Opinion
VIEWPOINT
Michelle M. Doty, PhD, MPH The Commonwealth Fund, Survey Research and Evaluation, New York, New York. David Blumenthal, MD The Commonwealth Fund, President. Sara R. Collins, PhD The Commonwealth Fund, Health Care Coverage and Access.
Corresponding Author: Michelle M. Doty, PhD, MPH, The Commonwealth Fund, Survey Research and Evaluation, 1 E 75th St, New York, NY 10021 ([email protected]). jama.com
The Affordable Care Act and Health Insurance for Latinos Individuals of Hispanic American or Latino origin are among many millions of Americans at high risk of lacking health insurance who are making considerable gains under the Affordable Care Act (ACA). Historically, Hispanic Americans/Latinos have been more likely to lack health insurance than any other ethnic or racial group. The full implementation of the ACA, however, could substantially reduce this disparity and has the potential to be one of the most important developments affecting Latino health care. Recent survey results from The Commonwealth Fund show that, at the end of the first open-enrollment period of the ACA, the uninsured rate for working-age Latinos decreased from 36% to 23% (Figure).1 Much of this decline has been concentrated among the young and the poor—groups with historically the highest rates of uninsurance. In comparison, the uninsured rate for nonHispanic white adults decreased from 16% to 12%. Recent federal surveys have also found declines in uninsured rates among Latinos early in 2014.2 The potential benefits for these newly insured persons are well established. Past insurance expansions have been associated with reduced mortality, improved mental health, and fewer episodes of bankruptcy.3,4 However, significant barriers complicate continued expansion of health insurance for Latinos under the ACA. First, language continues to pose a considerable obstacle. At the end of open enrollment, 30% of Latinos who primarily speak Spanish remained uninsured, compared with 19% of English-dominant Latinos.1 Second, comparatively few Latinos know about their new coverage options. By the end of the first enrollment period, only 50% of potentially eligible Latinos were aware of the insurance marketplaces compared with 74% of non-Hispanic whites, and only 29% of potentially eligible Latinos had visited a marketplace. Rates were even lower among Spanish speakers. Even though Latinos were less likely to visit the insurance marketplace than non-Hispanic whites, they were more likely to enroll in a health plan when they did.1 Third, state decisions not to expand eligibility for Medicaid under the law have had significant consequences for Latinos with the lowest incomes. In states that expanded Medicaid, the uninsured rate for Latinos decreased from 35% to 17%; in the 25 states without Medicaid expansion as of April 2014,5 the uninsured rate remained statistically unchanged (Figure).1 Twenty million Latinos live in these states that have not expanded Medicaid, including 14 million in Texas and Florida alone. As the second enrollment period of the ACA approaches, there are important lessons from the first enrollment period. Foremost is the need to dedicate sufficientresourcestoensurethatenoughbilingualenrollment
counselors are available for Latinos seeking information or wishing to enroll, including, although not limited to, the Spanish-language website for the federal marketplace.6 In addition, trusted organizations, such as churches and communitygroups,willbekeyvenuesforreachingLatinos potentially eligible for the law’s coverage options.7 Despite these remaining challenges, millions of Latinos are gaining new health insurance coverage and with it the financial ability to access health care when they need it. The increased access to affordable quality care will hopefully serve to improve the health and quality of life for millions of Hispanic Americans/Latinos in the United States. Figure. Uninsured Rate Among Latino Adults Between July-September 2013 and April-June 2014 by Age, Language Spoken, and Income Overall All Adults
July-September 2013 April-June 2014
White Latino Latino Adults Dominant Language English Spanish Age, y 19-34 35-49 50-64 Income, % FPL
VIEWPOINT
Michelle M. Doty, PhD, MPH The Commonwealth Fund, Survey Research and Evaluation, New York, New York. David Blumenthal, MD The Commonwealth Fund, President. Sara R. Collins, PhD The Commonwealth Fund, Health Care Coverage and Access.
Corresponding Author: Michelle M. Doty, PhD, MPH, The Commonwealth Fund, Survey Research and Evaluation, 1 E 75th St, New York, NY 10021 ([email protected]). jama.com
The Affordable Care Act and Health Insurance for Latinos Individuals of Hispanic American or Latino origin are among many millions of Americans at high risk of lacking health insurance who are making considerable gains under the Affordable Care Act (ACA). Historically, Hispanic Americans/Latinos have been more likely to lack health insurance than any other ethnic or racial group. The full implementation of the ACA, however, could substantially reduce this disparity and has the potential to be one of the most important developments affecting Latino health care. Recent survey results from The Commonwealth Fund show that, at the end of the first open-enrollment period of the ACA, the uninsured rate for working-age Latinos decreased from 36% to 23% (Figure).1 Much of this decline has been concentrated among the young and the poor—groups with historically the highest rates of uninsurance. In comparison, the uninsured rate for nonHispanic white adults decreased from 16% to 12%. Recent federal surveys have also found declines in uninsured rates among Latinos early in 2014.2 The potential benefits for these newly insured persons are well established. Past insurance expansions have been associated with reduced mortality, improved mental health, and fewer episodes of bankruptcy.3,4 However, significant barriers complicate continued expansion of health insurance for Latinos under the ACA. First, language continues to pose a considerable obstacle. At the end of open enrollment, 30% of Latinos who primarily speak Spanish remained uninsured, compared with 19% of English-dominant Latinos.1 Second, comparatively few Latinos know about their new coverage options. By the end of the first enrollment period, only 50% of potentially eligible Latinos were aware of the insurance marketplaces compared with 74% of non-Hispanic whites, and only 29% of potentially eligible Latinos had visited a marketplace. Rates were even lower among Spanish speakers. Even though Latinos were less likely to visit the insurance marketplace than non-Hispanic whites, they were more likely to enroll in a health plan when they did.1 Third, state decisions not to expand eligibility for Medicaid under the law have had significant consequences for Latinos with the lowest incomes. In states that expanded Medicaid, the uninsured rate for Latinos decreased from 35% to 17%; in the 25 states without Medicaid expansion as of April 2014,5 the uninsured rate remained statistically unchanged (Figure).1 Twenty million Latinos live in these states that have not expanded Medicaid, including 14 million in Texas and Florida alone. As the second enrollment period of the ACA approaches, there are important lessons from the first enrollment period. Foremost is the need to dedicate sufficientresourcestoensurethatenoughbilingualenrollment
counselors are available for Latinos seeking information or wishing to enroll, including, although not limited to, the Spanish-language website for the federal marketplace.6 In addition, trusted organizations, such as churches and communitygroups,willbekeyvenuesforreachingLatinos potentially eligible for the law’s coverage options.7 Despite these remaining challenges, millions of Latinos are gaining new health insurance coverage and with it the financial ability to access health care when they need it. The increased access to affordable quality care will hopefully serve to improve the health and quality of life for millions of Hispanic Americans/Latinos in the United States. Figure. Uninsured Rate Among Latino Adults Between July-September 2013 and April-June 2014 by Age, Language Spoken, and Income Overall All Adults
July-September 2013 April-June 2014
White Latino Latino Adults Dominant Language English Spanish Age, y 19-34 35-49 50-64 Income, % FPL
