California has surged ahead in implementing the federal health care law, but it is lagging in one way that could have major implications for the program's success: Latinos appear to make up only a small fraction of those who have signed up.
The numbers have prompted concern, because so many of the state's uninsured are Hispanic, and it could be a sign that enrollment efforts targeted toward Latinos are behind nationwide as well.
Hispanics are a linchpin of the health care law because they comprise more than a third of the estimated 29 million people who are eligible to buy coverage on the online insurance exchanges. The population skews young, making Latinos an important demographic for the Obama administration, which is seeking to keep premiums low by coaxing healthy people to join the insurance pools.
Even though the administration has not released national Hispanic enrollment numbers, the California figures are a "red flag" for what might be happening more broadly, said Gabriel Sanchez, a pollster specializing in the Hispanic community and head of the Robert Wood Johnson Center for Health Policy at the University of New Mexico.
"California was supposed to be out in front of the pack on marketing efforts targeting Latinos," he said. "The fact that their numbers don't look good is pretty dire for the administration."
Less than 5 percent of the 109,296 people who enrolled in health insurance in California in October and November identified themselves as Spanish speakers, according to data released by the state on Thursday -- a strikingly low number considering that more than a quarter of the state's population primarily speaks Spanish, and Latinos comprise nearly half the number of uninsured who are eligible to buy coverage on the state exchange.
Although the figure does not reflect the number of Latinos who probably registered in English, the 4,498 sign-ups among Spanish speakers were significantly less than the 6,453 enrollments among speakers of Asian and Pacific Islander languages -- a group that makes up about 10 percent of the state population, according to census data.
The state has had an aggressive $86 million promotional push devoted to boosting enrollment among Californians of all stripes, including Latinos.
"What the heck was that money for? I'm very frustrated by what I see as a poor job to implement the promise of the Affordable Care Act," said state Sen. Norma Torres, a Democrat who represents a heavily Hispanic part of Los Angeles County. "We have to do better."
Administration officials say it is premature to be raising alarm bells about Hispanic enrollment, because people have until March 31 to sign up and they expect December enrollments to be much higher than the previous two months.
A big promotional push by the White House aimed at Latinos won't start until January. Numbers specifying how many Hispanics have enrolled have not been released.
"Our expectation was always that the number of enrollees, including Latino consumers, would be low in the first months, but we expect enrollment to increase over time," Katherine Vargas, a White House spokeswoman, said in a statement.
But the technical problems that beset the federal marketplace, HealthCare.gov, was a major setback. The administration was forced to cancel a "Hispanic Week of Action" that was planned for late October. The Spanish-language version of HealthCare.gov, CuidadoDeSalud.gov, became active only last weekend even though it was scheduled to launch with the English site Oct. 1.
One problem identified by workers helping Hispanics sign up for coverage around the country is the confusing process for submitting applications from people whose families include U.S. citizens as well as legal and illegal immigrants.
Moreover, because people with complex family situations must complete more steps to finish their applications, the system has more opportunities to crash.
Another problem has plagued U.S. citizens born in other countries. The marketplaces require people to submit something called a "naturalization certificate number," which was assigned to them when they attained citizenship, for some people many years or decades ago.
The request sent Juan Carlos Perez digging through his old paperwork in his garage in Pasadena, Calif., to produce a number he was given at age 14 and hasn't had to use since.
"It was one of those moments where I was reminded I am not an equal citizen," said Mr. Perez, 43, a freelance writer who was born in Peru. "It just felt very alienating, and a reminder that you're not quite fully accepted. It was not something I expected to see on this site."