Hispanic/Latino Adults Lack Adequate, Affordable Health Insurance Coverage

Good health insurance is an essential component of affordable, accessible, and equitable health care. That’s why the Commonwealth Fund regularly asks people: how good is your coverage? And, when we say good, we mean: does it ensure you can get and afford the health care you need?

As a primary care physician, I regularly have patients for whom a necessary medication or a diagnostic or therapeutic procedure is out of reach because of cost. Often, I’ll fight the good fight on prior approvals, or do the best I can to find alternatives, but the outcomes are frequently less than ideal. In some cases, situations evolve from easily manageable to a matter of life or death. What’s more, the United States spends more on health care than any other high-income nation, yet we have the least to show for it — lower life expectancy, higher maternal and infant mortality, more chronic disease and disparities than our peers. Undoubtedly uninsurance, underinsurance, and affordability challenges are major root causes of this painful difference.

As is often the case, these challenges impact certain groups disproportionately. In my practice, I care for a diverse group of patients, including a significant number of Hispanic/Latino people.

Since the Affordable Care Act was signed into law, the uninsured rate for Latinos had decreased from 33 percent to 18 percent — which means 9 million more Latinos now have insurance coverage in the U.S. However, in a new survey, we found that more than half (55%) of Hispanic/Latino adults are inadequately insured. This means they don’t have health insurance (or went without it for some amount of time in the past year) or they are underinsured, that is, they have insurance, but their out-of-pocket health care costs are so high relative to their income that they can’t always afford the care they need. This is higher than the non-Hispanic/Latino population, where about 42 percent are inadequately insured. This difference is driven by lack of coverage: more than one-third of Hispanic/Latino adults were uninsured for all or part of the year, compared to 18 percent of non-Hispanic/Latino people.

When it comes to health care costs, more than half (52%) of Hispanic/Latino adults said that, because of costs, they either did not fill a prescription, did not go for follow-up tests or specialty care their doctor recommended, or skipped going to the doctor entirely when they were sick.

Timely access to the right care is critical to health outcomes. Costs are interfering with some Latinos’ ability to get their health problems treated. They say it is harming their health. In fact, two of five Hispanic/Latino adults who had skipped care because they couldn’t afford it said their health was worse as a result. Sicker people and those with lower incomes were the most likely to say that their health was worse off.

Beyond the impact on their health, when insurance is not meeting people’s needs, they are also at risk of falling into medical debt. Thirty percent of Latinos report they are paying off medical or dental debt and it is causing them significant anxiety and worry. In addition, Latinos with medical or dental debt report making financial trade-offs like using up all or part of their savings, cutting back on rent or food, or skipping medications.

Health issues — severe illnesses or injuries, for example —happen regardless of how much money people have or how good their insurance is. When faced with a chronic or sudden illness, people must get care. It’s critical that health insurance meets basic standards: assuring people they can get and afford the care they need without debt or bankruptcy.

There are several ways federal legislation and regulations could ensure that health insurance meets this standard for Hispanic/Latino people — and all Americans — including:

• Permanently extend enhanced marketplace premium tax credits introduced during the COVID pandemic, which are set to expire in 2025. Without these credits, annual premium costs for consumers in marketplace plans will spike by an average $705; an estimated 4 million people could lose coverage.
• Remove medical debt from credit reports and enforce stronger requirements on hospitals to prevent patients from accumulating debt.
• Lower deductibles and out-of-pocket costs in marketplace plans.
• Adjust premiums and cost sharing in employer plans based on workers’ incomes to make coverage more affordable and comprehensive for lower-wage employees.
• Establish a federal fallback option to cover the estimated 1.5 million uninsured people in the 10 states that haven’t expanded their Medicaid programs.
• Allow states to maintain continuous Medicaid eligibility for adults for 12 months — as has been done for children in Medicaid and the Children’s Health Insurance Program. This would help prevent lapses in coverage due to eligibility changes, administrative errors, and other factors that can leave people uninsured and unable to get care.

Our survey results provide strong evidence for health care coverage policy conversations on the horizon. The decisions that will likely be made in the months and years to come will have implications for all Americans, especially those who are already struggling to get the health care they need. The health and well-being of people is at stake and the policy solutions recommended here can go a long way in protecting and strengthening health care coverage gains made in recent years.