Healthcare Reform Implementation in Hispanic Rhode Island: Perspectives of Spanish-speakers, Insurance Navigators, and Social Workers

One year after implementation of the Massachusetts Health Connector, the nationwide model for Health Insurance Exchanges, Hispanics were uninsured at twice the rate of the general Massachusetts population. As healthcare reform is implemented in Rhode Island (RI), Hispanics – 34% of the state’s uninsured – are similarly at risk for low participation.  

We conducted five focus groups with Spanish-speaking lay participants recruited in the greater Providence area. A moderator guide was used to explore knowledge, awareness, and attitudes towards healthcare reform, with an emphasis on how to access benefits. Semi-structured interviews were conducted with social workers and navigators trained to enroll individuals in insurance plans. Interviews explored perceived barriers to access and possible areas of improvement to increase Hispanic enrollment. Sessions were audio recorded, professionally transcribed, and analyzed using standard qualitative methods.

Our study population consisted of 32 lay participants between ages 18-65, mostly of Colombian and Dominican origin. Focus groups demonstrated participants’ basic knowledge of the individual and employer mandate, non-discrimination against pre-existing conditions, and coverage under parental insurance until age 26. Semi-structured interviews confirmed limited awareness of the cost implications of the Medicaid Expansion, the standardization of plans, and role of the health insurance exchange. Common misconceptions included that insurance cost would significantly increase, that enrollment would delay citizenship applications, and that reform benefits would apply to undocumented workers.

Our results suggest that RI’s Hispanic Spanish-speakers are likely at risk for poor participation in insurance enrollment. Developing targeted educational efforts addressing knowledge gaps and misconceptions may improve participation.