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On the surface, the story of the Affordable Care Act’s implementation in Texas is one fraught with politics. Republicans oppose the law and don't promote the federal health insurance marketplace in Texas, while Democrats tout increasing Obamacare signup numbers and want the state to expand Medicaid eligibility.KUT's Veronica Zaragovia has just completed a six-month reporting project on the Affordable Care Act in Texas as a 2014 National Health Journalism Fellow. This is part of the California Endowment Health Journalism Fellowships, a program of the University of Southern California Annenberg School for Communication and Journalism.While she's been reporting on the political debate, for this fellowship she's focused on the people in Texas affected by this federal health care law and the impact on businesses and nonprofits.The three feature stories below and a discussion panel are all projects for the fellowship, which started off last July beneath sunny skies and skinny palm trees in Los Angeles, where the 2014 fellows gathered at USC for several days of health care sessions and site visits.We hope the stories below have helped shed light on the federal health care law here in our community. Share your own experiences with health insurance and the ACA or any comments you may have.

Finding Health Care for Uninsured Latinas to Reduce ER Visits

Veronica Zaragovia/KUT
Seton Survivorship Nurse Navigator Veronica Serrano, right, helps a purposely unidentified former cancer patient on Nov. 19, 2014.

We've all heard the stories about how a lack of health insurance can force someone to ignore small health issues, until they end up in the emergency room with a more traumatic, and sometimes untreatable, problem. This is happening frequently with the country's uninsured Latina population.

In Austin and across the U.S., nonprofits are helping connect them with health care resources in their communities.

The Seton hospital system, for instance, has started a program with a survivorship navigator who helps Latina cancer patients learn where to get health insurance on the federal marketplace under the Affordable Care Act, or if they don’t qualify, learn about other options to get medical care.

One of the women who's been a part of this program is Eva Bish, a cervical cancer survivor who bought a gold tier Humana health insurance plan last year on the federal marketplace and pays a $150-a-month premium.

"To me, $150 isn’t much to pay for that," Bish says. "Some people pay more and sometimes they can’t qualify. I mean, I’m lucky."

For 2015, her same plan will cost her $99 a month. Bish, who’s 59, says she’s lucky because she has two jobs, and she’s in the country legally, so she can get an Obamacare plan. She says most Latina women she knows, however, don’t get regular check-ups. When she first had the heavy bleeding that led her to the ER, her friends told her not to worry because it was probably menopause.

"All the time, people in Spanish, we say, ‘Oh, we’re healthy,' but you never know," she says. "Now I learned the hard way that I have to have no matter what."

Bish is now passionate about getting regular checkups and having insurance in large part because of Veronica Serrano, the survivorship nurse navigator at the Seton hospital system.

"I work with cancer survivors who have terminated their treatment," Serrano says.

Last year, Seton provided $340 million worth of charity care. One way the hospital can reduce its charity care costs is through Serrano’s position, which is about a year old. According to the hospital, her job is a result of a program under the Affordable Care Act that gives the hospital federal matching funds for care that would be unaffordable if only local funds were available.

In the last year she’s seen almost 80 patients – about half have been Latinas.

"They for the first time probably showed up in the emergency room because they had symptoms," Serrano says. "Specifically in gynecological cancers they were bleeding. Some sort of symptom that prompts them to go to the emergency room, and that’s where their journey starts."

After they finish their cancer treatment, Serrano refers them to a staff dietician if they have diabetes or to an application counselor if they are in the U.S lawfully and qualify for an Affordable Care Act health insurance plan.

According to the American Congress of Obstetricians and Gynecologists, lacking health insurance is the strongest predictor of not getting a mammogram or Pap test.

Nonprofits in Austin, but also across the U.S., are finding that many immigrant women don’t know where to start.

"The number one reason that Latinos call our 1-800 number from around the country is health," says Maite Arce, director of the D.C. based Hispanic Access Foundation, which created a help line to connect Spanish speakers with health resources.

"So I think what the hospital in Austin is doing is very interesting because they are connecting individually, interpersonally with their patients and helping them to navigate the issue of cancer and what’s happening to them and connect with the resources that they need," Arce adds.

Luz Marina Terreros helps answer those calls that come into the Hispanic Access help line.

"Most of the calls that I receive are women that are not eligible for Obamacare and for the Medicaid," Terreros says.

Under Obamacare, undocumented immigrants can’t qualify for a marketplace health plan – specifically, one that comes with tax subsidies to make it more affordable. Another issue is the low-income women in states that haven’t expanded Medicaid eligibility under the ACA."

"To answer these phone calls at the help line is difficult for me because sometimes I feel so frustrated," Terreros says.

She says she feels frustrated because for the uninsured who are undocumented; resources are scarce. But sometimes Terreros finds a nonprofit in a caller’s state that gives her a list of local health resources.

"At that moment I say, Okay, this is good. This is my job, and I like my job," she says. "When I can do that, this is good for me because I feel like life is continuing, and I can help some of the women that need the help."

As for Eva Bish, she smiles when she talks about surviving her own battle with cancer and the help she received from Serrano and from her doctors. In January Bish will see her oncologist – a doctor’s visit she makes every year.

"It’s scary, but if you trust in your doctor, you can make it. You can make it," Bish says.

Hispanic Access Foundation's help line can be reached at 1-800-206-9096.

This story was produced as a project for The California Endowment Health Journalism Fellowships, a program of the USC Annenberg School for Communication and Journalism.

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