Latino America: How America's Most Dynamic Population is Poised to Transform the Politics of the Nation

by Matt Barreto, Gary Segura

  We continued to examine the attitudes of Latinos toward the ACA as it developed and found strong support among this population for the law despite tremendous opposition. For example, polling data from March 2010 found that Latino registered voters remained supportive of health care reform even as their support for immigration reform began to take hold. More specifically, when asked in that poll what the single most important issue facing the nation was, health care reform topped the list (32%), followed by jobs and the economy (29%) and then immigration reform (17%). The poll of 500 Latinos fielded in early March 2010, just before the health care vote, found that Latino registered voters remained very strong supporters of health care reform.

  The federal health care reform debates captured the nation’s attention during President Obama’s first year in office. Obama and his fellow Democrats had little time to celebrate their historic policy victory, however, as Republican candidates rode a wave of voter frustration with the economy and the federal government itself to take control of the House of Representatives in the 2010 midterm elections. Making the Affordable Care Act their primary target, the newly installed Republican-majority House wasted little time before passing a symbolic repeal of President Obama’s signature domestic policy. Although Republican efforts to repeal this law were stalled quickly in the Democratically-controlled Senate, this legislative action set the stage for a longer-term policy battle over the future of our nation’s health care policy.

  As the debate heated up in Washington, public opinion polls suggested that efforts to criticize the law moved public opinion. For example, a Gallup poll from January 2010 indicated that 46% of Americans wanted their congressional representative to vote to repeal the health care law, compared to 40% who wanted it to stand.13 This trend was consistent with other national polls conducted at the time that consistently showed that Americans were divided in their attitudes toward the Affordable Care Act. But did those attitudes match Latinos’ views?

  A poll conducted in February 2011 by ImpreMedia and Latino Decisions gave us the opportunity to explore how Latinos viewed this issue. Latinos’ support for maintaining the law remained higher than the general public’s support: 49% of the sample reported that the Affordable Care Act “should be left as law” compared to 31% who believed that “the bill should be repealed.” Latinos demonstrated a much lower preference for repeal (31%) in the Gallup poll compared to the general public (46%). However, Latino support for Obama’s health care plan dipped over time. At first glance, when we review a figure used in a report based on an ImpreMedia–Latino Decisions survey from November 2009 (see Figure 11.1), it appears that Latino attitudes toward this policy remained surprisingly stable over time. Specifically, just before passage of the Affordable Care Act, 28% of Latinos supported maintaining the current health care system relative to expansion-based reform, a share very similar to the 31% in the more recent (February 2011) poll who supported repeal.

  FIGURE 11.2Support for Retaining/Repealing ACA among Latinos, February 2011

  Source: Latino Decisions, February 2011.

  By October 2011, a largely symbolic attempt to repeal the ACA had been passed by the Republican majority in the House of Representatives, a multi-state lawsuit challenging its constitutionality had been filed, and there was widespread speculation that the Supreme Court would rule on the case. Results from a third survey (October 2011) showed that Latino support for the ACA remained relatively high: 50% of the Latino electorate believed that the act should “stand as law,” compared to 29% (27% of nonvoters) who felt that it should be repealed. Besides their opinions on the issue of repeal, the attitudes of Latinos toward the ACA itself remained remarkably stable: the trends found in the October 2011 poll were nearly identical to those revealed in a February 2011 survey. When we compare our trends to those from a Kaiser Family Foundation health tracking poll conducted in September 2011, we see again that Latino support for the health care reform legislation remained higher than that of the general population: only 19% of the general population in the Kaiser poll indicated that Congress should “keep the law as is.”

  Beyond the broad question of whether to keep the law or repeal it, the Latino electorate’s very supportive attitude toward most of the landmark legislation had one major exception. When the poll asked respondents to indicate whether “lawmakers should keep or repeal” various aspects of the law, 85% of Latino voters said that they supported providing tax credits for small businesses to provide their employees with coverage, and 80% supported providing financial aid to those with low and moderate incomes to purchase coverage. Only 32% of Latinos, however, supported the “individual mandate”—the requirement that all Americans have health insurance coverage. Furthermore, only 25% of the uninsured in the sample supported keeping the individual mandate.

  These trends suggest that what they perceived as the high cost of purchasing health insurance during a period of high economic stress and their lack of confidence in—or awareness about—future financial support for mandatory purchase may have been driving Latino attitudes toward the individual mandate. A robust 52% of respondents who reported that their health care costs had increased over the past year were opposed to the individual mandate. Plus, the extensive efforts of many within the Republican Party to challenge the constitutionality of this aspect of the law may have found traction among Latinos.

  The survey also provided an overview of the attitudes of Latino voters toward the perceived benefits of the core goals of the ACA—increasing access to health care, improving the cost of health care, and improving its quality. Across all three of these dimensions, Latino voters ultimately believed that their health care would “stay about the same” with implementation of the ACA. More specifically, when asked about the quality of their care, the same percentage of Latino voters believed that the quality of their health care would “get better” (23%) as believed it would “get worse” (23%). Regarding cost, there were more Latinos who thought that the cost of health care would “get worse” (31%) than those who thought costs would “get better” (24%). In short, a large segment of the Latino electorate seemed to believe that their care would not improve much with implementation of the ACA, and might cost them more.

  While these data suggest that Latinos were not very optimistic about the ACA improving health care for their families, 29% of Latino respondents believed that the law would improve their ability to get and keep health insurance, compared to 22% who believed their ability to acquire health insurance would get worse. Finally, results from a post-passage Kaiser Family Foundation tracking poll suggest that Latinos are a bit more optimistic about the law than the general public. For example, responses from the general population in the March 2011 Kaiser Family Foundation tracking poll show that 32% felt that the quality of care would get worse with the implementation of the law, and 42% felt that the costs of care would get worse. Those percentages are significantly higher than what we found for the Latino population: in our polling, 23% believed that the quality of health care would get worse, and 24% believed that health care would become more expensive.

  Overall, Latinos were similar to the wider population in having mixed views on the Affordable Care Act following its passage. Although Latinos remained generally positive about the law—as reflected by their support to maintain most of its provisions—they expressed some opposition to the individual mandate to purchase insurance. It also appears that the uncertainties about the implementation of the law and their ongoing experiences over the past two years with lost access to coverage and rising health care costs have weakened Latinos’ optimism that the reform legislation will improve their access to health care services.

  WITH THE OPENING OF THE ACA MARKETPLACE, HOW MUCH DID LATINOS KNOW ABOUT IT?

  Latino Decisions followed up on the 2011 survey by partnering once again with ImpreMedia to conduct a new poll of Latino adults in April 2013.14 In this study, 800 Latino adults were queried about their knowledge of the new health care law. What we found was
a major need not only for more outreach to the Latino community about the new law but for information more directly targeted to this population. In response to our questions, only 12% of Latino adults felt very informed about the ACA, compared to a combined 52% who felt either “not all that informed” or “not that informed” (see Figure 11.3).

  FIGURE 11.3Latino Knowledge of, and Familiarity with, the Affordable Care Act

  Source: ImpreMedia/Center for Health Policy/Latino Decisions National Health Care Survey, May 1, 2013 (N = 800).

  This result was reinforced by the overwhelming majority (69%) of Latino adults who said that the ACA was confusing and complicated. Another component of this segment of the survey indicated that only 13% of Latinos thought that public officials in Washington had taken the health needs of the Latino community into account during the ACA debates and bill passage. Finally, when asked to provide the names of different parts of the new law, a robust 71% indicated that they “did not know” any of those subpolicies.

  Levels of knowledge about the ACA were higher among those with higher levels of education, with college graduates expressing greater knowledge of the new health care reform law than those with less education. Even 39% of Latino college graduates, however, were either “not at all informed” or “not that informed” about the ACA.

  Despite low levels of expressed knowledge, 89% of Latinos said that they were interested in learning more about the ACA, including 56% who said that they were “very interested.” Furthermore, after hearing some basic information, 75% believed that the ACA would be good for the Latino community in the long run, compared to only 16% who said that it would be bad for that community. These survey findings provided some reason for optimism that, if properly engaged, the Latino community would be avid consumers of information pertaining to the historic reform legislation, and would enroll in the marketplaces. However, on deadline day—March 31, 2014—Latino subscribership was lagging significantly.

  What can be done to increase Latino participation in a program they support? In the April 2013 national survey, we tested a series of messages intended to interest Latinos in learning more about the ACA. Each message was linked with a specific element of the new law, and all of the messages generated a positive response among Latinos, a fact that reveals underlying enthusiasm for the components of the law. However, some messages—such as increasing credits for small businesses, increasing access to health care by expanding the number of community health centers, and improving the availability of medical services such as OB-GYN visits and HIV/AIDS testing—tested better than others. We also included multiple measures of the potential effectiveness of specific messengers in the ACA outreach effort. All of the messengers listed in Figure 11.4 had a lot of traction with the Latino community.

  Tapping into social networks for outreach is key, given the high number of Latinos who reported that they would be more likely to enroll if encouraged by family members and friends. Utilizing Latino doctors is also vital: among the messengers tested in the survey, they are outperformed only by family members. One potential group of messengers that is not as obvious as family members and Latino doctors is Latino teachers, who could be very valuable to increasing Latino engagement with the ACA given the trust and respect Latino families accord to teachers.

  In another April 2013 poll of Latino adults, this one in the state of Colorado, we found trends very similar to those revealed in the national poll. However, as a final mechanism to assess knowledge of the ACA, we asked respondents in Colorado to indicate whether they believed that undocumented immigrants would be able to purchase private health insurance through the state health exchanges. Only 25% of the sample were correct in saying that undocumented immigrants would be “restricted from purchasing insurance through the exchanges,” while 50% believed that they would be able to participate in the exchanges and another 25% indicated that they did not know. Interestingly, a strong majority (61%) of Latinos in Colorado believed that regardless of the current structure of the law, undocumented immigrants “should be able to access benefits” through the ACA. During the congressional debates on the law, a vast majority of Latinos nationally expressed support for undocumented immigrants being included in the reform legislation.

  FIGURE 11.4Effect of Messengers on the Likelihood that Respondents Seek More Information about Obamacare

  Source: ImpreMedia/RWJ Center for Health Policy/Latino Decisions National Health Care Survey, April 2013 (N = 800).

  A major focus of the Colorado poll was on identifying best practices for those interested in doing ACA outreach. For example, when asked which language they would like to be used to convey information about the ACA, 59% of respondents indicated a preference for English, compared to 14% who preferred Spanish. However, a large segment (27%) of the Latino population in Colorado preferred to receive information in both languages. This suggests that information about the ACA (and about health care more broadly) needs to be given to Latinos in both English and Spanish, with sensitivity to the bilingual nature of the Latino community in Colorado and other states. This is a troubling finding in light of the very late arrival of the Spanish-language version of the ACA website.

  Latinos in Colorado also differed when it came to which name for the new health care law they favored: 38% preferred “Obamacare,” 29% preferred “Affordable Care Act,” and 14% preferred “Health Care Reform Program.” There was similar variation among Latino Spanish speakers in Colorado: 34% preferred Reforma de Cuidado de Salud, compared to 20% who preferred Reforma de Seguro Medico. Interestingly, the third most popular term for Spanish speakers was “Obamacare,” with 18% indicating that this term had traction for both English- and Spanish-speaking Latinos in Colorado.

  The long-term success of the Affordable Care Act will depend on how well the law performs for Latinos, who all along, according to our data, have supported the law more than non-Latinos, from its inception to the opening of the marketplaces across the nation. Even by the official enrollment deadline of March 31, 2014, the credibility of the law among Latinos remained tenuous owing to a lengthy delay in the provision of Spanish-language tools for enrollment.15 Uptake among Latinos has been slow—46% of Latinos say they have not enrolled because of the lack of Spanish-speaking materials to aid its implementation in their communities—and states are only now beginning to aggressively market the benefits and communicate information about signing up through the state and federal exchanges.16 Even if these obstacles do not bode well for the short-term success of the law, however, Latinos remain highly interested in learning more about the ACA since they stand to gain more from its success than any other racial/ethnic population in the nation.

  Chapter 12

  LATINO ENVIRONMENTAL ATTITUDES

  With Adrian Pantoja

  In 2010 Vista Valley Services submitted a proposal to the Pomona City Council in California to build a solid-waste transfer station in the city’s designated industrial zone.* If approved, the proposed waste transfer station would include a 55,000-square-foot building, sitting on ten to thirteen acres of land, and handle about 1,500 tons of trash per day. Open twenty-four hours a day, the site will process the contents of an estimated 600 garbage trucks daily. Advocates for the waste transfer station claim that it will create fifty permanent, well-paying jobs for a city that has endured decades of economic decline. Opponents, most of whom are Latino, claim that this proposal is the latest manifestation of environmental racism, since over 70% of the city’s residents are Latino and the proposed site is within a one-mile radius of nine schools, all of which are majority-Latino.

  The Pomona case is not an isolated event. Latinos have mobilized elsewhere to protect their communities from environmental damages. In 1991 grassroots organizations and national environmental groups stopped the building of a hazardous-waste incinerator in Kettleman City, California, a predominantly Latino town. In the 1980s, the “Mothers of East Los Angeles,” a group of Latina churchwomen, prevented the building of an incinerator in the c
ity of Vernon and later a hazardous-waste treatment plant in the city of Huntington Park. Both Vernon and Huntington Park are largely immigrant Latino cities. Indeed, environmental activism among Latinos can be traced back to the mid-1960s, when opposition to pesticides and other environmental toxins factored prominently in the union organizing of Cesar Chavez and the United Farm Workers.

  Of course, protests and activism around environmental matters are frequently carried out by a small group of committed individuals who are willing to spend the time and energy to protect the wider community. Absent in these examples are data documenting the feelings and beliefs of Latinos more generally. In other words, despite these examples and the prevalence of environmental hazards in Latino communities, only a handful of studies have systematically analyzed the environmental attitudes of Latinos.1 As Latinos gain a meaningful voice in government, they will be in a position to develop and influence public policies. Will environmental issues factor prominently in their policy agenda? How will environmental issues rank for Latinos relative to other issues?

  DO LATINOS CARE ABOUT THE ENVIRONMENT?

  The dearth of research investigating Latino environmental attitudes suggests that scholars assume that Latinos have other policy priorities, like immigration or education. Indeed, there is a general assumption that concern for the environment is largely a white issue. Early research comparing white and African American environmental attitudes seems to confirm this assumption.2 The theoretical framework underlying these initial studies draws on Maslow’s “hierarchy of needs” theory by essentially arguing that poor and minority populations have more pressing issues like personal security, economic needs, affordable housing, better schools, and affordable day care services and that, compared to these pressing needs, environmental matters are secondary or insignificant.3 Whites and affluent individuals in the United States and other Western industrialized countries, so the argument goes, have had their basic material needs met and therefore have the time and money to concern themselves with other, more distant matters like environmental conservation.