Communities of color recorded huge health insurance coverage gains from 2020 to 2022 due in large part to improved affordability and increased outreach efforts to get people enrolled, according to a report this week from the Department of Health and Human Services.
During that time, Hispanic people saw a 53 percent jump in enrollment rates through the Affordable Care Act insurance marketplace, Black people 49 percent and Native Americans 32 percent.
The report, which was produced by researchers in HHS’s Office of the Assistant Secretary for Planning and Evaluation, analyzed trends in marketplace enrollment by race and ethnicity from 2015 to 2022 and showed that health insurance coverage rates improved across the board over the last two years. Growth in Black and Latino communities, where uninsured rates historically have been highest, exceeded other groups, growing by nearly 40 percent for both groups between 2021 and 2022, the report says.
Still, gaps remain in who has health insurance, with 25.7 percent of adult Latinos younger than 65 uninsured in early 2022 compared with 14.8 percent of Black adults and 6.9 percent of White adults, according to the report.
“This underscores the importance of outreach and enrollment assistance,” said Cynthia Cox, vice president at the Kaiser Family Foundation, where she is also director of the program on the ACA. “We know that there were large numbers of people, particularly Hispanic people, who were eligible for free or reduced cost coverage but weren’t taking it up.”
Cost has certainly been a barrier to access. But the reasons often go beyond dollars and cents, Cox said, encapsulating a host of factors that include immigration status, limited internet and computer access, and word-of-mouth information that might not be applicable to an individual’s circumstances.
The ACA is a sprawling piece of health-care legislation that was pushed through a Democratic Congress and has become a source of partisan warring ever since.
President Donald Trump was a vehement foe of the law, which allows a wider pool of low-income earners to qualify for public health insurance coverage, and his administration took aim at the insurance marketplaces created for consumers who cannot get affordable benefits through a job. Most people buying marketplace plans receive federal subsidies.
The Trump administration slashed federal money for advertising, community outreach and “navigators” who serve as enrollment coaches helping people navigate the byzantine system of plans and subsidies.
“The Biden administration, when it came in, not only restored dollars that had been there before, but increased them,” said Linda J. Blumberg, a research professor at Georgetown University and Urban Institute fellow whose recent work analyzes the ACA.
That “big new influx of dollars and assistance” — coupled with increased subsidies for marketplace shoppers through the American Rescue Plan, credits extended through 2025 by the Inflation Reduction Act — means “we’ve got a situation where the dollars available to reduce the price of marketplace coverage … is much better,” Blumberg said.
The coronavirus relief law Congress adopted in March 2021 contained the first expansion of federal subsidies for ACA health plans in the program’s history. The law increases tax credits for monthly insurance payments and allows people with higher incomes to qualify for help.
In August 2021, the Biden administration awarded $80 million in grant funding to about 60 organizations, quadrupling the number of navigators to more than 1,500. Those navigators held more than 1,800 outreach events at libraries, vaccination clinics, food drives, county fairs and job fairs, the administration said.
This year, the administration announced that it was awarding nearly $99 million in grant funding to those same organizations so that they can retain staff and hire more people to help consumers find coverage during the 2023 open enrollment period, which begins Tuesday. People can apply through healthcare.gov, the federal insurance marketplace on which 33 states rely.
A record breaking 14.5 million people signed up to get health coverage through the insurance marketplaces in 2022, meaning a lot of people are going to be shopping to renew their coverage for the first time when open enrollment begins.
“One thing that’s really important for people to know is if they don’t actively shop on Nov. 1, they’ll be automatically re-enrolled in the same plan, but the cost can significantly change from year to year,” Cox said. “It’s not just getting people in the door in the first place, but making sure they are able to keep their coverage going from one year to the next.”
The nation’s rate of uninsured reached “an all-time low” in early 2022, according to the federal report. And this, health policy experts say, is a good thing because it improves access to medical care. Being uninsured means being less likely to have health-care needs met, which translates into being diagnosed with an illness later, receiving lower-quality care and being at greater financial risk should a medical emergency arise.
“We also saw public health emergency provisions during the pandemic that allowed a new enrollment period for people enrolling through the federal marketplace and more flexibility in staying enrolled,” said Katherine Baicker, dean of the University of Chicago’s Harris School of Public Policy. States, for example, weren’t allowed to kick anyone off Medicaid during the pandemic in exchange for increased federal dollars to support the public insurance program.
“We’re going to see some of those provisions expire when the national public health emergency expires,” Baicker said. “That may lead to some churn off of insurance for people.”
Georgetown’s Blumberg agrees “a decent chunk” of the people will lose Medicaid coverage when the public health emergency ends, but she said she thinks they will be eligible for subsidies to make marketplace coverage more affordable.
The expanded tax credits expire in three years, which Margaret A. Murray, founder and CEO of the Association for Community Affiliated Plans, said is troubling.
“We wanted them to be permanent,” said Murray, whose trade organization represents more than 70 nonprofit safety-net health plans that provide coverage to more than 20 million people with low incomes and complex health needs. “You can’t address some of the health equity issues without people getting coverage, but we want to make sure people are not drawn to junk insurance because of the low rates.”
The key, she said, is affordable and comprehensive coverage.
“Junk insurance looks affordable” and the coverage looks great, she said — “until you get sick.”