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Box I. The Impact of theacaonHispanics in2014
The
Patient Protection andAffordableCare
Act (aca) was signed into law in 2010 as a reform of the health
andmedical insurance system for all Americans and lawful permanent residents. The law aims to introduce
new protections for consumers, lower costs and improve quality of care, and improve access to affordable
care, with implementation from 2010 to 2015. Hispanics are a key target population for these efforts. In
2011, prior to the initial implementationof theaca, they representedaround17%of thepopulationbut32%
of the nation’s uninsured.
Hispanic communities andmanyMexican immigrants have benefitted from the aca. They are profiting
from expanded eligibility for
Medicaid
(for low-income persons) in half of the states, from subsidized insurance
offered throughnewhealthbenefit exchanges if their incomes are lowbut above thepoverty level, via increased
fundingof community clinics that provideprimary carebasedonability topay, or through increased coverageof
preventiveservices inall health insurancepolicies.However, certainsegmentsof theHispanicpopulation, particu-
larlyundocumented immigrantsandmixed-status families, arestill underinsured,withconsequent risks tohealth.
In2014 some of themost significant provisions of the acawent into effect, particularly those aimed at
reducing theuninsured rate. Themostwidelydiscussed is thenew federally subsidizedprivate insuranceoffered
through government-organized “marketplaces” in each state. Open enrollment in theHealth InsuranceMarket-
places began inOctober, 2013withanadditional special enrollment period that lasteduntil April, 2014.
Hispanics in theUnitedStates are seenamainbeneficiarygroupof theaca; theyweredisproportionately
underinsured, representing1 in4eligibleHealth InsuranceMarketplaceconsumers. Becauseof theaca, about10
millionHispanics have new access to health insurance coverage, and80% of uninsuredHispanics are eligible for
assistance through
Medicaid
or aMarketplace (dhhs, 2014).
Despite thegreat benefit providedby theaca, Hispanicsareamong themost likely to remainuninsured,
possiblydue to cultural and linguistic issues, thepresenceofmixed-status families and that fact that adispro-
portionatepart of theundocumentedpopulation isHispanic and thus not coveredby the law.Mixed-status fa-
milies are thosewithmemberswhohavedifferent citizenshipor immigration statuses.While the legal resident
members of the familymay be eligible for public programs and subsidies, there is a “chilling effect” that deters
enrollment that comes from concerns over being detected by the immigration authorities and (often unjusti-
fied) fears that if theirUS-born childrenenroll ingovernment subsidizedhealth insurance that theparentsmay
bebarred in the future fromobtainingagreen card. Although the informationgathered for enrollment in these
programs is not used for immigration enforcement, misunderstandings or fear about thismay be a barrier to
getting coverage formixed-status families.
Surveys of first enrollment efforts show growth in health insurance coverage of the population and a
decline in the number of young peoplewho are uninsured. From the beginning of open enrollment until the end
of the special enrollmentperiod, 8019763people signedup for healthcoverageunder aHealth InsuranceMar-
ketplace, either state-basedor federallymanaged. Of those, 403632 reportedHispanicethnicity, representing
10.7% of enrollments among those who reported an ethnicity. Of all enrollees, 34% (or around 2,700,000)
migration & health •
mexican immigrants in the us: a 10 year perspective
