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Thursday, April 9, 2015

ACA Enrollment Drives Historic Decline in Uninsurance for Communities of Color

Cathy Kaufmann

Enrollment Program Director

Health care advocates across the nation are celebrating the milestone of nearly 11.7 million Americans gaining health insurance through the second open enrollment period of the Affordable Care Act. At the same time, the latest enrollment numbers from the Department of Health and Human Services (HHS) have led some to characterize enrollment of communities of color as “lagging.” What is getting less attention is the new HHS data showing a huge reduction in the disproportionately high rates of uninsured people of color. 

Greater decline in the uninsured rate of African Americans and Latinos than of whites

Through enrollment in the marketplace, Medicaid expansion, and other provisions, the ACA has contributed to an unprecedented decline in the national uninsurance rate for people of all races and ethnicities. Since the beginning of the first open enrollment period in October 2013, a total of 14.1 million adults gained coverage, reducing the national uninsurance rate to 13.2 percent.  

African Americans and Latinos experienced the most dramatic improvements. While whites’ uninsurance rates fell by 5.3 percentage points, African Americans’ rate fell by 9.2 percentage points, and Latinos by an impressive 12.4 percentage points—all in only two years. 

This historic achievement in reducing uninsurance for communities of color seems to be at odds with recent media coverage, which describes the enrollment of minorities in the health insurance marketplace as “lagging.” In particular, there’s a narrative that Latinos are not enrolling, as illustrated by such sensational headlines as “Why Latinos Don’t Care for Obamacare.” 

HHS data can provide only a partial picture of minority enrollment

Even in HHS’s March enrollment report, the only hard data on race and ethnicity were presented as a proportion of the overall pool of enrollees. Viewed this way, the percentage of total enrollees who were African American fell from 17 percent in the first open enrollment period to 14 percent in the second. And the percentage who were Latinos remained stable at 11 percent. 

But this is far from the full picture—which is much brighter: 1 million more people of color signed up for marketplace coverage this year than signed up last year.

HHS data show that the number of people of color enrolling in the marketplace increased by 1 million over last year.

When looking at the March enrollment data from HHS, here are four things people who care about access to health insurance for communities of color should keep in mind: 

  • Race and ethnicity data from states with their own marketplaces were not included.  The race and ethnicity data came only from the 37 states that used This excludes state-run marketplace data. Thus enrollees from states with large numbers of people of color, like California and New York, were not counted.
  • Even for the states that were included, the race and ethnicity data that are available is incomplete and should be treated as merely a floor. More than one-third of enrollees did not answer the optional race and ethnicity questions. This means that these data represent merely the minimum number of people of color that enrolled in the 37 states that used The actual number is higher. The report itself says that the data “should be interpreted with great caution” because “its quality is low.”  
  • The absolute number of people who identified themselves as a racial or ethnic minority who enrolled through actually increased between the first and second enrollment periods. Far from losing ground, the number of people of color enrolling in the marketplace increased by 1 million over last year. In fact, comparing this year’s (incomplete) numbers to last year’s, the rate of increase in enrollment for Latinos was comparable with whites (63 percent vs. 68 percent).  
  • New enrollees were more likely to be African American or Latino than white. One of the most encouraging bits of data buried in the HHS report is that new enrollees (who self-identified) were more likely to be African American or Latino. This is great news for these communities, where so many have lacked insurance for so long.

This is not just an issue of seeing a glass half full instead of half empty. It is important to recognize the great strides that have been made in improving access to health insurance for underserved, vulnerable, communities of color. It is a testament to the extraordinary, well-coordinated, and creative efforts made by navigators, assisters, and minority enrollment advocates working together at the national, state, and local levels. Across the country, much time and many resources were invested to educate and enroll the so-called “hard to reach” in their own communities.

Recently, HHS Secretary Burwell pointed out that a number of events focused specifically on minorities—including social media events, visits to African-American churches, and Spanish media advertising—may have all contributed to the great gains seen in minority enrollment. 

Investment in outreach to communities of color must remain a priority

Even as we celebrate the enormous leap toward health equity that expanding coverage to more people of color represents, our communities can’t afford for us to rest on our laurels. In addition to the work that remains to ensure that having an insurance card actually translates into access to high-quality care for people of color, the march toward achieving coverage for all is far from over.

Sure, Latino uninsurance rates have dropped from 1 in 3 to 1 in 4, but that is still more than twice the rate of non-Hispanic whites who lack insurance. And with each subsequent open enrollment period, reaching the remaining uninsured will be increasingly challenging. We must learn from our experience and double our efforts to help more people in communities of color get covered. 

Next week, Cathy Kauffman will highlight the strategies and tactics to help us build on the momentum of the second open enrollment period for the future.

Akshaya Kannan contributed to this article.