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Insights into Hispanics’ enrollment on the health insurance exchanges New McKinsey research sheds light on why Hispanic enrollment rates continue to be low—and how these numbers could be improved.
In the U.S., Hispanics are more likely to lack
lowing question: “Are you of Hispanic, Latino,
health insurance than any other racial or
or Spanish origin?” Respondents to the
ethnic group, and enrollment on the individual
Spanish-language version of the survey were
health insurance exchanges is disproportion-
drawn from an online U.S. Hispanic panel.
Erica Coe, Jenny Cordina, Elizabeth P. Jones, and Suzanne Rivera
ately low among Hispanics—issues that have been well documented. As payers are pre-
Of the 554 Hispanic survey respondents, more
paring for the 2016 open enrollment period
than half (53%) reported being without health
(OEP), we wanted to share new McKinsey
insurance in both 2014 and 2015. (Among
research that sheds light on why Hispanic
all respondents to our survey, 36% reported
enrollment rates continue to be low, and to
being uninsured in both years.) When we
offer suggestions on how to address some
compared the Hispanic respondents and non-
of the challenges involved in increasing
Hispanic respondents who reported being
Hispanic enrollment.
uninsured in those years, we found several similarities: both groups, for example, con-
Between February and April 2015, we survey
sisted predominantly of low-income men
ed 554 adults of Hispanic descent who were
between the ages of 30 and 49. However,
eligible for qualified health plans to better
health status was better among the Hispanics.1
understand the factors influencing enrollment rates. All of these respondents reported that
We also uncovered three factors that appear
they were U.S. citizens or legally entitled to
to be contributing to the lower enrollment
live in this country, and that they were not
rates among Hispanics: 1
eligible for Medicare or Medicaid. Penalty awareness. A slightly higher percentThe survey, which was conducted in both
age of Hispanics than non-Hispanics report-
English and Spanish, is part of a much
ed that they were unaware of the financial
broader research effort we have been con-
penalty for lacking health insurance (46%
ducting into decision-making among health-
vs. 41%, respectively). Once we informed all
care consumers, particularly those shopping
respondents in both surveys about that pen-
for health insurance on the public exchanges.
alty, however, the Hispanics were significantly
(Since November 2013, when we conducted
more likely to say that they would purchase
our first OEP study, we have surveyed more
coverage (41% vs. 27%, respectively).
than 14,000 consumers.) Respondents to this year’s English-language survey were defined
Subsidy awareness. In our surveys, price sen-
as Hispanic if they answered “yes” to the fol-
sitivity and affordability concerns were high
wide range of researchers A have found that health status is generally better among Hispanic than non-Hispanic Americans, for reasons not entirely understood. Average age is much lower among Hispanics than among other Americans, but other factors also appear to be involved. For more information about differences in health status between Hispanics and non-Hispanics, see the CDC report, Summary Health Sta tistics for the U.S. Population: National Health Interview Survey, 2012, and Population Research Bureau’s post, “Exploring the Paradox of U.S. Hispanics’ Longer Life Expectancy.”
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McKinsey & Company Healthcare Systems and Services Practice
Web 2015 <article slug> Exhibit 1 of 1
Shopping behavior on the public exchanges
Shopping behavior among consumers eligible EXHIBIT Shopping behavior among consumers eligible for qualified health plans Shopped1
69%
Enrolled in a plan1
Enrolled in ACA plan1
39%
20%
78%
Did not shop1
31%
58%
Did not enroll1
22%
30%
33%
Enrolled in non-ACA individual plan1
20%
Hispanics were 9
43% of Hispanics
percentage points
who shopped did
less likely to shop
not enroll, compared
10%
18%
Enrolled in non-individual plan
with 26% of the general population
% of Hispanic population
1
9%
7%
% of general population
Statistically significant difference between Hispanics (n = 554) and general population (n = 3,006) at 95% confidence level.
Source: McKinseyâ&#x20AC;&#x2122;s Center for U.S. Health System Reform Hispanic and National 2015 OEP surveys
among all survey respondents, independent
Decision not to complete a purchase. Lack
of ethnicity. The majority of the respondents,
of knowledge about penalties and subsidies
including the Hispanics, thought health
helps explain why the Hispanic respondents
insurance premiums should be less than
to our surveys were almost 30% less likely
$100 per month. However, awareness of
than other respondents to shop for insurance
subsidy eligibility was lower among Hispanics
(see Exhibit). However, the Hispanic respon-
than among other respondents. For example,
dents were also less likely to complete the
among those who remained uninsured in
purchase once they had started shopping.
both 2014 and 2015, only 5% of the Hispanic
Part of the explanation for this may be that
respondents were aware of the size of the
the Hispanic respondents were almost twice
subsidy they were eligible for, compared
as likely as the non-Hispanic respondents to
with 12% of the non-Hispanic respondents.
report having encountered technical prob-
[ADD 1 LINE HERE TO ALIGN?]
lems on the public exchanges. For example,
Insights into Hispanics’ enrollment on the health insurance exchanges
16% of the Hispanic respondents, compared
The campaigns should focus on increasing
with 9% of the non-Hispanic respondents,
awareness of the penalty for not having in
said they were unable to open a user account.
surance, the subsidy levels individuals may be eligible for, and the carriers offering health
Language barriers may have contributed to
insurance in a given region.
the technical problems in a few cases, but it is unlikely they were a major factor in most cases.
Price transparency should be a central
Just 4% of the Hispanic respondents in our
element of the campaigns. The Hispanic
surveys said they spoke only Spanish at home,
respondents in our survey, like their counter-
and 6% said they read newspapers and maga
parts in the general population, were very
zines only in Spanish. In contrast, 83% of the
price sensitive. Messages focusing on the
Hispanic respondents reported they spoke
economic benefits of having coverage may
English at home (part or all of the time), and
be compelling to Hispanics because our
77% reported they preferred to read in English.
research has shown that once individuals
Furthermore, those who preferred Spanish were
obtained health coverage on the exchanges,
more likely to have enrolled in an insurance
Hispanics were more likely than those in
plan than were those who preferred English.
the general population to try to access healthcare services.
Similarly, lack of computer proficiency does not appear to underlie the technical problems
The Hispanic population will continue to
many of the Hispanic respondents reported.
be important to payers, providers, and
More than 90% of both Hispanic and non-
government agencies as they work to enroll
Hispanic respondents said they used comput-
the residually uninsured and to understand
ers at home, and use of smartphones and
how individuals shop for coverage on the
tablets was higher among Hispanics than
exchanges and use healthcare services.
non-Hispanics.
Increasing enrollment among Hispanics to equal that in the general population will
In addition to technical difficulties, another
require targeted efforts from all of these
factor that may have contributed to the low
organizations.
purchase rates among Hispanics was unfamiliarity with health insurance companies. For example, 69% of the Hispanic respondents, compared with 83% of the other respondents, had heard of their local Blues plans. Awareness of national health insurers was also lower among Hispanics (54% vs. 63%, respectively).
Moving forward It appears, therefore, that awarenessbuilding campaigns are likely to be crucial for boosting enrollment rates among Hispanics.
Erica Coe (erica_coe@mckinsey.com) is a senior expert in the McKinsey Center for US Healthcare Reform. Jenny Cordina (jenny_ cordina@mckinsey.com) is an expert principal in the firm’s Detroit office. Elizabeth P. Jones (elizabeth_jones@mckinsey.com) is a consumer knowledge expert in that office. Suzanne Rivera (suzanne_rivera@mckinsey.com) is a consultant in the firm’s Denver office. This article was originally published on the Health Affairs Blog (http://healthaffairs.org/blog/ 2015/08/26/insights-into-hispanics-enrollmenton-the-health-insurance-exchanges/).
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