Friday, June 29, 2018

Hispanic Enrollment on HealthCare.gov up 8% in 2018

To return to a point I addled somewhat last week...

Applicants for health insurance on HealthCare.gov, the federal platform used by 39 states, are prompted to identify their race, and separately, whether they are of Hispanic/Latino "ethnicity." The questions are optional. Race is reported as unknown for 30% of enrollees, and ethnicity as unknown for 25%. The data is self-reported and somewhat volatile. I've been warned it should be taken with a grain of salt -- or considerably more.

That said, in 2018 self-identified Hispanic/Latino enrollment on HealthCare.gov is up 8% compared to 2017, to 1,033,699, and up 12.7% from 2016. Overall enrollment on HealthCare.gov is down 9% since 2016, to 8,743,642. Those self-reporting as Hispanic in 2016 accounted for 9.5% of total enrollment on HealthCare.gov; in 2018, they accounted for 11.8%.

[Update, 8/25/18]: in 2016, ethnicity was not broken out separately from race, and a larger percentage of race was reported as "unknown" than in subsequent years. In 2017, moreover, when ethnicity was broken out separately, there was no "unknown" category -- simply Hispanic/not Hispanic. The comparison with 2016 seems particularly suspect, since race and ethnicity were rolled together. ]

In Florida, the state with the highest ACA marketplace enrollment and the highest takeup among those who are subsidy-eligible, Hispanic enrollment was way up in 2018, from 327,965 to 378,471. That's a 15% increase, and accounts for most of the 39-state increase. Overall Florida enrollment was down 2.5%. In Miami-Dade County, however, which is about two thirds Hispanic, enrollment was up by about 7,000, to 394,677. In Osceola County, 45% Hispanic, enrollment was up about 1,700, to 40,414.

Here is Hispanic and total enrollment, 2018 vs. 2017, in the 10 Florida counties with the highest Hispanic enrollment this year.  In all of them, Hispanic enrollment is up this year -- not surprising given the large overall increase.


Hispanic Marketplace Enrollment in Florida, 2017-2018
Top ten counties by 2018 Hispanic Enrollment

County
2017 Hispanic enrollment
2018 Hispanic enrollment
2017 total enrollment
2018 total enrollment
Miami-Dade
130,495
150,966
387,848
394,677
Broward
 43,878
 51,395
240,984
234,419
Orange
 31,028
 38,504
130,014
133,742
Palm Beach
 22,451
 23,867
141,487
132,761
Hillsborough
 17,965
 19,828
  84,631
 81,954
Osceola
 13,392
 15,994
  38,707
 40,414
Lee
   8,227
 10,485
  54,614
 55,750
Collier
   6,669
   7,790
  29,811
 30,445
Seminole
   6,063
   6,778
  35,640
 34,063

Hispanic enrollment was up more modestly in Texas, from 306,741 to 313,098 -- while overall enrollment was down 8% in the state. Together, Hispanic enrollment in Florida and Texas make up 67% of all Hispanic enrollment on HealthCare.gov.

With Hispanic populations under siege by the Trump administration, one would expect Hispanic marketplace enrollment to be curtailed. The application requires submission of extensive personal and financial data. Just this week Kaiser Health News reported, albeit anecdotally, that "a growing number of American children are dropping out of Medicaid and other government programs because their parents are not citizens." Some 10 million American children have at least one parent who is not a citizen, Kaiser reports. The Trump administration has proposed a rule that would penalize those seeking green cards if they or their family members receive government services.

Self-reported African American enrollment on HealthCare.gov went the other way. It's down 9.4% in 2018, to 598,440, and 15% since 2016.*

A couple of caveats. First, in the race category, the "unknown race" category was down over 500,000 in 2018, just about equal to the overall enrollment drop on HealthCare.gov. But a new category, "other race" was added, and tallied 185,150 enrollees, while "multiracial" was up 34% to 136,017 The recategorizations and volatility raise questions about the reliability of these numbers.

On the other hand, the Hispanic/Latino category is under ethnicity, not race, and is a simpler choice. Through 2017, enrollees were classified simply as Hispanic/Latino or not Hispanic/Latino. This year, "unknown" was broken out separately, but that shouldn't affect the totals of those who identified positively as Latino.

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* That drop of 106,716 from 2016-2018 who identify as African American may be due in part to Louisiana's expansion of Medicaid, which went into effect on July 1, 2016. At that point, about 75,000 Louisiana marketplace enrollees were eligible for Medicaid. Since 2016, marketplace enrollment in the state has plummeted from 214,148 to 109,855. On the other hand, of the slightly more than 50% of Louisiana enrollees who identified their race in 2016, only 27% were African American. But African Americans a) may be less likely to identify by race and b) were likely more concentrated in 100-138% FPL income bracket, which became Medicaid-eligible.



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