In the U.S., Hispanics are more likely to lack health insurance than any other racial or ethnic group, and enrollment on the individual health insurance exchanges is disproportionately low among Hispanics -- issues that have been well documented. As payers are preparing for the 2016 open enrollment period (OEP), we wanted to share new McKinsey research that sheds light on why Hispanic enrollment rates continue to be low, and to offer suggestions on how to address some of the challenges involved in increasing Hispanic enrollment.
Between February and April 2015, we surveyed 554 adults of Hispanic descent who were eligible for qualified health plans to better understand the factors influencing enrollment rates. All of these respondents reported that they were U.S. citizens or legally entitled to live in this country, and that they were not eligible for Medicare or Medicaid.
The survey, which was conducted in both English and Spanish, is part of a much broader research effort we have been conducting into decision-making among healthcare consumers, particularly those shopping for health insurance on the public exchanges. (Since November 2013, when we conducted our first OEP study, we have surveyed more than 14,000 consumers.) Respondents to this year’s English-language survey were defined as Hispanic if they answered “yes” to the following question: “Are you of Hispanic, Latino, or Spanish origin?” Respondents to the Spanish-language version of the survey were drawn from an online U.S. Hispanic panel.
Of the 554 Hispanic survey respondents, more than half (53 percent) reported being without health insurance in both 2014 and 2015. (Among all respondents to our survey, 36 percent reported being uninsured in both years.) When we compared the Hispanic respondents and non-Hispanic respondents who reported being uninsured in those years, we found several similarities: both groups, for example, consisted predominantly of low-income men between the ages of 30 and 49. However, health status was better among the Hispanics.1
We also uncovered three factors that appear to be contributing to the lower enrollment rates among Hispanics:
Penalty awareness. A slightly higher percentage of Hispanics than non-Hispanics reported that they were unaware of the financial penalty for lacking health insurance (46 percent vs. 41 percent, respectively). Once we informed all respondents in both surveys about that penalty, however, the Hispanics were significantly more likely to say that they would purchase coverage (41 percent vs. 27 percent, respectively).
Subsidy awareness. In our surveys, price sensitivity and affordability concerns were high among all survey respondents, independent of ethnicity. The majority of the respondents, including the Hispanics, thought health insurance premiums should be less than $100 per month. However, awareness of subsidy eligibility was lower among Hispanics than among other respondents. For example, among those who remained uninsured in both 2014 and 2015, only 5 percent of the Hispanic respondents were aware of the size of the subsidy they were eligible for, compared with 12 percent of the non-Hispanic respondents.
Decision not to complete a purchase. Lack of knowledge about penalties and subsidies helps explain why the Hispanic respondents to our surveys were almost 30 percent less likely than other respondents to shop for insurance (see Exhibit). However, the Hispanic respondents were also less likely to complete the purchase once they had started shopping. Part of the explanation for this may be that the Hispanic respondents were almost twice as likely as the non-Hispanic respondents to report having encountered technical problems on the public exchanges. For example, 16 percent of the Hispanic respondents, compared with 9 percent of the non-Hispanic respondents, said they were unable to open a user account.
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Language barriers may have contributed to the technical problems in a few cases, but it is unlikely they were a major factor in most cases. Just 4 percent of the Hispanic respondents in our surveys said they spoke only Spanish at home, and 6 percent said they read newspapers and magazines only in Spanish. In contrast, 83 percent of the Hispanic respondents reported they spoke English at home (part or all of the time), and 77 percent reported they preferred to read in English. Furthermore, those who preferred Spanish were more likely to have enrolled in an insurance plan than were those who preferred English.
Similarly, lack of computer proficiency does not appear to underlie the technical problems many of the Hispanic respondents reported. More than 90 percent of both Hispanic and non-Hispanic respondents said they used computers at home, and use of smartphones and tablets was higher among Hispanics than non-Hispanics.
In addition to technical difficulties, another factor that may have contributed to the low purchase rates among Hispanics was unfamiliarity with health insurance companies. For example, 69 percent of the Hispanic respondents, compared with 83 percent of the other respondents, had heard of their local Blues plans. Awareness of national health insurers was also lower among Hispanics (54 percent vs. 63 percent, respectively).
It appears, therefore, that awareness-building campaigns are likely to be crucial for boosting enrollment rates among Hispanics. The campaigns should focus on increasing awareness of the penalty for not having insurance, the subsidy levels individuals may be eligible for, and the carriers offering health insurance in a given region.
Price transparency should be a central element of the campaigns. The Hispanic respondents in our survey, like their counterparts in the general population, were very price sensitive. Messages focusing on the economic benefits of having coverage may be compelling to Hispanics because our research has shown that once individuals obtained health coverage on the exchanges, Hispanics were more likely than those in the general population to try to access healthcare services.
The Hispanic population will continue to be important to payers, providers, and government agencies as they work to enroll the residually uninsured and to understand how individuals shop for coverage on the exchanges and use healthcare services. Increasing enrollment among Hispanics to equal that in the general population will require targeted efforts from all of these organizations.
This article was originally published on the Health Affairs Blog
- A wide range of researchers 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 Statistics 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.”