Friday, April 12, 2019

Latinx enrollment continues to *rise* in HealthCare.gov states

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In 2019, an anomaly in ACA marketplace enrollment continues: for the third straight year, Latinx enrollment has risen in HealthCare.gov states, while overall enrollment has fallen.

Caveats abound. Ethnic data is self-reported, and about a quarter of enrollees don't report ethnicity -- which CMS has broken out separately from race since 2017*. But still, the steady rise in the percentage of enrollees who self-report as "Hispanic/Latino" is striking.

Latinx enrollment, 2016-2019, HealthCare.gov states
Self-reported ethnicity 

Enrollee group
2016*
2017
2018
2019
Latinx
   918,626
   956,516
1,033,699
1,037,306
All enrollees
9,719,648
9,201,805
8,743,642
8,411,614
Percent Latinx
9.5%
10.4%
11.8%
13.3%

* Because Kentucky switched to the HealthCare.gov platform in 2017, I have added the state's totals to the 2016 totals for HealthCare.gov states. Because there is no 2016 breakout of Hispanic enrollment in KY in  2016 (as it was an state-based-exchange), I have estimated the total (1656) by adding 14.8% to the 2017 total (1442), as that's the degree to which 2016 enrollment exceeds 2017 in the state.

The rise is all the more mysterious in light what would appear to be growing deterrents or impediments to Latinx enrollment. The Trump administration's proposed changes to the public charge rule, which would penalize noncitizens seeking permanent resident status if they access an expanded range of public services, does not include marketplace enrollment as a public charge category, but it does include Medicaid -- and applications submitted through HealthCare.gov may determine eligibility for Medicaid. CMS's radical cuts to funding for navigator organizations that provide enrollment assistance -- cut 84% since 2016 -- mainly affect low income enrollees and those with limited English proficiency. Probably at least in part as a result of those cuts, the percentage of subsidy-eligible HealthCare.gov enrollees with incomes between 100% and 200% of the Federal Poverty Level has shrunk from 68% in 2016 to 64% in 2019.**

I have no explanation for the apparent rise in Hispanic enrollment on HealthCare.gov -- and I remain mindful that analysts view self-reported ethnicity with some suspicion.  Still, the steady increase in a time of shrinking enrollment is striking.

--
* For more detail on changes in HealthCare.gov's changes in race/ethnicity reporting, see my post on the Latinx spike in 2018.

** Unsubsidized enrollment has shrunk even more sharply, as unsubsidized enrollees are fully exposed to the steep premium hikes of 2017 and 2018.

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