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Coverage Opportunities and Obstacles for Hispanics Under the ACA

The Hispanic community—a group whose vote is highly valued by both political parties—stands to benefit significantly from the Affordable Care Act (ACA). At least a third of all Hispanics under the age of 65, or 15.3 million people, lack health insurance. According to RAND estimates, 5.4 million of these individuals will gain coverage by 2016 because of the ACA.

But this depends on whether states act to expand Medicaid and whether Hispanics take advantage of new state and federal insurance marketplaces. So far, 26 states and the District of Columbia have decided to expand eligibility for Medicaid, including two states with large Hispanic populations, New York and California. Yet, Florida and Texas, home to an estimated 14 million Hispanic residents, are among those states that haven’t expanded Medicaid.

Hispanic adults have a number of important new coverage opportunities. Adults with incomes below 138 percent of poverty are eligible to enroll in Medicaid if their state opts to expand their Medicaid program. Adults with incomes above 138 percent of poverty are eligible to buy subsidized coverage in state and federal exchanges if they do not have affordable job-based coverage. Although undocumented immigrants are ineligible for Medicaid or participation in state and federal marketplaces, because of the ACA, legal immigrants are now eligible for Medicaid or subsidized private coverage depending on what state they live in and how long they have been residing in the United States.1

One potential obstacle to realizing the promise of the ACA for Hispanics is their general lack of awareness of the law and its provisions. According to The Commonwealth Fund Marketplace Survey conducted three months into the first open-enrollment period, only 49 percent of Hispanics who were potentially eligible for marketplace coverage were aware of the marketplace in their state, compared with nearly seven of 10 whites and blacks. Only 19 percent of Hispanic, 20 percent of black, and 28 percent of white adults who were potentially eligible for coverage had gone to the marketplace by the end of December 2013 to shop for health insurance.

Although the proportion of people who visited the marketplaces within the first three months of open enrollment was low, the survey found that the vast majority of potentially eligible Hispanics (73%) were likely to go or return to their state marketplace by March 31, 2014, to enroll in a health plan. But targeted outreach and assistance is still needed to increase awareness and enrollment among Hispanics. In recognition of this need, the U.S. Department of Health and Human Services has begun an outreach plan in English and Spanish appealing to mothers in the Hispanic community to encourage them and their family members to enroll.

If Hispanics do take advantage of the ACA’s new insurance options in large numbers, and millions more have access to health care and insurance, then any major changes in the law would have significant consequences for the Hispanic community. The Hispanic vote could then become a major factor in the continuing political battle over the future of the ACA.

In states that are expanding Medicaid, legal immigrants who have been in the United States for five years or more and have incomes below 138 percent of poverty are eligible to enroll in Medicaid. And those immigrants who have the same income or lower but have lived in the U.S. for less than five years can buy subsidized coverage through the marketplace if they do not have affordable coverage through an employer. This is an important new opportunity for people legally present in the United States who previously had to wait five years to gain access to affordable health insurance. In states that do not expand their Medicaid programs, people with incomes between 100 percent and 400 percent of poverty are eligible for subsidized private plans. But in those states, U.S. citizens and legal residents with income under 100 percent of poverty are not eligible for subsidized private coverage while lawfully residing immigrants are. See L. Ku, "New Opportunities to Increase Legal Immigrants’ Health Insurance Coverage," The Commonwealth Fund Blog, Dec. 13, 2013. 

Publication Details

Publication Date: February 13, 2014
Citation: M. M. Doty and D. Blumenthal, "Coverage Opportunities and Obstacles for Hispanics Under the ACA," The Commonwealth Fund Blog, February 2014.


Michelle M. Doty
Vice President, Survey Research and Evaluation, The Commonwealth Fund
David Blumenthal, M.D.
President, The Commonwealth Fund