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

19%

19-25

18%

26-34

23%

35-44

20%45-6421%

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 THoff@kff.org.

For more information