Access Is Vital in Health Reform : Language skills and cultural sensitivity are vital if Latinas and others outside the system are to be adequately served.

Latinos in the United States represent a rapidly growing and diverse population. According to a recent census report, there are approximately 19.4 million Latinos comprised of several ethnic subgroups such as Mexican, Puerto Rican, Cuban and other Central and South American. Both geographic proximity and political and economic forces have resulted in the Mexican-origin group comprising the bulk of the Latino population in the United States.

More than a third of all U.S. Latinos live in California, as do more than 60% of U.S. amnesty applicants under the 1986 Immigration Reform and Control Act. Los Angeles County, with the largest concentration of the State’s Latino population and home to half of all the state’s amnesty applicants, is also home to thousands of Latinos without health insurance.

According to a recent national study on Latino health-care access by UCLA researcher Robert Valdez, almost four out of 10 working-age Latinos do not have health insurance, compared with about one quarter of blacks and one seventh of whites. Given these grim statistics, it’s not surprising that the states with the largest number of uninsured in the country are California, Texas and Florida--states with large concentrations of Latino workers. In all three states, most of the Latino uninsured lack employment-based health coverage because, too often, they have jobs in the small-employer labor market, where neither employer nor worker can afford premiums. In addition, eligibility requirements to programs such as Medicaid vary among states, hurting those who live in states with restrictive eligibility requirements.

The stark portrait of dwindling health-care access due to poverty becomes more bleak for Latinas. For many, the dream of employer-based insurance will never be realized as daily cash wages provide immediate survival but benefits such as health insurance are reserved for the lucky few. Because they mainly are in low-paying clerical, service and manufacturing jobs, these women can’t pay for private health insurance. Thus we find that more than 40% of women from Mexico in service-sector jobs do not have health insurance.

Although employment and poverty have often been cited as the key reasons for lack of health insurance for Latinas, other issues become equally significant in understanding why these women do not have health insurance. Recent immigrants from Mexico without much education, who are unmarried and have limited English will have lower rates of public or private health-insurance coverage. Lack of health insurance for Latinas has potentially devastating consequences. Higher birth rates of Latinas indicate a greater need for access to prenatal and postpartum care. Yet many of these women have little or no prenatal care. High rates of teen-age pregnancy, low use of contraception and relatively high rates of cervical cancer compared with non-Latina women are all preventable but require immediate intervention to avoid the potential catastrophic losses to the community. Piecemeal approaches to address the reproductive health issues of Latinas can no longer ignore these issues and assume that the existing safety net for the poor will adequately meet their health-care needs.

As the Clinton task force announces sweeping reforms for the nation’s health-care system, one can only hope that a community health agenda is developed that incorporates Latinas and others who have been historically disenfranchised from the delivery of health-care services. Latinas as well as others who are marginally attached to the labor force must be included in any health-care financing reform. Such reforms must go beyond traditional employer-based programs, and portability of benefits must be guaranteed so no one is locked into an undesirable job because of health-care benefits.

Health-care reform must also include a community health agenda targeted to the needs of the underserved to ensure better use of low-cost preventive services. Access, broadly defined, goes beyond financial access; it requires humanitarian treatment of all patients regardless of income, ethnicity or sex. It demands both financial and educational empowerment of all participants to prevent illness. One step in providing empowerment for Latinas and others who historically have been marginalized is to insist that health professionals have appropriate language skills and cultural sensitivity, as is the case in many community-based clinics in Los Angeles.

As Angelenos anxiously await the announcement of the Clinton task force, we must recognize that our diverse city will be the gauge that determines success or failure of this program. Our community must actively participate in the reform process so that universal health-care coverage for all becomes more than just a dream.