The number of minority members signing up for Affordable Care Act (ACA) exchange plans increased substantially from 2020 to 2022, with more targeted outreach and higher subsidies key reasons, according to new data.
New reports from the Commonwealth Fund and the Department of Health and Human Services (HHS/PDF) detail how data-driven outreach and emphasizing low-cost plans helped fuel the growth. Open enrollment for the 2023 ACA coverage starts Nov. 1, with HHS looking to build on the 14.5 million record-breaking sign-ups for 2022.
“Access to high-quality, affordable health care is [a] top priority of the Biden-Harris Administration, and the Affordable Care Act is central in our efforts to increase access for America’s families,” said HHS Secretary Xavier Becerra in a statement. “This report shows that our efforts are working, including among Black, Latino, and American Indian and Alaska Native consumers.”
HHS’ report shows that Black consumers had a 49% increase in enrollment in 2022 compared to 2020, increasing from 0.9 million to 1.3 million.
The report also highlighted growth in enrollment among Latinos over the same period, increasing from 1.7 million in 2020 to 2.6 million in 2022. American Indians and Alaskan Natives enrolled also increased to 68,000, a 32% bump.
“Asian American, Native Hawaiian and Pacific Islander enrollees increased from 0.8 million in 2020 to just under 0.9 million in 2022 (a 6% increase); and White enrollees increased from 4.7 to 5.2 million (an 11% increase),” the report said.
HHS looked at data from HealthCare.gov for plan selections made from 2015 through 2022. States that do not have their own exchanges rely on HealthCare.gov for residents to pick plans.
A key factor driving growth was increasing the income-based tax credits that lower the cost of insurance.
The enhanced subsidies passed under the American Rescue Plan Act extended tax credits to enrollees that earned more than 400% above the federal poverty level, previously the cutoff for eligibility for subsidies. It also ensured that some low-income customers could find plans at little to no premium cost.
The Inflation Reduction Act passed earlier this year extends the subsidies through 2025.
There are some limitations to the findings. Chief among them is that HHS relied on self-reported race and ethnicity data according to the 2010 census, which could be outdated for certain areas that saw major changes in the past decade. It also doesn’t factor in exchanges run by 17 states and the District of Columbia.
A separate report issued by the Commonwealth Fund on Wednesday looked at what those state-run exchanges did to promote health insurance for the 2022 coverage year, which could yield clues on the enrollment gains.
“Most [state-based marketplaces] surveyed invested more in outreach during the open enrollment period for 2022 coverage compared to the previous open enrollment period,” the report said. “Nearly all [state-based marketplaces] extended the annual sign-up window into January.”
Of the 17 marketplaces that responded to the survey, more than half increased their budget for one-on-one assistance. Most of them also increased the advertising budget for TV, radio and print ads. Some states also created more targeted efforts to reach uninsured individuals and people who may not know about the new changes in affordability.
For instance, Rhode Island employed a “street team” that distributed materials such as brochures and posters in the areas most likely to have uninsured residents based on state data. New York targeted outreach toward industries that have a high concentration of uninsured individuals.
State-based exchanges also pointed to new efforts to mitigate language barriers by printing fliers and other materials in English and Spanish. Some exchanges, like the District of Columbia's, hired interpreters as part of a biweekly effort to offer one-on-one assistance.
“Culturally appropriate outreach is key to addressing current gaps in knowledge of health insurance eligibility,” the report said.