51
were youngpeopleunder 35 years old (dhss, 2014b). Enrollment surgedduring the special enrollment period,
withover 900000newenrollments,manyofwhomwereyoungpeople. Inaddition to themore than8million
people who signed up for insurance under a Health InsuranceMarketplace, numerous others have purchased
off-marketplace plans. Estimates of the total decrease in the uninsured population from 18 to 24 years old
range from2.7% to4.7%.
Theacaalsohadan important impact onenrollment in the
Medicaid
program. Growth in
Medicaid
enroll-
ment has been strong, with a total of over 65million persons covered and an estimated 10% growth between
the summer of 2013andApril 2014.Whileonlyabout half of states decided to take the federal funds available
toexpand their
Medicaid
programs, thepublicityandoutreachunder theacawasexpected tohavesome impact
on
Medicaid
inall states. Aswouldbeexpected, in the states that expanded
Medicaid
to covermore low-income
adults, thegrowth inenrollment outpaced thenational averageandwas higher than in states that hadnot (15%
vs 3.3%) (hkff, 2014). InCalifornia, enrollment increased by amonthly average of 19% from the pre-open en-
rollment averageuntil June2014 (hkff, 2014b).
Hispanic enrollment rates are also likely to be affected by the many undocumented workers and their
families in their ranks. By excluding undocumented residents, the aca has little impact on rates of health insu-
rance coverage for this vulnerablegroup that is themost uninsuredof anygroup. This provision implicitlyaffects
Mexicans, above all other groups. It is estimated thatMexicansmake up59%of the undocumented population
(Hoefer et al., 2013). Those who are undocumented are restricted from the subsidized programs of the aca,
however, they can take advantage of health system improvements in other ways. For example, there is increa-
sed funding available for community health centers, where services are often offered regardless of immigration
status, andwhere1 in3patients isHispanic. Inaddition, agreater focusonpreventive careand theexpansionof
freeor low-costpreventive treatmentswill improvemanagementofdiseases thatareprevalentamongHispanics.
Improving health access for Hispanic andMexican immigrants in particular requires better understanding
and addressing the barriers they face in enrolling for coverage. Special outreach and education efforts may be
necessary to target mixed-status families. Removing the aca’s restrictions on the undocumented would help
increaseHispanic enrollment in health insurance coverage. Given thatmost undocumented residents tend to be
youngand ingoodhealth, expanding theaca to cover all residents, regardless of immigration status, would sup-
portboth theHealth InsuranceMarketplacesand thehealthpreservationof these individuals.Anycomprehensive
immigration reform should include a mechanism for access to affordable health services, either in the United
Statesor in the countryof origin (segob, conapo, uc, 2013).
chapter i i •
access to health insurance and service use
