The magazine of the UW School of Public Health

Asesor de Seguro Medico: Connecting People to Health Care

Jose Carmona is an in-person assister with Global to Local. who has helped Spanish-speakers sign up for health care.

As told by Jose Carmona

Health departments throughout the Northwest play an important role in implementing the Affordable Care Act. For example, since August 2013, Public Health - Seattle & King County has trained more than 600 "in-person assisters," people who guide individuals through the complex process of finding and enrolling in health insurance. Jose Carmona of Global to Local ( shares his experiences working as an in-person assister in south King County.

I work for Global to Local. Global to Local is an organization that uses community-driven and global health strategies to improve health and economic disparities for the local underserved community. Global to Local focuses on the SeaTac/Tukwila region. This is an area that is highly diverse, and we are using evidence-based practices to improve health outcomes in this area. A basic strategy that Global to Local uses is to hire people who share the language and cultural background of groups with lower rates of health care access. We currently run the Affordable Care Act Enrollment program for the SeaTac, Tukwila, and Des Moines communities.

This is where I come in. I am an in-person assister for the Washington Health Benefit Exchange, our state’s new insurance marketplace for health care reform. My job is to help Spanish-speaking individuals and families in south King County apply for health insurance on the Washington Healthplanfinder website, Most of my clients don’t speak English. Many of them don’t feel comfortable with computers. Some don’t have an e-mail address of their own. Whatever the case, it’s my job to help clients find out if they are eligible for health care coverage. If they are eligible, I help them sign up for it. I was trained to do this work by Public Health - Seattle & King County.

I work out of our SeaTac office at the Angel Lake Center. I also attend other open enrollment events that Global to Local holds with other organizations such as HealthPoint, Matt Griffin YMCA, and Lutheran Community Services. Global to Local organizes events at various locations in the SeaTac/Tukwila region and community members are invited to come if they want help signing up for health insurance under the new provisions of the ACA. Although my colleagues and I work in large, open spaces in these community centers, we try to be confidential as possible with the information that is given to us. We walk clients through a series of questions, some of which may be sensitive. For example, I am required to ask female applicants of childbearing age if they are pregnant. I also ask about immigration status. To me, the fact that clients stay and respond to these questions shows how much they want health coverage.

Sometimes, when we finish an application and send it in, it doesn’t go through. It’s better now, but in the fall of 2013, I would send people home without getting them signed up. During these early days, to maximize the help we were able to get from Healthplanfinder representatives, my fellow in-person assisters and I would pass the phone around once we got someone on the line. We knew that if we hung up, it would be a long time before we were able to connect with a representative again. As the enrollment events have gone by, the number of application errors has gone down.

It takes from 30 minutes to 2 hours to complete an application. Sometimes, clients have to come in two or three times to finish application because of their schedules or because they need to track down information. The applications that go the fastest are for clients who are United States citizens who are also are unemployed and applying as individuals. The process becomes more challenging when there is more than one person applying for health insurance in a family or if clients are naturalized citizens or residents and have an income of some sort.

Language can be a huge barrier to getting the most from Healthplanfinder, so clients want me to explain as much as possible during their visit. Health insurance terms can seem strange to people who haven’t had health insurance before. Although the Healthplanfinder website has all necessary forms in Spanish, the language used is quite technical. The clients who seek us out are often recent immigrants, with no prior experience with signing up for health insurance. So even when I talk to them in Spanish, I still find myself having to use jargon that they can find challenging. One of my approaches is to use real life scenarios on how premiums, deductibles, co-payments, etc., would affect their budget.

It doesn’t happen very often, but sometimes, I’ll have clients who are forced to decide between signing up for coverage or paying rent. These are often immigrants who do not qualify for Medicaid because they haven’t lived in the United States for five years or more. These clients are sometimes eligible for tax subsidies. It is my understanding that policy changes are underway to allow recent immigrants to qualify for more subsidies.

I find my work satisfying, especially when clients leave an enrollment event knowing that they will be covered soon. For many of the people I see, this will be the first time in many years that they can start making plans to go see a health provider. I often hear my clients say something like, “This will be the first time I see a doctor in 10 years. I haven’t been going because I haven’t been able to afford it. But now I can.”

Jose Carmona is an undergraduate student in the UW School of Public Health