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06/23/2014

Young, Hispanic, and insured? A closer look at health insurance enrollment


by Sarah Thomas, Research Director, Deloitte Center for Health Solutions, Deloitte Services LP

The entire health care system – including health plans, hospitals, life sciences companies, and government agencies – has a stake in whether heath reform delivers on the promise of covering more Americans. For this reason, we have been closely tracking the rollout of health insurance marketplaces (also known as public exchanges) and reporting on significant regulatory and other milestones in the Health Care Current. We also recently commissioned a study on the “Young Invincibles” – young adults who were uninsured at the beginning of the 2014 open enrollment period. We discussed the preliminary findings from the survey in a recent Live from the Center webcast, in the infographic A tall order to fill: enrolling young adults in health insurance, and will release the full findings in coming weeks.

 While young adults have been a group of keen public and business focus throughout the speculation of “who will come,” another group of interest has been the Hispanic population. This group has been of particular interest mainly because they make up a large share of the uninsured population – the federal government has reported that 1 in 4 of the uninsured is Hispanic.1 And the Hispanic population is growing; the Kaiser Family Foundation reported that Hispanics account for 17% of the total U.S. population (more than 50 million of 307.9 million), a share expected to increase to 30% by 2050.2

Although many Hispanics signed up for coverage in marketplaces, they were less likely than other groups of uninsured to do so. The U.S. Department of Health and Human Services (HHS) reported that for the federally-facilitated marketplaces, 14.5% of Hispanics were exchange-eligible, while 10.7% showed up.3 Note that HHS reports that around a third of exchange enrollees did not report their ethnicity or language, so it is possible that these percentages do not reveal the true underlying percentage of Hispanic enrollees. State-based marketplaces also reported gaps in the share of people eligible to enroll and who ended up enrolling.

Deloitte’s survey of young adults and health insurance allows us to look at young Hispanics to learn more about their experiences and preferences related to health insurance. Some responses to the questions for this group trended differently from the responses of the non-Hispanic population. Among some of the findings related to the young Hispanic population:

  • When we asked those who remained uninsured at the end of open enrollment for their reasons, Hispanics tended to be more likely to report they were healthy and that that the plans offered did not meet their needs, though these results were not statistically significant due to low sample size.
  • Hispanics tended to use navigators who provide in-person assistance while enrolling in coverage. Hispanics are more likely to think navigators are important when choosing a plan (44% vs. 20% for non-Hispanics). This is consistent with findings from Enroll America, which found that in addition to personal outreach, multiple touches helped close the gap between being uninsured and insured for young Hispanics (and African-Americans).4
  • While there is no dominant source or channel for information in guiding health insurance decisions, traditional sources were more trusted. This finding was consistent across the Hispanic and non-Hispanic populations.
  • As the table below shows, Hispanics were nearly twice as likely to say that TV and radio advertisements could have a major influence on how they choose health insurance plans. They also tended to report they found other types of media more influential than was the case for non-Hispanics.              

HIX enrollment

  Statistically significant

One of the most important findings from the survey (that holds for respondents of any ethnicity) is that despite most young people understanding elements of the health reform law, such as the mandate and the deadline, they were not as likely to be aware of the availability of financial support (through subsidies) to help reduce the cost of premiums. Enroll America also found that “Informing consumers about the availability of financial assistance was the single most important way to motivate uninsured consumers to enroll.”4

So what are some considerations for the next open enrollment period?

  1. Stakeholders (governments, health plans, and others) should continue to invest in in-person outreach in order to help harder-to-reach populations – such as Hispanics – enroll.
  2. Even while maintaining support for in-person outreach, continued investment in a variety of media to reach our diverse population makes sense as consumers (especially Hispanic consumers) consider this information to be influential.
  3. Stakeholders should develop messages that more clearly explain the availability of financial support to help make coverage more affordable.

We should not be surprised to see differences in the way consumers think about health care. In conducting research about hospice use years ago, for example, I saw very different patterns in care by ethnicity. Many health care industry stakeholders want to benefit from the growth in demand that is likely to accompany expanded health insurance coverage. Hispanics are a large and growing share of the U.S. population and make up a large share of the uninsured. Enrolling young Hispanics in particular will not only expand insurance coverage, but will help to make sure that there are enough healthier young people in the risk pool, which in turn will help keep premiums affordable. Developing awareness and marketing strategies that leverage what we have learned from the first year’s open enrollment makes good sense.

 

Sources: 1U.S. Department of Health & Human Services, “The Affordable Care Act and Latinos,” April 10, 2012.http://www.hhs.gov/healthcare/facts/factsheets/2012/04/aca-and-latinos04102012a.html; 2Kaiser Family Foundation, Commission on Medicaid and the Uninsured, “Health Coverage for the Hispanic Population Today and Under the Affordable Care Act,” April, 2013.http://kaiserfamilyfoundation.files.wordpress.com/2013/04/84321.pdf; 3ASPE, “Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period,” May 1, 2014.http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014apr_enrollment.pdf; 4Enroll America, “State of Enrollment: Lessons Learned from Connecting America to Coverage, 2013-2014,” June, 2014. https://s3.amazonaws.com/assets.getcoveredamerica.org/20140613_SOEReportPDFlr.pdf

 

Sarah Thomas, Director of Research, Deloitte Center for Health Solutions, Deloitte LLPSarah Thomas is a director with Deloitte Services LP and the director of research for Deloitte's Center for Health Solutions. Sarah has experience in public policy, ranging from reimbursement to addressing issues such as quality in Medicare, Medicaid and the private health insurance market, including health insurance exchanges and marketplaces.She has more than 13 years of government experience.

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