title: Racial Differences in Awareness of the Affordable Care Act and Application Assistance Among Low-Income Adults in Three Southern States.
abstract: The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes under 138% of the federal poverty level, leading to substantial reductions in uninsured rates among low-income adults. Despite large gains in coverage, studies suggest that Latinos may be less likely than other racial/ethnic groups to apply and enroll in health insurance, and they remain the group with the highest uninsured rate in the United States. We explore two potential factors related to racial/ethnic differences in ACA enrollment-awareness of the law and receipt of application assistance such as navigator services. Using a survey of nearly 3000 low-income U.S. citizens (aged 19-64) in 3 states in late 2014, we find that Latinos had significantly lower levels of awareness of the ACA relative to other groups, even after adjusting for demographic covariates. Higher education was the strongest positive predictor of ACA awareness. In contrast, Latinos were much more likely to receive assistance from navigators or social workers when applying, relative to other racial/ethnic groups. Taken together, these results highlight the importance of ACA outreach efforts to increase awareness among low-income and less educated populations, two groups that are overrepresented in the Latino population, to close existing disparities in coverage.
authors.affiliation: Harvard University, Cambridge, MA, USA garciamosqueira@g.harvard.edu.
authors.forename: Adrian
authors.initials: A
authors.lastname: Garcia Mosqueira
authors.affiliation: University of Texas at Austin, USA.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Hua
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
mesh_terms: D000328:Adult; D001364:Awareness; D005260:Female; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D006630:Hispanic or Latino; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000331:legislation & jurisprudence; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence*; D017057:Medically Uninsured; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D011203:Poverty; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
keywords: Affordable Care Act; Hispanic health; Medicaid; disparities; navigators