The Affordable Care Act (ACA) and What It Means for Latinos
An Overview by the Kaiser Family Foundation for Univision Affiliates
Webinar Briefing June 19, 2013
Larry Levitt
Senior Vice President for Special InitiativesandCo-Executive Director of the Program for the Study of Health Reform and Private Insurance
Today’s Speakers
Samantha Artiga
Director of Disparities Policy ProjectandAssociate Director of the Kaiser Commission on Medicaid and the Uninsured
Tina Hoff
Senior Vice President andDirector of Health Communication and Media Partnerships
Claudia Deane
Associate Director for Public Opinion & Survey Research
1. The Basics of the Affordable Care Act (ACA)
New and Increased Coverage Options available starting in 2014• For states that chose to, Medicaid will be expanded to cover adults with incomes up to 138% of the
federal poverty level (about $16K per year for a single person, $21K for a couple). The Supreme Court ruling on the ACA changed the expansion from a nationwide action to a state option.
• New health insurance “marketplaces” (also called “exchanges”) will provide options for individuals buying insurance on their own and for small businesses. Enrollment begins Oct. 1 2013 thru March 31, 2014. Tax credits will be available to persons with incomes from 100% to 400% of the federal poverty level (about $46K for an individual and $94K for a family of four) to help offset costs.
• Employers with 50+ workers must offer affordable insurance to their workers or pay a penalty.• As of end of 2010, parents are now able to keep children on their insurance up to age 26.
Insurance Market Reforms Taking Effect in 2014• Insurers will be required to provide coverage to everyone regardless of pre-existing health
conditions. Variations in premiums limited for age and prohibited for gender and health status.• All insurance plans sold to individuals and small businesses will have to provide a minimum
level of coverage, including preventive care, maternity, mental health, and prescription drugs.• To help these reforms work and keep premiums down, most Americans will be required to have
insurance or pay a penalty (the “individual mandate”).
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Feb
Mar
Apr
Jun
2010 2011 2012 2013
0%
20%
40%
60%
80%
46
41
48 50
43
49
4242 42
41 4342 4142 42 42
39 41
3437
4137
4241
4237
4138 38
45
38
43
36 37 35 35%40
44
41
35
45
40
44
40 41
50 48 4641
44 4643 44 43
51
44 43 44 43
40
43 4441
44 43
40
43
39
42 40 4043%
14 1410
14 12 1115
18 18
9 813
1814 12
15 17 16 1519 17 19
1519
1519 18 17 19
1419 19 23 23 24 23%
Favorable Unfavorable Don't know/Refused
SOURCE: Kaiser Family Foundation Health Tracking Polls
2. At Three Years Public Opinion on ACA Remains Divided
As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?
ACA signed into law on March 23, 2010
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Feb
Mar
Apr
Jun
2010 2011 2012 2013
0%
20%
40%
60%
80% 78
7269
7368
75
69 68 6973
6671
64
72
65 6460
65
52
62 64 62 64 6670
62
71 6964
72
64
72
57 58 57 58%
36 37
49 48
41 42
3437 37
34
43
3741
35 3338
3336
32 34 3330
40 40 3934
3835 34
41
3237
32 3136
32%
138
23 2116
21
1115
12 12 11 912
1720
16
24
1411 12
19
1216
127 8 7
128
16
10 12 12
1815
12%
Democrats Independents Republicans
SOURCE: Kaiser Family Foundation Health Tracking Polls
3. Ongoing Partisan Divide on ACA
Percent who say they have a favorable opinion of the health reform law:
ACA signed into law on March 23, 2010
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May Jun Jul
Aug
Sep
Oct
Nov
Feb
Mar
Apr
June
2010 2011 2012 2013
0%
20%
40%
60%
80%
68
54
66
73
6260
66
59
52 51
59 59
71
6359
5646
63
4449
69
5257
6663
43
38
59
46
55
46
5248 48
40
49%
18
29
2114
28 29
23
17
24
39
33
23
16
2528
23
31
16
35
2315
33
25
17
24
32
2727 29 27
30
22
26
19 19 18%
1418
14 13 11 11 12
24 25
9 9
18
12 12 13
2124 21
20
28
15 1518 16
13
25
35
14
24
18
25
26
25
32
42
34%
Favorable Unfavorable Don't know/Refused
SOURCE: Kaiser Family Foundation Health Tracking Polls
4. More Hispanics Lean Favorably Toward ACA
As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?
ACA signed into law on March 23, 2010
AMONG HISPANICS
Spanish dominant
English dominant
51%
41%
9%
25%
40%
34%
Favorable Unfavorable Don't know/Refused
SOURCE: Kaiser Family Foundation Health Tracking Polls (conducted April 15-20, 2013 and June 4-9, 2013)
5. Spanish-Dominant Hispanics Most Favorable Views Toward ACAAs you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?
Hispanics by Language Preference
Yes53%
Dk/Ref2%
No45%
Whites
SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted April 15-20, 2013)
6. Two in Three Hispanics Feel Uninformed About Law
Yes51%
Dk/Ref1%
No48%
Blacks
Yes34%
Dk/Ref1%
No65%
Hispanics
Do you feel you have enough information about the health reform law to understand how it will impact you and your family, or not?
7. Hispanics are at Highest Risk of Being Without Insurance Compared to Other Races/Ethnicities
1 or More Full-Time
White
High School
Non-Workers
Less Than High School
Non- Workers
22%
1 or More Full-Time
62%
35-5434%
26-3421%
HispanicAmerican Indian
BlackAsianWhite
39%40%47%67%71%
30%32%32%
15%15%
32%27%21%18%13%Uninsured Medicaid /Other Public Employer/Other Private
SOURCE: KCMU/ Urban Institute analysis of 2012 ASEC Supplement to the CPS.
161.6 M 14.7 M 1.9 M33.5 M 49.2 M
Insurance Coverage of Nonelderly in the U.S. by Race/Ethnicity, 2011:
U.S.-Born Citizen43%
Naturalized Citizen
11%
Non-Citizen >5 Years
42%
Non-Citizen <5 Years
4%
Part-
Time
Worker 14%
Non-
Worker18%
8. Most Uninsured Hispanics are in Working Families; More than Half are under the age of 26
0-18
38%
19-2513% 26-34
15%
35-54
27%55-647%
Family Work Status Age
At Least 1 Full-Time Worker
68%
Characteristics of 15.5 Million Nonelderly Uninsured Hispanics in the U.S.
Citizenship Status
SOURCE: KCMU/ Urban Institute analysis of 2012 ASEC Supplement to the CPS.
9. ACA Expands Access to Health Insurance Coverage
Eligibility for Multiple Programs Determined in
Real Time
Information Provided
on Available Plans for Comparison
Enrollment Into Selected Plan
Plan A
Plan B
Plan C
John Doe123 Main Street
12345
Medicaid/CHIP
Unsubsidized Marketplace Coverage
Premium Tax Credits
10. Most Uninsured Hispanics are at Income Levels that Qualify for Medicaid Expansion or Subsidies
Uninsured
Medicaid*
Health Insurance Status among the 49.2 Million Non-Elderly Hispanics in the U.S.
15.5 Million Non Elderly Uninsured Hispanics By Income Level
≤138% FPL Medicaid (57%)
139-399% FPL Subsidies (38%)
≥400% FPL (5%)
32%
Employer-Sponsored Coverage/Other Private
UninsuredMedicaid/
Other Public
39%
30%
SOURCE: KCMU/ Urban Institute analysis of 2012 ASEC Supplement to the CPS.
Adults up to
Elderly & Persons with Disabilities
Parents
PregnantWomen
Children
Extends to Adults ≤138% FPL*
Medicaid Eligibility Today Medicaid Eligibility in 2014
11. The ACA Medicaid Expansion Extends Eligibility to Low-Income Adults
138% FPL
WY
WI
WV
WA
VA
VT
UT
TX
TN
SD
SC
RI PA
OR
OK
OH
ND
NC
NY
NM
NJ
NH
NV NE
MT
MO
MS
MN
MIMA
MD
ME
LA
KY KS
IA IN IL
ID
HI
GA
FL
DC
DE
CT
CO CA
ARAZ
AK
AL
Debate Ongoing (7 States)Moving Forward at this Time (24 States including DC)
Not Moving Forward at this Time (20 States)
12. Current Status of the Medicaid Expansion Decisionas of June 14, 2013
SOURCE: Based on KCMU analysis of recent news reports, executive activity and legislative activity in states.
13. Hispanics have High Stakes in State Decisions to Expand Medicaid
44%in States Not
Moving Forward at this Time
(20 States)
Distribution of Uninsured Hispanics who are Income Eligible for Medicaid Expansion (8.9 Million)
Other18%
CA26%
NY4%
AZ4%
TX22%
FL9%
GA 3%
Other10%
Debate Ongoing 4%
52% in States Moving
Forward at this Time
(24 States)
SOURCE: Based on KCMU analysis of 2011 American Community Survey.
14. State Health Insurance Marketplace Decisionsas of May 28, 2013
Partnership Marketplace (7 states)State-based Marketplace (16 states and DC)
Federally-facilitated Marketplace (27 states)
WA
OR
WY
UT
TX
SD
OK
ND
NM
NV NE
MT
LA
KS
ID
HI
CO CA
ARAZ
AK
WI
WV VA
TN SC
OH
NCMO
MS
MN
MI
KY
IA IN IL
GA
FL
AL
VT
PA
NY
NJ
NHMA
ME
CT
DE
RI
MD
DC
• Outreach and education campaigns will ramp up in Summer 2013– October 2013: Open enrollment for Marketplace coverage begins– January 2014: Start date for Marketplace and Medicaid expansion coverage– March 2014: Initial open enrollment period for Marketplace coverage ends– Enrollment in Medicaid is not limited to the open enrollment period
• Outreach initiatives– HHS/CMS– States– Enroll America and other private initiatives
• Resources to direct individuals for more information– Healthcare.gov– National and state call center help lines– Network of certified “assisters” or “navigators”– Community health centers– National Alliance for Hispanic Health Buena Salud Club and Su Familia Provider Database-- Subsidy Calculator from Kaiser Family Foundation: http://www.kff.org/interactive/subsidy-calculator
15. Outreach and Enrollment Resources for Hispanics
16. Key Issues to Watch
• How will implementation vary by state?• How many people are signing up for new coverage options? Are the young and
healthy getting insured as well as those who are sick? How does gaining insurance impact individuals’ health care and personal lives?
• How many states expand Medicaid? What will expansion decisions mean for coverage and costs? For efforts to reduce health care disparities? What happens to poor adults who do not gain a new coverage option in states that do not expand Medicaid?
• Are the new marketplace insurance options affordable, taking into account tax credits for low and middle income people? How competitive are the new insurance marketplaces? Are new, local plans entering the market?
• What happens to the safety-net for those left out of expanded insurance?• There will be technical glitches in the new marketplaces. Are they widespread or
anecdotal? Are they addressed quickly? Are people getting the help they need to understand new coverage options and enroll?
• How well do education, outreach, and enrollment efforts meet the language and cultural needs of the community?
• How are employers reacting? Are they expanding health benefits or paying the penalty?
Please use the chat function within your webinar screen to submit questions to our speakers.
Q&A
• Please visit our website: www.kff.org/health-reform-resources
• Contact: Tina Hoff at [email protected].
For more information