Early Findings on ACA Awareness and. Implications for Outreach and Enrollment Among Latinos and African Americans

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1 Early Findings on ACA Awareness and Marketplace Visitors: it Implications for Outreach and Enrollment Among Latinos and African Americans Petra W. Rasmussen, MPH Senior Research Associate, Health Care Coverage and Access The Commonwealth Fund 2014 Annual Research Meeting The ACA: Exchanges, Awareness, and Outreach San Diego, CA June 9, 2014

2 Exhibit 1. Latinos, African Americans, and the Affordable Care Act Under the Affordable Care Act, new coverage options are available through health insurance marketplaces and expanded Medicaid eligibility Nearly three in ten Latinos lacked health insurance in 2012 (CPS) RAND estimates that 5.4 million Latinos will gain coverage by 2016 because of the ACA Half of the more than 4 million eligible White uninsured Latinos with incomes 49% below 100 percent of poverty live in states that are not expanding Medicaid Nearly twenty percent of African Americans were uninsured in 2012 (CPS) RAND estimates that 3.8 million African Americans will gain coverage by 2016 because of the ACA Sources: ASPE Report, The Affordable Care Act and Latinos. 2012; ASPE Report, The Affordable Care Act and African Americans. 2012; CPS Report, Income, Poverty, and Health Insurance Coverage in the United States: 2012; ASPE Report Eligible Uninsured Latinos: 8 in 10 could receive health insurance marketplace tax credits, Medicaid, or CHIP. February 11, The Commonwealth Fund Affordable Care Act Tracking Survey, July-Sept Adults ages who were uninsured during the year African American 14% Other 8% Latino 27%

3 Exhibit 2. State Action on Establishing Health Insurance Marketplaces and Participation in Medicaid Expansion, As of April 2014 Medicaid Expansion Health Insurance Marketplaces Pursuing state-run exchange (16 + DC) Pursuing state-federal partnership exchange^ (7) Pursuing a state-run small business exchange and a federally run individual exchange (1) Pursuing federally facilitated exchange, state will be responsible for the plan management functions (7) Pursuing federally facilitated exchange (19) Expanding (22 + DC) Customized approaches (5) Options under discussion (4) Not expanding (19) Note: CMS has approved waivers for expansion with variation in Arkansas, Iowa, and Michigan. Pennsylvania s waiver is currently under development by the state s health department. **In New Mexico and Idaho, the federal government will operate the individual market in Source: National Conference of State Legislatures, Federal Health Reform: State Legislative Tracking Database. State Refor(u)m; K. Keith and K. W. Lucia, Implementing the Affordable Care Act: The State of the States, The Commonwealth Fund, January 2014, Politico.com; Commonwealth Fund Analysis.

4 Exhibit 3. The Commonwealth Fund Affordable Care Act Tracking Surveys Methodology July-September 2013 survey Data collected by SSRS 17-minute telephone interviews in English and Spanish Random, nationally representative sample of adults ages 19 to 64 living in continental United States October and December 2013 surveys Data collected through SSRS EXCEL omnibus survey EXCEL uses a fully-replicated, stratified, single-stage, random-digitdialing g( (RDD) sample of telephone households, and randomly generated cell phones 19 to 64 year olds screened into CMWF insert from total EXCEL sample, where they were then screened based on insurance coverage Final sample included only those ages 19 to 64 who were uninsured or had individual coverage or who said they had signed up for health insurance through new state marketplace

5 Exhibit 4. Latino Adults Have High Uninsured Rates Percent of adults ages uninsured during the year, White African American Latino Total <138% FPL 138% 399% FPL %+ FPL Note: FPL refers to federal poverty level.*uninsured during the year. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, July-Sept

6 Exhibit 5. Awareness of Health Insurance Marketplaces Increased Across All Races and Ethnicities, But Latino Awareness Still Lags %Yes 100 Since the beginning of October, under the health reform law, also known as the Affordable Care Act, new marketplaces have been open in each state where people who do not have affordable health insurance through a job can shop and sign up for health insurance. Are you aware of this new marketplace in your state? t July-Sept Dec Total White African American* Latino 15 Adults ages who are uninsured or have individual coverage Note: The question wording differed somewhat between the summer and December surveys. *Smaller sample size (n=94) in December. Source: Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, July-Sept and Dec

7 Exhibit 6. Awareness of Availability of Financial Assistance Increased Across All Races, Latino Awareness Still Lags % Yes Many people without affordable health benefits through a job may be eligible for financial help to pay for their health insurance in these new marketplaces. Are you aware that financial assistance for health insurance is available under the reform law? July-Sept Dec Total White African American* Latino Adults ages who are uninsured or have individual coverage Note: The question wording differed somewhat between the summer and December surveys. *Smaller sample size (n=94) in December. Source: Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, July-Sept and Dec

8 Exhibit 7. Marketplace Use in December % Yes 75 Have you gone to this new marketplace to shop for health insurance? This could be by mail, in person, by phone, or on the Internet Total White African American* Latino Adults ages who are uninsured or have individual coverage *Smaller sample size in December (n=94) Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec

9 Exhibit 8. At The End of December 2013, Nearly Two Thirds of Marketplace Visitors Were White Compared to 55 Percent of Eligible ibl Population Total Marketplace Visitors African African American American 14% 12% White 55% Latino 24% White 64% Latino 19% Other 6% Other 7% Percent adults ages who are uninsured or have individual coverage Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec

10 Exhibit 9. Majority of Eligible Adults Plan to Use Marketplaces By End of Open Enrollment, Regardless of Race The enrollment period for health insurance in the marketplaces ends on March 31, How likely are you to go to/go back to the marketplace by March 31, 2014, to enroll in a health plan or find out if you are eligible for financial help to pay for your plan or for Medicaid? Very unlikely Somewhat unlikely Somewhat likely Very likely Total White African American* Latino Percent Adults ages who are uninsured or have individual coverage and have not gone to marketplace or did not enroll Bars may not sum to 100 percent because of don t know responses or refusal to respond; segments Bars may not sum to 100 percent because of don t know responses or refusal to respond; segments may not sum to subtotals because of rounding. *Smaller sample size (n=84). ** Respondents with individual market coverage who said they had received an offer from their insurance carrier to renew their plan for 2014 and said they planned to keep their policies were excluded from this analysis. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec

11 Exhibit 10. ACA Enrollment Lags for Both Latinos and African Americans in Federally Facilitated Marketplaces (FFMs) and California Percent of individuals who selected a marketplace plan 75 FFMs California 50 43% 25 35% 28% 0 12% 3% 7% White Latino African American Notes: Not all people reported their race/ethnicity on applications. For the first open enrollment period from October 1, 2013 March 31, 2014, including the special enrollment period up to April 19, 2014.

12 Exhibit 11. Looking Forward to the 2015 Open Enrollment Period Other surveys have found that Latinos more likely to go in person to enroll, enrolled later, less aware Increasing awareness and improving outreach Continued challenges for immigrants in gaining coverage through ACA No new coverage options for undocumented immigrants Cannot purchase insurance through Marketplaces (neither subsidized nor unsubsidized coverage) Ineligible ibl for Medicaid id coverage Ineligible for the Basic Health Program (BHP) Reduction in funding for hospitals that help cover the uninsured 5-year waiting period for most legally present immigrants for Medicaid, but not for marketplace coverage Mixed-status families Fears of deportation may be limiting some from enrolling legally present family members For those that are enrolling in new coverage options, access to care will be different for different family members

13 Exhibit April-June ACA Tracking Survey Sample of 4,500 adults ages /3 from RDD 1/3 from re-contacts/pre-screened who are uninsured or individual market prior to open enrollment Expect to have a sample size of about 2,200 who were potentially eligible for marketplaces prior to January 1, 2014 Large state samples in CA, TX, NY, PA, FL, IL Will be able compare use of marketplaces and impact of Medicaid expansion on Latinos and African Americans by state Will be able to look at experience using marketplaces and using new coverage by race/ethnicity

14 Acknowledgements Sara R. Collins Vice President Health Care Coverage and Access The Commonwealth Fund Michelle Doty Vice President Survey Research and Evaluation The Commonwealth Fund