford. Vizuete said she was sent home without answers or treatment.
"It was a terrible moment," she said.
The pain continued for months. Vizuete tried home remedies and called her doctor back in Ecuador. She said she even considered returning to Ecuador for care, but she would have had to leave behind her nine- and ten-year-old children for their safety. So she stayed in Upper Darby, turning to God and her family for help.
As a pregnant woman living in Pennsylvania, Vizuete is eligible for health insurance through the state's Medical Assistance program. But enrolling in insurance has proven extremely challenging for Vizuete and many others.
"There's a lot of paperwork that's required," Vizuete explained. "You send in what you can and they send you a letter saying you don't qualify. And then there's no way to reach them, there's nowhere to go, there's nothing that you can do to try and get an answer or figure out what's needed."
Vizuete's experience is all too common, according to Layla Ware de Luria, Executive Director of Centro de Apoyo Comunitario, a nonprofit that supports local immigrant communities. De Luria works with Vizuete and others like her to access health insurance and meet other basic needs.
"It doesn't take much to find yourself in a situation where you need extra help," de Luria said. "And if that's extra medical help, we all are disadvantaged by a system that doesn't respond to help people, to keep people healthy."
Inaccessible health insurance affects everyone, de Luria noted, from health care providers to neighbors and friends of those who are uninsured. Everyone's health is dependent on the health of their community, as demonstrated by the Coronavirus pandemic. But inequities in who has access to health care and insurance are severe in the Delaware Valley.
Across the Philadelphia-Camden-Wilmington metro area, Latino residents are 4.3 times as likely as white residents to be uninsured, according to a 6abc data analysis. Black and Asian residents are about twice as likely as white residents to lack health insurance. Those disparities are greater than the gaps in over three quarters of the 100 largest U.S. metros, the analysis found.
De Luria attributes these disparities to an enrollment process that is far from user friendly and further disadvantages communities that already have fewer resources.
"The system is very, very difficult to navigate, regardless of your citizenship, regardless of your first language," de Luria said. "It just takes a lot to try and make sure that you check every box, and that you have every piece of paper, and that the person on the receiving end of that paperwork actually looks at it and processes it the way that it should be processed."
Among Philadelphia's surrounding counties, Chester County has the highest rate of Latino residents who do not have health insurance, with 23.5 percent uninsured. Montgomery County has the greatest inequity in health insurance rates: Latino residents are nearly seven times as likely as white residents to be uninsured.
The actual gaps in health insurance are likely even greater than what the reported numbers show. 6abc's analysis relied on data from the U.S. Census Bureau's American Community Survey, which experts say tends to undercount people of color, low-income households and undocumented immigrants - the very populations who face the greatest barriers to accessing health insurance.
There are many reasons why these groups of people may be less likely to answer government surveys: They may distrust the government, those who work multiple jobs may be less available, and those who move frequently or experience homelessness may be more difficult to reach. In particular, people who are undocumented may fear that giving personal information to the government could lead to their deportation. Since these residents are ineligible for health insurance, their underrepresentation in the data suggests the true gaps are larger than we know.
These figures come as no surprise to Dr. Donald Price, Vice President of Health and Homeless Services for Asociación Puertorriqueños en Marcha (APM), a Latino-based nonprofit that connects Philadelphia families to services like health insurance and medical care.
Price said the greatest barriers his clients face to getting insured are language, technology and a lack of culturally responsive outreach and support. While he does see some people who are undocumented, he said most of his clients are eligible for insurance but lack the tools they need to access it.
"Most of the forms are in English, most of the websites are in English," Price said, adding that "there is a reluctance in our community to present yourself to the government." This reluctance keeps many community members from seeking health insurance and care until they have an acute medical need, he explained.
Price's clients often end up in the emergency room for much of their care, he said. And more emergency room visits in place of preventive care means greater costs for the entire health care system - falling on hospitals, insurance companies and all Americans, whose tax dollars fund Medicaid and Medicare.
Price and de Luria are both working to fill in the gaps of the health care system. APM and Centro help clients fill out insurance forms, get ID needed for enrollment and follow up throughout an arduous process. They also educate Latino community members about their rights, including the right to health care in their language.
"This idea that you've got to bring your own interpreter, or that you're somehow a problem or a burden to the system because you speak a different language is just patently false," de Luria said. "It's an ethical mandate for practitioners to make sure that their patients understand their health."
Many Latino community members don't know what services they are entitled to access and are hesitant to ask for basic amenities for fear of breaking a rule or seeming disrespectful, de Luria added.
"We come here as Latinos and we work hard," Vizuete said, adding that she and others in her community pay their taxes and don't want anything for free. "The only thing we ask for is the ability to work hard and not be subject to violence. But families need things, they need the ability to get medical care."
In addition to helping individual families get what they need, Centro is building a village of people who are equipped to help each other.
"We have folks in the community who have been through this process, and they will then go and help someone else," de Luria said. She estimates the organization can reach up to 1,000 community members through its network.
Still, many Latino community members - including Centro clients like Vizuete - have been unable to get health insurance and care. Particularly during the pandemic, the consequences have been "inhumane," de Luria said.
Last year, when her children both got sick, Vizuete took them to the hospital. They were given some pills and sent home, where Vizuete cared for them with advice from her mother, who is a nurse in Ecuador. When she finally was able to get her children tested for COVID-19, the tests came back positive.
"They could have died in my arms," Vizuete said. "I took care of them the way that I knew how to take care of them, with help from my mother, and that's how they got better."
As soon as her children recovered, Vizuete and her husband both got COVID, too.
"We don't get anything from the government, we don't ask for anything," Vizuete said. "But I have two kids who can be impacted by this, and for me, the least that I could ask for is to be able to stay healthy."
As Vizuete's due date approaches, she feels a confusing combination of joy and sadness.
"Babies are a blessing, but they come with difficulty, and not having health insurance is a real worry of mine," she said. "It's what I need most."
This report was produced with data from the Equity Report, a tool created by data journalists at Action News and our ABC-Owned Television Stations across the country. Now this database is available to officials working on solutions and to the public. You can go to https://ouramericaabc.com/equity-report to find the Equity Report. There you will be able to review equity data from various regions including the Philadelphia area. You will have access to local data measuring equity in five categories: Housing, Health, Education, Policing and Environment.
Philadelphia area Latino residents face barriers to health insurance
Across the tri-state metro area, 15.1% of Latino residents do not have health insurance, compared to just 3.5% of white residents.
EQUITY REPORT - HEALTH
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