The Impact of the Affordable Care Act on Latinas in the U.S.
By Munira Gunja, Christine Haran, and Michelle Doty
María Herrera, a single mother originally from Colombia, had been living without health insurance for more than 30 years in 2014 when she signed up for an Affordable Care Act (ACA) health plan “the moment the marketplace was open.” Herrera, age 60, had never had an offer of job-based insurance and couldn’t afford to buy a health plan on her own until premium subsidies became available through the ACA. Today, she has a $460 tax credit to help her pay for coverage.
“I feel much better now,” Herrera says. “I used to have to go to the doctor all the time because of my allergies to dust.” Thanks to her health coverage, the Virginia resident now has preventive allergy medicine that makes it much easier for her to perform her job.
Since coverage expansions under the ACA, also known as Obamacare, went into effect three years ago, the number of American women living without health insurance has dropped by more than 50 percent. Latinas, who have long had very high uninsured rates, are among those who have benefitted from the ACA and begun to obtain coverage.
The ACA provides affordable health insurance through state health insurance marketplaces and the expansion of eligibility for Medicaid. In the marketplaces, people who do not have access to a public plan or an affordable employer plan can shop for a private health plan, and tax credits are available for low- and moderate-income enrollees to subsidize the cost of premiums. While the law mandated the expansion of Medicaid eligibility for adults earning up to about $16,000 for an individual and $33,000 for a family of four, a 2012 U.S. Supreme Court decision made expansion optional for states. Since that time, 31 states have expanded Medicaid to low-income adults, while the remaining 19 have maintained their older rules, which often limit the program to pregnant women, children, and people with disabilities.
The ACA has also provided women with improved access to coverage by ending discriminatory practices such as denying coverage or charging higher premiums based on gender. In 2014, 7.3 million women—or 38 percent—who tried to buy their own health insurance over the previous three-year period were turned down, charged a higher premium, or had a condition excluded from coverage because it was preexisting, according to a recent study from the Commonwealth Fund.
As of 2014, the reforms were already translating into improved access to care. A recent U.S. Department of Health and Human Services report found women, and particularly African American women and Latinas, were more likely to have a usual source of care, such as a doctor’s office or clinic, and to report that they were less likely to forego care due to costs.
However, despite the marked gains in coverage and access since the passage of the ACA, Latinas continue to be much more likely to be uninsured than other U.S. women. In 2016, 23 percent of Latinas were uninsured (down from 31 percent in 2013), compared to 12 percent of black women, and 7 percent of white women, according to the Commonwealth Fund study. Latinas who were born outside of the United States had the highest uninsured rates: while 9 percent of U.S.-born Latinas were uninsured, 35 percent of foreign-born Latinas were uninsured.
Language likely plays a major role in more limited awareness of coverage options among Latinas. The Commonwealth Fund survey shows that 49 percent of uninsured Latinas are unaware of the marketplaces in 2016 compared to 13 percent of white women. “Historically Latinos have been excluded from affordable health coverage and health care,” says Annette Raveneau of the nonprofit Enroll America. “While the uninsured numbers have been reduced greatly, Latinas have barriers like language and immigration status, which can affect awareness and access to care. We know that access to an in-person assister, who speaks the language they prefer to communicate in, has helped Latinos with the enrollment process.”
For some Latinas, Spanish-language materials are not all that is needed. “Language is key,” Raveneau says. “A lot of people think Latinos speak Spanish and that’s correct. But for a lot of communities, like farm workers, Spanish might be their second language. They speak their own native tongue from their region or tribal connection.”
Sinsi Hernández-Cancio, director of health equity at Families USA, points out that as each year passes, the remaining uninsured become harder to reach, while at the same time, funding for enrollment assistance is dwindling. And the funding that is available, she says, is not always going to the right organizations. “There are people in all of these neighborhoods who know how to reach the so-called hard-to-reach. For example, there are a lot of health promotion and other community-based organizations, potentially churches, and community health workers who have been in the communities for a long time, but they are not the ones getting navigator grants [to provide in-person enrollment assistance. They already have the trust and recognition of the people we are trying to reach.”
States’ decisions about whether to expand Medicaid to low-income adults have also had a significant impact on uninsured rates among minorities. Latinas living in states such as Texas and Florida, which have not expanded their Medicaid programs to low-income adults, are the most likely to be uninsured. Thirty-four percent of Latinas in non-expansion states are uninsured, compared to 13 percent of black women, and 10 percent of white women.
A large number of Latino immigrants who are still uninsured may not qualify for coverage, as the ACA bars people who are not living in the United States legally from Medicaid or marketplace coverage. This may change, however: California has expanded Medicaid to undocumented children under the age of 19 and since then, 170,000 undocumented children have become eligible for Medicaid. California is seeking a waiver from the federal government to allow low-income undocumented adults to also qualify for Medi-cal, as well as allow higher-income undocumented adults to buy marketplace plans—without financial help. The Democratic presidential candidate Hillary Clinton has made a similar proposal. Still, as a Kaiser Family Foundation report shows, uninsured, undocumented Latino immigrants may not be able to afford unsubsidized plans, or they may be reluctant to purchase plans out of fear of deportation, especially those within mixed-status families.
Including undocumented immigrants and expanding Medicaid programs in all states will allow many more low-income people to have health coverage. For now, raising awareness of the health insurance marketplaces and Medicaid will play a critical role in enrolling women who qualify for subsidized plans or Medicaid coverage, yet go uninsured. For the Latina community, Enroll America offers Spanish-language online tools such as the Get Covered Calculator, which quickly indicates whether you are eligible for financial help with coverage, and the Get Covered Connector, which helps people set up appointments with bilingual in-person assisters who can guide them through the complex enrollment process.
Outreach to women will ultimately help insure both men and women, experts say. “When it comes to getting health coverage and then using that coverage, Latinas are the ones who are pushing for the coverage and then using the services. It’s not only the mother, it’s the sister, it’s the grandmother,” Raveneau says. “What we’re trying to do when it comes to our outreach is give that power and the tools—the education—to these women so they can not only talk to their families and make sure they have coverage, but also talk to their friends.”
TOP PHOTO CREDIT: Morgan Janine