11/08/2011 12:31 pm ET | Updated Jan 08, 2012

Will Health Insurance Reform Reach Those Who Really Need It?

Issues that affect our lives don't happen in a vacuum. Everything affects everything else, and there's no area where that's truer than health and access to care. So I'm going to take a slight detour from the financial and economic issues I write about most of the time to say a bit about the Affordable Care Act, which marks a historic expansion of access to health care.

Thanks to the law, an estimated 32 million previously uninsured Americans will be able to purchase health insurance in 2014. But right now there are real questions about whether this historic expansion of coverage will reach those Americans who need it most.

My colleagues on The Greenlining Institute's health team have been looking into this, and just published their findings in the form of a new report. They focused on the new Health Benefit Exchanges, which will allow consumers to compare the price, quality, and benefits of competing health insurance plans. Maybe most important, Americans will be able to purchase coverage through their state's Exchange with federal subsidies that will help low and middle-income families cover the cost.

The bottom line is that getting the word out about these new options may be more complicated than it seems, and state Exchanges should get communities involved in the process sooner rather than later.

Current plans call for Web portals to serve as the main route through which consumers will access the Exchanges, but these websites won't be able to do the job by themselves. States will need to pursue a variety of outreach and enrollment strategies, strategies that must be based on the populations they must reach.

Nationally, roughly one-third of currently uninsured individuals who would qualify for Exchange subsidies are between ages 18 and 29, and one in three are Latino. Both of these figures are far greater than for the population as a whole. In some places, such as my home state of California, the proportions will be even greater. Most Californians newly eligible for health insurance through the Exchange will be from communities of color, many living in households where English is not the primary language.

These demographics present some challenges.

It may seem counter-intuitive, but young people, and particularly young people of color, may have a difficult time enrolling online. For one thing, communities of color have less reliable Internet access than whites. Only 49% of Latino homes have broadband access compared to 59% of black households and 69% of white households. Research by the Public Policy Institute of California found that Asian American, African American and Latino households were markedly less likely than whites to use the Internet to access government services.

Getting healthy young adults into the expanded health insurance pool is critical to making the whole system work. And young people, and particularly young people of color, are more likely than other groups to use smartphones rather than computers to access the Internet. Nationally, 40% of smartphone owners ages 18-29 use their phone as their primary Internet access point, while 38% of black and Latino smartphone owners access the Internet primarily through their phone.

But mobile devices may not sync well with Exchange web portals, presenting an additional barrier to access for many uninsured Americans. Removing that hurdle is vital, and likely will require specialized apps designed for use with iPhones, Blackberries and Android phones.

But that's just the beginning. The state Exchanges will need to use a variety of tools to reach the people they need to enroll, including social networking sites, kiosks in key public places, and telephone and in-person assistance in a variety of languages.

It's important to remember that the above ideas aren't a laundry list of items that officials can just check off one by one. Each state is different, with varying demographic, geographic and cultural characteristics. Each state Exchange will have to figure out a strategy that works for their communities, and that means reaching out to those communities and listening to what they have to say.

With full implementation of the Affordable Care Act just a little over a year away, the time to start that listening process is now.