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Thursday, July 16, 2015

New Data Show ACA Enrollment for Communities of Color

Earlier this month, health equity advocates received an unexpected surprise when the Department of Health and Human Services (HHS) released new county-level enrollment data by race and ethnicity from the 37 states that use the federal health insurance marketplace. This level of data had never before been made available to the public.  

Knowledge is power when it comes to enrolling communities of color in health insurance. Thanks to this data, enrollment assisters, health equity advocates, and policymakers are now better equipped to examine particular communities within specific geographies. This helps them assess the impact of gains in health coverage, track enrollment progress, and develop targeted plans to improve for the next open enrollment period.

Until now, race and ethnicity enrollment data were only available by state

Previously, the most specific data available by race and ethnicity was by state. HHS reported data by zip code level (for states using the federal marketplace), but they were not broken down by race and ethnicity. That level of data was not granular enough to be very useful in assessing outreach and enrollment efforts at the community level or for informing future efforts in hard-to-reach minority populations. 

As helpful as this data is, it is important to note, however, that it paints an incomplete picture for two reasons. First, more than one-third of those who enrolled did not indicate their race and/or ethnicity. Moreover, this information does not include big states like California and New York that have large minority populations and have established state-based marketplaces.

Takeaways from HHS’s newly released racial and ethnic data by county

While it would be better to have access to zip code-level data by race and ethnicity to analyze for future enrollment targeting efforts, county-level data provides more information than we’ve had before. 

Following are some highlights from the HHS data that show how individual counties in states using the federal marketplace compared in enrolling people of color: 

  • South Florida counties seemed to excel in enrolling Latinos and African Americans. Miami-Dade enrolled the most Latinos in any federal marketplace state (78,000) while Broward, Miami-Dade, and Palm Beach were 3 of the top 10 counties in federal marketplace states with the most African-American sign-ups, totaling more than 84,000. These totals undercount enrollments, because in these counties fewer than half of the enrollees indicated their race and ethnicity.
  • Predictably, 6 of the top 10 counties among federal marketplace states enrolling Latinos were in Texas: Harris, El Paso, Bexar, Dallas, Hidalgo, and Tarrant, totaling more than 167,000. Interestingly, response rates on race and ethnicity were higher, ranging from 60 percent to 71 percent. 
  • Texas topped enrollment for Asian Americans, too, with 5 of the top 10 counties among federal marketplace states: Harris, Dallas, Fort Bend, Tarrant and Collin, totaling more than 74,000. Number two on that list was Fairfax County, VA, with more than 20,000. 

New data supports the importance of targeted outreach in communities of color 

The evidence shows that the Affordable Care Act’s marketplace coverage options have been a boon for millions of people across our country, particularly for communities of color, who have struggled with pervasive health disparities and higher rates of uninsured people compared to non-Hispanic whites. 

In fact, the reduction in the rate of uninsured Latinos and African Americans over just the last two years significantly outpaced whites—the rate dropped 12.4 percent and 9.2 percent respectively compared to 5.3 percent for whites. This is welcome news for the hundreds of national, state, and local organizations that conducted concerted outreach and enrollment efforts in minority communities across the country. In the states with the federally facilitated marketplace alone, more than 1.9 million enrollees identified as a racial or ethnic minority

These data are particularly useful for local advocates, enrollment assisters, and decision makers to analyze in the context of population levels and rates of uninsured for each ethnicity. This way they can learn which areas were most successful in signing up particular communities and discover where the biggest gaps exist between potential enrollees and those who are covered. 

Future enrollment efforts should target communities of color and be based on solid data

For the next open enrollment period, we must redouble our efforts to enroll people of color. With each subsequent round of open enrollment, the remaining uninsured will be increasingly harder to reach. That’s why it’s crucial to develop tailored, data-driven approaches to target these populations. We must make it a priority to collect and report race and ethnicity enrollment data in a timely fashion and at the most granular level possible. This new data from HHS should be just the beginning in an ongoing effort to narrow the coverage gap for communities of color.