As today begins the era of Obamacare, the debate over the president's healthcare reform plan continues. There’s a wonder whether the minorities and immigrants that need coverage the most and known to make up the bulk of uninsured Americans, will truly benefit from the opening of the health insurance marketplace. And it’s not because of the actual law.

According to a new Census Bureau report, nearly 6 in 10 uninsured Americans currently live in states that refused to set up their own health-insurance exchanges under Obamacare. To make matters worse, many of those same states are also opting out of adopting the Medicaid expansion, leaving many of the poor uninsured. Couple that with the omnipresent jargon used to explain the law and you have a cloud of unpredictability and complication hindering the success of the new system. This clear partisan dissension and confusion will disproportionately affect minority and poor communities.

Debbie Wasserman Schultz, Democratic National Committee chairwoman and Florida Rep., tells EBONY that Republicans are too “hell-bent” on destroying Obamacare.

“They’ve chosen to give up control,” she said. “Its a little ironic. Republicans are usually supportive of state control. It’s moreso meanspirited and more harmful to so many Americans."

Wasserman Schultz says this leaves hundreds uninsured–and since Florida is a Republican state, it leaves thousands of her constituents without coverage. “Its irresponsible and short-sighted and really fiscally irresponsible. The Medicaid is paid for by the federal government for the first three years–they’re leaving money on the table.”

Dr. Michael Sparer, chair of Columbia Mailman School of Public Health’s Department of Health Policy and Management, says he has many questions about the success of the marketplaces. “Will minorities and immigrants try to sign up on October 1st? How many even know about it? The exchange is a bit of a mystery at this point because each state looks so different.”

He adds that there’s also concern around the preparedness of the states and whether they’ll be able to accommodate the 8.5 million people in the country expected to use the marketplaces. The administration, on the other hand, isn’t too worried about a big rush of people. In a recent interview with Politico, Tara McGuinness, a senior White House communications adviser, said that the open enrollment start date is more-so the beginning of a soft-launch rather than the sign of a stampede.

“October 1 will be an important day to raise awareness, but it is the first day of a six-month public education effort,” she said.

No one can actually predict whether there’s going to be a reasonable build up or an immediate rush to access the exchange. However, glitches, misperception, flooded call centers and even web crashes are all still likely to happen.

Even though each state will look different when the exchange finally opens, there is a common trend among Republican-led states to both refuse an increase in Medicaid expansion and opt to a federally run exchange; the liberal states are generally doing the complete opposite.

“African Americans are in the Southern states and those are the same Southern states choosing to do a federal exchange and choosing not to do a Medicaid increase,” says Errol Pierre, assistant vice president of product management for Healthfirst, a not-for-profit insurance company.

With one-fifth of the Black population currently uninsured, and high rates of poverty among the Black community, the implications associated with the launch become even more deafening.

“Accountability and decision making is the biggest difference between state and federal run marketplaces,” Pierre says. Medicaid will run through the marketplace and regardless of whether it’s a state or federal run operation, “the federal government can’t force states to increase Medicaid–which means a lot more people uninsured.”

It doesn’t help that a lot of the language around Obamacare has been lost in translation. The name of the law itself is confusing, labeled alternately as "the Affordable Care Act," "Obamacare," and "healthcare reform." Pierre believes that’s why many people have found it hard to follow the implementation of the law.

“Its very easy to understand why the public is confused. 2010 you heard exchanges. 2011 you heard exchanges. Now its 2013 and we’re saying marketplaces. Its hard for the public to connect the dots to know that exchanges mean marketplace.”

According to the Pew Research Center, 44% of Americans think the new healthcare law has been repealed, overturned in court or are unsure whether it remains in effect. This doesn’t come as too much of a surprise since the Republican-controlled House has voted 40 times to repeal all or part of it since its passing in 2010.

There’s also the issue of language barriers and undocumented immigrants. Many of the immigrants eligible to use the marketplace may find it difficult to get through the system, particularly if the information isn’t translated.

“The bulk of the uninsured needs it translated,” says Pierre. “This exponentially makes the awareness campaign harder. A lot of the bill uses language that you can’t use publicly for awareness.” Even at Healthfirst, Pierre says they’ll have to walk many of their immigrant clients through the process.

When it comes to illegal immigrants, of course, they are unable to participate. The complication comes when mixed-immigration families, families that have some illegal and some legal members, wish to participate in the exchange. Doing so could expose the members.

With a plethora of questions still unanswered and the likelihood of early expected system glitches,  most agree that year one will be a testing ground as opposed to a full kick-off. Still, we do know that thousands of Americans will have access to insurance when they had none before—and that's change we can believe in. 


Find out whether your marketplace is state or federal run here.