Association for Public Policy Analysis & Management

The Affordable Care Act (ACA) has significantly expanded opportunities for individuals to acquire both public and private health insurance coverage. The enrollment of Hispanics has been an expressed priority of the ACA because Hispanics have the highest uninsured rates of any racial or ethnic group in the United States and the lack of health insurance is highly equated with reduced access to care and poorer health outcomes.  Therefore, assisting Hispanics with the health insurance enrollment process can be a first step in resolving greater health disparities.

During the first enrollment period, both national and state-led outreach efforts and campaigns were conducted, some specifically targeting Hispanics. These efforts were hindered by poor development, the delay of a Spanish-version of the ACA website, poor Spanish translations, and outreach efforts that did not cross-over well to Hispanic communities.  During the second enrollment period outreach efforts to Hispanics have improved.  However, a significant disparity in insurance uptake between Hispanics and other racial and ethnic groups remains.

Researchers at the Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico, with funding from the National Institutes of Health, conducted a mixed-methods study designed to better understand the challenges and barriers that Hispanics face when interfacing with the ACA. The survey tool was developed with the assistance of state personnel and informed by focus groups of representative from community organizations engaged in efforts to increase insurance uptake in New Mexico. The survey was then distributed to approximately 900 Hispanics from rural New Mexico and the South Valley of Albuquerque administered by Latino Decisions and conducted by phone, using both landlines and cell phones.

Researchers at the RWJF Center for Health Policy then analyzed survey response data. These findings will be more important as subsequent enrollment periods may face difficulties in getting the same amount of traditional media coverage because the ACA is no longer a novelty and the 2016 election campaigns will be competing for attention during the same time. In addition, the people who were most eager and capable of enrolling will have already enrolled during the first and second open enrollment periods, leaving a large percentage of Hispanics who have significant barriers to enrolling. Our paper contributes to the current ACA literature by identifying the barriers to enrolling that Hispanics, in particular face, and how these barriers may be overcome. We hope that these findings will help inform outreach efforts and programs with actionable policy recommendations: identifying Hispanics’ preference for terminology used related to the ACA in both English and Spanish, identifying better communication strategies related to the ACA and marketplace information, and providing a better understanding of Hispanics’ utilization and experiences with the health care marketplace.