By Eliza Brown and Brigitte Vaughn
Today with the Supreme Court ruling to allow insurance subsidies in federally-run exchanges of the Patient Protection and Affordable Care Act (ACA), we look at the status of health and health care coverage for Hispanics, as well as gains and gaps in coverage in recent years. With today’s Supreme Court ruling, residents of the 34 states without their own state-run exchanges will not lose subsidies for their health care coverage. States impacted the most by the ruling include some with the largest Hispanic populations, including Florida and Texas.
Hispanic Health and Health Care Disparities
Hispanic children have poorer health overall and are more likely to have issues such as obesity, and asthma than their non-Hispanic white counterparts. Compounding these health concerns, Hispanic children also do not have the same access to health care, as they are less likely to be covered by health insurance than non-Hispanic white and black children.
Hispanic parents have even lower rates of coverage than their children. This is especially troubling since research shows that if parents have continuous health insurance coverage, their children are more likely to have coverage.
Overall, in 2014, one in four Hispanics, including children, was uninsured – significantly more than any other racial/ethnic group. Moreover, one in three Hispanic adults ages 18-64 was uninsured in 2014, significantly higher than the uninsured rates for other adults.
Recent Health Care Gains for Hispanics
Enacted in 2010, the ACA aims to increase the quality and affordability of health insurance, lower the uninsured rate, and reduce the costs of health care. Since then, increasing numbers of Hispanics have purchased health care insurance through federal and state exchanges.
Since October 2013, 2.6 million Latinos ages 18 to 64 have gained insurance through the ACA. In the 2014 open enrollment period, Latinos made up seven percent of those individuals who selected the Marketplace Plan in the 36 states using the HealthCare.gov federal platform; in 2015, that percentage increased to 10 percent, with 471,051 Latinos enrolling in the 37 states using the HealthCare.gov platform.
Hispanics have seen significant gains in the most recent years: the percentage of uninsured Hispanics younger than 65 decreased from 30 percent in 2013 to 25 percent in 2014.
Gaps for Hispanics in Care
Despite these gains, there are still gaps in coverage policies that may affect low-income Hispanic families disproportionally. Specifically, in the 19 states (as of June 2015) that did not expand Medicaid, many adults fall into a “coverage gap”—in other words, having incomes above Medicaid eligibility limits, but below the lower limit for eligibility for Marketplace premium tax credits. This makes coverage difficult to obtain.
In 2014, adults residing in states that expanded Medicaid were less likely to be uninsured than those residing in states that did not expand Medicaid. The states that chose not to expand Medicaid include Texas and Florida, whose populations add up to over a quarter of the total U.S. Hispanic population. For these states, and the low-income Hispanics who live in them, this eligibility gap can leave many adults who are near the federal poverty line without health insurance.
Documentation Concerns: Effects on Hispanic Enrollment
Health care eligibility and access for documented immigrants varies by state. States can choose to provide Medicaid and Children’s Health Insurance Program (CHIP) benefits to lawfully present children and pregnant women without a waiting period. However, in states that do not elect this option, these children and pregnant women must wait five years or more from when they receive an approved immigration status before they can get affordable health care coverage. Indeed, some of the states with the largest Hispanic populations, such as Texas and Illinois, do not extend benefits for pregnant women with a lawfully residing immigration status.
Undocumented immigrants are ineligible for insurance subsidies and Medicaid in every state. However, children who are lawfully present but whose parents are undocumented are eligible for subsidies, Medicaid, and CHIP. Although ACA provides some protection of families’ information, fears on the part of undocumented family members may inhibit their application for subsidies for their eligible children.
Increasing Gains, Closing the Gap
Although many Hispanics have enrolled for health care plans via the ACA in the most recent period, their enrollment lags compared with other race/ethnic groups. The coverage gap can be attributed to several factors including variability of access depending on state of residency, as well as immigration status. Continuing the gains and closing the gaps in health care coverage for low-income Hispanic families may require addressing these issues, among others.
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 For health insurance purposes, lawfully present residents generally include people fleeing persecution, including refugees and asylees; other humanitarian immigrants, including those granted temporary protected status; Cuban/Haitian entrants; and survivors of domestic violence, trafficking, and other serious crimes.
The National Research Center on Hispanic Children & Families is supported by grant #90PH0025 from the Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. The contents are solely the responsibility of the National Research Center on Hispanic Children & Families and do not necessarily represent the official views of the Office of Planning, Research and Evaluation, the Administration for Children and Families, or the U.S. Department of Health and Human Services.