“That’s a big fear and something that the campaign is trying to address,” said Hilda Martinez, a campaign manager for California Endowment’s “Get Covered” campaign, which has spent tens of millions of dollars on Spanish-language media outreach. Unwilling to take a chance with their family being torn apart, some immigrants are taking a chance with their health or their children’s health.

The issue is especially critical in California, which has a big Latino population and has employed one of the most vigorous public-outreach campaigns in the country.

Authorities have deported a record number of immigrants in recent years—more than 1.9 million since President Obama took office. With immigration reform stalled, it looks like more of the same will occur in the new year.

U.S. Immigration and Customs Enforcement has issued a letter assuring people that information submitted as part of applying for health insurance under the Affordable Care Act will not be used for immigration enforcement.