To get a better handle on the health care access barriers Hispanic immigrants in the U.S. often face, researchers from the University of Kansas Medical Center surveyed Hispanic immigrants in the Midwest about their experiences with the health care system.

“The Affordable Care Act has helped many Latinos, but it has systematically excluded the undocumented,” said Mariana Ramírez, a bilingual research counselor at the Kansas medical center who spoke during a Tuesday session on “Emerging Issues in Refugee and Immigrant Health” at APHA’s 2019 Annual Meeting and Expo in Philadelphia.

Even those who have ACA plans sometimes struggle with high deductibles and premiums and limited coverage. Ramírez and her fellow researchers found that many times, people would change plans every year, which can make coverage inconsistent and confusing.

Researchers found that while a majority of people surveyed were employed, only 11% had employee-sponsored health insurance. In comparison, about two-thirds of adults in the region overall had insurance through their employer.

And it’s not a simple problem of access to insurance or paying for coverage. There’s a real fear in the Hispanic community that trying to get medical care could have negative consequences, Ramírez reported. For example, a vast majority of those surveyed — 86% — were worried that either they, a family member or a close friend could be deported. And about 60% said they were concerned that health care practitioners would share their information with immigration officials or were worried that using publicly funded health care services would negatively impact their immigration status.

The problems didn’t stop there. Even if an Hispanic immigrant is able to access needed health care, significant challenges such as language barriers can persist. And, unfortunately, translation services are often inconsistent and insufficient. Indeed, study participants reported lower quality of care because they were unable to effectively communicate with health care providers.

“(When) everything is in English, you just kind of have to hope that everything goes well and cross your fingers,” Ramírez said.

As a result, some Hispanic immigrants end up calling a doctor back in their home countries for consults or ask family or friends to bring them medications from abroad. They may even turn to self-medication, home remedies or unlicensed practitioners — such as someone who studied dentistry in another country and now operates in the U.S. without a license.

“A couple of people provided an example of having an (unlicensed) dentist come to their home for a tooth extraction,” Ramírez told attendees. “They’re aware of the risks associated with this practice, but there is no other option for them.”