In Utah: They make up 9% of the population, 24% of the uninsured

Ramona Hernandez is "doing the rounds" at a high-density apartment complex in Midvale and stops by to check on Yolanda and Felisa.

The two sisters are pregnant, and Hernandez, a field worker for the health advocacy group Comunidades Unidas, has come to make sure they're keeping up with their prenatal care.

Neither woman has health insurance, and their medical bills are mounting. But through Hernandez they are enrolled in free or discounted parenting and nutrition classes. They have doctors willing to charge them on a sliding scale. And Felisa, who is due in a week, has applied for emergency Medicaid to help cover delivery costs that may range from $5,000 to $20,000.

Her wish for the baby: "That he has a better future here than I did in Mexico."

Going without health insurance is an affliction of the working poor and no ethnic group is immune. But the epidemic has hit Latinos harder than any other population.

They represent roughly 9 percent of Utah's population, but more than 24 percent of the uninsured. And a recent Robert Wood Johnson study contends the disparity is worse here than almost anywhere.

Utah has the nation's second-highest rate of uninsured employed Latinos, at 55 percent, compared with 14 percent of working whites, the foundation reports.

State Health Department surveys use different measures and show lower numbers of uninsured residents. But that doesn't explain why border states with larger Latino populations - Arizona, California, New Mexico and Texas - are faring better, with a smaller gap between Latinos and white residents. (see graphic).

Health officials say any state-driven health care reform, such as Gov. Jon Huntsman Jr.'s pledge to halve in five years the 250,000 to 300,000 Utahns without health insurance, will take Latinos into account.

But Huntsman isn't expected to unveil his plan of attack until next fall, and some advocates for minority and low-income people say Utah is behind in tackling its ethnic disparities.

Three years ago, a state survey of more than 900 Latino adults revealed they, in addition to being uninsured, were more likely to smoke and suffer from diabetes and obesity - conditions known to lead to more chronic health problems, such as heart disease and stroke. The study was hailed as a guide for creating "interventions to improve Hispanic health care."

But such help has been slow in coming, said Anita Watchman at the University of Utah Westside Partnership, which works with Comunidades.

"Until recently, outreach has been very poor. It has improved somewhat, but hasn't been consistent," Watchman said.

National experts say the marginalization of Latinos by the health care system will take federal intervention to fix.

Elena Rios, president of the National Hispanic Medical Association, blames Utah's disproportionate rates on its economy, heavy in lower-skilled, service-sector jobs that pay little and don't offer employer-based health coverage.

"Lots of Hispanics work in manual labor or service industry. There is little the state can do to change that," said Rios. But she says Utah can follow the lead of other states, such as California, which has made headway with community health care centers that offer discounted fees and portable health insurance plans.

Latinos tend to be highly mobile, following the boom-and-bust cycles of various industries, said Rios, explaining that it would help to create ways for people to buy insurance in one state and take it with them to the next.

Rios also applauds the federal government's recent decision to reimburse hospitals for free emergency care provided to illegal immigrants.

Huntsman has promoted charity care as a solution to the uninsured problem. Advocates agree large networks of discounted and free health clinics in Arizona and California have helped alleviate disparities in those states. They are pleased to see Utah's network growing, but warn charity care is far from a cure-all.

Less than two weeks ago, the Maliheh Free Clinic for the uninsured celebrated its grand opening, and already morning appointments have to be booked two to three weeks in advance.

On its third day of operation, office director Kristen Yancey says, patients were lining up outside the Salt Lake City clinic during the lunch break, hoping to be admitted as walk-ins. "Our phones are ringing off the hook," she said.

From one-third to one-half of the patients are Latino, says Yancey.

Some minority and low-income advocates say the state health department has done little to inform Latinos of benefits that already exist, such as Medicaid.

"This is a unique and particularly vulnerable group," said Judi Hilman, health policy analyst at Utah Issues, an advocacy group for low-income people. "You have to market programs in a certain way to these families. Many are first-generation immigrants who came here for jobs and don't speak the language. They tend to be afraid of systems like hospitals and government institutions."

Just last year, Hilman and others lobbied to change a state policy that penalized Medicaid applicants from mixed immigration households.

In determining eligibility for a child who is a citizen, but was born to illegal immigrant or noncitizen parents, workers were trained to ignore siblings who were not citizens. Eligibility is based on income and family size. The deliberate undercount could incorrectly make children ineligible for help, since it would appear their parents were supporting a smaller family on their income.

The policy was changed, but Hilman says the department has not done much to educate Latinos or retrain caseworkers.

The health department hasn't performed an audit to measure how the policy has helped. But Michael Hales, the agency's assistant finance director, says it was projected to benefit only a sliver of the Latino population.

Hales says statewide outreach efforts have ramped up in the past two years, including advertising on Spanish-speaking radio and television, and in newspapers.

"Almost every one of our 14 media campaigns has a Spanish component to it," says Hales. The result, he says, has been robust enrollment in medical assistance programs. Roughly 17 percent of the state's Medicaid and 10 percent of Children's Health Insurance Program (CHIP) beneficiaries are Latino.

Latino enrollment in the Primary Care Network, bare-bones preventative insurance for the working poor, is at 7.5 percent.

In the health department's defense, Hilman acknowledges the agency can only do so much given its budget constraints. Utah's medical assistance programs are limited in scope, compared to those of other states. But barriers to policy changes are more than political; they're cultural, she says.

We got e-mails from eligibility workers who disagreed with Medicaid policy changes. Philosophically, they believed these kids shouldn't have been born here to begin with," says Hilman. "The banality of evil; it's at this very local level of the individual bureaucrat."

stewart@sltrib.com