April is Minority Health Month, a good time to consider ways to reduce the wide disparities in health insurance access and coverage that particularly affect the Latino/Hispanic community. Latino individuals represent 19 percent of the total U.S. population but 29 percent of the uninsured. However, thanks to the Biden administration’s establishment of a special enrollment period that will run through August 15 and expanded premium tax credits for Affordable Care Act (ACA) marketplace health plans, there is a real opportunity to build on the gains achieved under the ACA and increase coverage rates among this population.

The ACA’s Effect on Health Equity

The ACA brought about significant coverage gains, reducing the uninsured rate to an historic low over the past decade. The number of uninsured adults fell from 48.2 million in 2010 to 35.7 million in 2014, when the ACA’s reforms went into full effect. The expansion of Medicaid eligibility was particularly helpful in reducing uninsurance among Latinos. Between 2010 and 2016, 4 million Latino adults gained coverage. Overall, from 2010 to 2019 the rate of uninsured Hispanic or Latino individuals decreased by nearly one third, but at its current rate of 22 percent it is still almost 2.5 times the rate for white individuals.

Persisting Coverage Inequities

Between 2017 and 2019, the number of uninsured individuals began to rise. This was largely due to federal policy changes made to coverage options available under the ACA and Medicaid, reduced funding for outreach and enrollment assistance in the ACA marketplaces, and immigration policies that had a chilling effect on immigrant families’ engagement with public coverage programs. A total of 29.6 million people were uninsured in 2019, of whom 10.8 million were nonelderly Latinos. Further, research indicates that over 30 percent of adults were ineligible for marketplace coverage in 2018 due to immigration status. 

Racial and ethnic inequities in access to coverage persist particularly in states that have not yet expanded Medicaid. In Texas for example, while 13 percent of white people were uninsured in 2019, 30.8 percent of Latino Texans were uninsured. The exclusion of undocumented immigrants from Medicaid and Marketplace coverage options has likely contributed to the high uninsurance rate among this community. 

These unequal rates in access to coverage have likely contributed to the significant inequities in health outcomes for racial and ethnic minorities throughout the COVID-19 pandemic. Latino people have disproportionately suffered from increased rates of morbidity and mortality over the past year. According to the Centers for Disease Control (CDC), compared to white individuals, Hispanic or Latino individuals have had twice as many COVID-19 cases, three times as many hospitalization cases, and 2.3 times as many deaths overall. 

New Opportunities to Expand Coverage and Reduce Health Care Disparities: The American Rescue Plan Act of 2021

In an effort to reduce the number of uninsured people in the country, President Biden has mandated a COVID Special Enrollment Period through August 15 and signed the American Rescue Plan Act (ARPA) into law. The bill encourages states to expand Medicaid and increase financial assistance for individuals and families seeking marketplace coverage. The Biden administration has also begun to reverse a number of the previous administration’s immigration policies.

Overall, ARPA subsidies are expected to yield lower health insurance premiums for a total of 29 million people, 15 million of whom are uninsured but are eligible for marketplace coverage, and 14 million who currently have coverage on the individual market. Of this number, 2.6 million uninsured Latino nonelderly adults may be eligible for $0 premium plans, and 3 million uninsured Latino nonelderly adults may be eligible for a plan for less than $50 per month.

Looking Ahead

The ACA made great strides in reducing the number of uninsured people, particularly for people of color. However, significant coverage gaps persist, especially in the twelve states that have not yet expanded Medicaid. The ARPA offers all Americans, especially the most underserved, a critical chance to gain access to care and save on coverage costs thanks to increased subsidies for marketplace plans. However, the ARPA subsidies are temporary and Congress will need to act to make them permanent.

For the time being, increasing enrollment in health insurance coverage should be a top priority. The Biden administration has increased the federal investment in marketplace outreach to $100 million, and is expected to expand personalized consumer assistance through the marketplace Navigator program. This help can’t come too soon, as determining eligibility for subsidies and enrolling in a health plan can involve a complicated set of factors, and can be particularly challenging for families who need language assistance, or have mixed immigration statuses or multiple sources of income. During this week and beyond, HHS, CMS, and many other national organizations have pledged to make collaborative efforts to amplify the COVID-19 SEP and raise awareness about the coverage options available through HealthCare.gov for the Latino community. CHIR’s Navigator Resource Guide can also be a helpful reference for consumers and assisters during this time.