Study: Latinos, low-income adults most likely to remain uninsured post-ACA

While the Affordable Care Act (ACA) and its expansion of Medicaid lowered the number of Americans without health coverage, millions are still uninsured, and a new study from the Commonwealth Fund aimed to identify who they are and why they aren’t covered.

The study said the uninsured rate has dropped from 20 percent in 2013, before the health insurance exchanges openings, to 13 percent, or about 24 million adults. Within that uninsured population between the ages of 19 and 64, 41 percent were white (down from 50 percent in 2013), 40 percent were Latinos (up from 29 percent), 12 percent were black (down from 13 percent) and 6 percent were Asian or other races (unchanged from 2013).

Despite Latinos’ increased share in the remaining uninsured population, their overall uninsured rate dropped, from 36 percent pre-ACA to 29 percent in 2016.   

“Still, Latinos are significantly more likely than any other racial and ethnic group to be uninsured,” wrote Michelle Doty, one of the authors of the report and the Commonwealth Fund’s vice president of survey research and evaluation. “One reason is that Latinos make up a disproportionate share (about 56 percent) of unauthorized immigrants, who are currently ineligible for Medicaid or participation in state and federal marketplaces.”

The authors said immigration status can’t fully account for the uninsured rates, citing an analysis of the American Community Survey in saying more than half of Latinos without health insurance in 2014 were citizens and therefore eligible for the full benefits of the ACA.

Latinos make up a significant portion of other groups that are more likely not having coverage. Among uninsured adults earning less than $16,243 for an individual or $33,465 for a family of four, 47 percent are Latino. Latinos also make up 47 percent of uninsured young adults and 46 percent of the uninsured who work for small businesses.

Whether or not Latinos live in a state that expanded Medicaid also appeared to be a factor.

“Among adults living in the 30 states and D.C. that had expanded Medicaid at the time of the survey, uninsured rates for blacks, whites and U.S.-born Latinos are similar, ranging from 7 percent to 9 percent,” the study said. “In contrast, in states that had not expanded their Medicaid program, 16 percent of blacks and 24 percent of U.S.-born Latinos are uninsured, compared with 10 percent of whites.”

Overall, more than half (51 percent) of those who remain uninsured live in one of the 20 states that had not expanded Medicaid before 2016.

For those who still aren’t covered, concerns about affordability and overall awareness of the ACA remain the biggest obstacles. Some 64 percent of uninsured adult who responded to the survey knew about the marketplaces, but didn’t look for coverage because they assumed it would be too expensive. Of those who did look at the exchanges but didn’t buy coverage, 85 percent attributed their decision to not being able to find an affordable plan. 86 percent of that group had incomes which would qualify them for subsidies or Medicaid, though immigration status may have rendered them ineligible.

About 62 percent of uninsured respondents were aware of the existence of the marketplaces, compared to 79 percent of all adults.