Health Insurance Marketplace: Summary Enrollment Report For the Initial Annual Open Enrollment Period. Appendix C: Characteristics of Persons WHO Have Selected Marketplace Plans Through the Ffm by Race / Ethnicity

05/01/2014

The following section describes the race and ethnicity of those who have selected a plan in the Federally-facilitated Marketplace (FFM) through during the period October 1, 2013–March 31, 2014 (including Special Enrollment Period (SEP) activity through April 19, 2014). States with State-based Marketplaces are not required to report race and ethnicity to CMS.

Race and Ethnicity Data Obtained from the FFM Application

The application for coverage through the FFM contains questions on race and on ethnicity, both marked as optional (See Figure C1 below).29 For ethnicity, applicants can choose one or more options describing Latino and Hispanic origin or “Other” ethnicity. The question on race contains several detailed race categories, plus an option for “Other” race.30

Figure C1.

Questions on Race and Ethnicity on the Application for Coverage through the FFM.

Fiure C1: Questions on Race and Ethnicity on the Application for Coverage through the FFM.

For our analysis of the characteristics of individuals who selected a Marketplace plan through the FFM by race/ethnicity, we have combined the detailed categories on the Marketplace application into eight basic categories for race/ethnicity: American Indian/Alaska Native, African-American, Asian, Latino, Native Hawaiian/Pacific Islander, White, Multiracial, and Unknown/Other.31 For example, the detailed categories Japanese and Chinese are grouped with other detailed races into the broader “Asian” category.

Our first step in creating mutually exclusive classifications for race/ethnicity was classifying as Latino those who reported any Latino/Hispanic ethnicity. Next, non-Latinos were classified as multiracial if they reported two or more major race categories. The remaining non-Latinos were classified as American Indian/Alaska Native alone, African-American alone, Asian alone, Native Hawaiian/Pacific Islander alone, and White alone. Using these combined racial/ethnic categories, 31.1 percent of persons who selected Marketplace plans through the FFM were classified in the category Unknown/Other.

For the race question alone, 34.8 percent of the total 5.45 million who selected a Marketplace plan through the FFM either did not respond or selected “Other,” which is not distinguishable from nonresponse (“unknown”) in the data available for analysis. For the ethnicity question, 92.6 percent either did not respond or selected “Other.” Overall, we have information on neither race nor ethnicity for 31.1 percent of those who selected a Marketplace plan through the FFM.

Rates of Unknown Race/Ethnicity in Other Data

At 31.1 percent, the share of unknown race/ethnicity in FFM Marketplace plan selection data is higher than in survey data. Federal surveys have lower non-response rates to questions on race and ethnicity: the main Census surveys have missing data on 3 to 5 percent of respondents, and the National Health Interview Survey has missing information for about 5 percent of respondents. The federal statistical agencies generally impute race and ethnicity to fill in these gaps in survey data.32

However, the proportion of missing race/ethnicity data among those who have selected a Marketplace plan through the FFM is lower than that reported in administrative data sources in the healthcare industry. One study found that one-third to one-half of commercial plans report challenges in collecting data from enrollees due to concerns for privacy, as well as inadequate IT resources, and a lack of race/ethnicity fields on forms.33 As of 2008, commercial plans that collected race and ethnicity data only had information for about 40 percent of their members.34 The health insurance company Aetna, which began collecting data on race and ethnicity for all its members in 2002 via enrollment forms, currently has information on race/ethnicity for about 35 percent of its membership.35 A study of administrative data from the Department of Veterans Affairs found that race/ethnicity information was missing from files for 36 percent of patients.36 Research shows that administrative data may not accurately reflect applicants’ race and ethnicity, and minority groups may be particularly under-reported. Studies examining sources of administrative data have found that race and ethnicity data does not match self-reported data, or other analyses that reclassify race/ethnicity data. For example, numerous studies demonstrate that the Medicare Enrollment Database under-identifies Hispanics, Asians, Pacific Islanders, and American Indians, compared to White and African-American beneficiaries.37,38,39,40 Researchers who compared self-reported race against information in the Medicare Enrollment Database found that race information in the database was correct for only 29.5 percent of people who self-reported as Hispanic, 35.7 percent of those who self-reported as of American Indians/Alaska Natives, and 54.7 percent of those who self-reported as of Asians/Pacific Islanders.41,42

Moreover, the racial/ethnic makeup of 31 percent of persons with unknown race and ethnicity who selected a Marketplace plan through the FFM may differ substantially from that among those who reported race and ethnicity. For example, if racial and ethnic minorities are more likely to skip the optional questions, they would be disproportionately under-reported in the overall totals. Moreover, the percentage unknown varies greatly by state. In four states (Arkansas, Montana, North Dakota, and South Dakota), the percentage with unknown race/ethnicity is less than 20 percent, while the rate of unknown race/ethnicity is over 35 percent in Michigan, Louisiana, and Florida. See Appendix Table C2 below for state level numbers of individuals who did and did not report their race and ethnicity.

Research shows that minorities may be concerned, skeptical, or confused about why their race/ethnicity data is being collected, and fear that this data may be used to target them for charging higher premiums or denying care.43 Some people believe that they would receive disparate services based on their answers to questions about race and ethnicity.44 Consumers want assurances that their race and ethnicity data will be confidential, and used for purposes of improving quality.45

Race/Ethnicity among Persons Who Selected a Marketplace Plan through the FFM

Unknown/Other included: According to self-reported information on race/ethnicity on Marketplace applications, including those who chose not to report information, Whites (43.3 percent) account for the largest proportion of Marketplace plan selections through the FFM. The next largest race/ethnicity categories are African-Americans (11.5 percent), Latinos (7.4 percent), and Asians (5.5 percent). Nearly one-third (31.1 percent) of the total 5.4 million individuals who have selected a Marketplace plan through the FFM selected either no choice or “Other” for both ethnicity and race on their application for Marketplace coverage. (See Table C1, column A for details.)

Unknown/Other excluded: Among those individuals who selected a Marketplace plan through the FFM and reported their race/ethnicity, Whites represent the largest proportion (62.9 percent), followed by African-Americans (16.7 percent), Latinos (10.7 percent), and Asians (7.9 percent) (see Column B of Table C1 and Figure C3 below for details).

Appendix Table C1.

Distribution of FFM Marketplace Plan Selections by Race and Ethnicity46

10-1-2013 to 3-31-2014, Including Additional SEP Activity through 4-19-14

Race/Ethnicity Total Who Selected a Marketplace Plan 
Including Unknown/Other (A)
Total Who Selected a Marketplace Plan 
Where Race/Ethnicity Is Reported, Excluding Unknown/Other (B)
Number % Number %
FFM TOTAL 5,446,178 100.0% 3,755,008 %100
Unknown/Other 1,691,170 31.1% N/A N/A
American Indian/Alaska Native 13,061 0.2% 13,061 0.3%
Asian 298,515 5.5% 298,515 7.9%
Native Hawaiian/Pacific Islander 3,282 0.1% 3,282 0.1%
African-American 625,934 11.5% 625,934 16.7%
Latino 403,632 7.4% 403,632 10.7%
White 2,360,672 43.3% 2,360,672 62.9%
Multiracial 49,912 0.9% 49,912 1.3%

Comparison to the QHP Eligible Population

Racial and ethnic minorities make up a disproportionately large share of the nation’s uninsured nonelderly U.S. citizens and others lawfully present (“eligible uninsured”).47 The private plans in the Marketplaces serve eligible individuals who are uninsured, as well as those who may have previously sought coverage through the individual market. For this reason we compare the FFM Marketplace plan selections to the estimated QHP eligible population—individuals potentially eligible for Marketplace coverage but not for Medicaid/CHIP. For purposes of this analysis, our estimate of the “QHP eligible” includes U.S. citizens and others lawfully present who are uninsured or have nongroup health insurance (coverage through the individual market) and who have family incomes that are too high to qualify either for Medicaid or an exemption from the coverage mandate on the basis of financial hardship. Specifically, the QHP eligible include uninsured and nongroup-covered adults in Medicaid expansion states with family incomes above 138 percent of the FPL, adults with incomes above 100 percent of the FPL in non-expansion states, and children (age 0-18) with family incomes above 250 percent of the FPL in both types of states.48

Overall, the distribution of FFM Marketplace plan selections by race/ethnicity looks similar to the distribution of the QHP eligible population. However, the proportion of Whites and of Latinos is lower among FFM Marketplace plan selections than among the QHP eligible, while the proportion of Asians and African-Americans is higher among FFM Marketplace plan selections than the QHP eligible (see Figure C2).

Figure C2.

Distribution by Race/Ethnicity of Marketplace Plan Selections and the QHP Eligible Population in the 36 FFM States, Where Race/Ethnicity Is Reported (Unknown/Other Category Is Excluded), 10-1-2013 to 3-31-2014, including Additional SEP Activity through 4-19-14

Figure C2: Distribution by Race/Ethnicity of Marketplace Plan Selections and the QHP Eligible Population in the 36 FFM States, Where Race/Ethnicity Is Reported (Unknown/Other Category Is Excluded), 10-1-2013 to 3-31-2014, including Additional SEP Activity through 4-19-14

Notes:

(1) AI/AN represents American Indian/Alaska Native; NH/PI represents Native Hawaiian/Pacific Islander.

(2) Native Hawaiians/Pacific Islanders account for 0.1 percent of FFM Marketplace plan selections and of the QHP eligible.

(3) This table shows the proportion of each race/ethnicity within the two different populations specified. For example, 62.9 percent of all individuals who have selected a Marketplace plan through the FFM are White, while 66.5 percent of all QHP eligible are White. The two percentages are based on different denominators.


Figure C3.

Distribution of Marketplace Plan Selections in the FFM by Race/Ethnicity Where Race/Ethnicity Is Reported, (Excluding Unknown/Other), 10-1-2013 to 3-31-14, Including Additional SEP Activity through 4-19-14

Figure C3: Distribution of Marketplace Plan Selections in the FFM by Race/Ethnicity Where Race/Ethnicity Is Reported, (Excluding Unknown/Other), 10-1-2013 to 3-31-14, Including Additional SEP Activity through 4-19-14

Notes: Percentages are out of the total 3.8 million persons who selected a plan through the FFM and reported race/ethnicity. Of the total 5.4 million who selected a plan through the FFM, 31.1 percent did not report race or ethnicity.


Special Provisions for American Indians and Alaska Natives

The Affordable Care Act contains special provisions for American Indians and Alaska Natives relating to cost-sharing reductions, a special monthly enrollment period, and cost and eligibility rules for Medicaid/CHIP.49 The Marketplace application includes a separate question related to eligibility for these special protections provided to American Indians and Alaska Natives that is asked as part of the financial assistance application process. In response to this question, which is specific to American Indian/Alaska Native status, more than 48,103 persons who have selected a Marketplace plan through the FFM have indicated that they were American Indian or Alaska Native.50

Data from the optional race/ethnicity question on the Marketplace application provide an incomplete picture of American Indian and Alaska Native Marketplace plan selections because answering the question is voluntary.51 The optional race question on the Marketplace application is not used for determining whether American Indians and Alaska Natives qualify for benefits such as cost-sharing reductions and other protections.

In addition to special protections in the Marketplace, American Indians and Alaska Natives may be eligible for services through the Indian Health Service, which provides comprehensive primary health care and disease prevention services through a network of hospitals, clinics, and health stations on or near reservations. Indian Health Service facilities are predominately located in rural primary care settings and are managed by Indian Health Service, Tribes and Urban Indian programs. Initial American Indian and Alaska Native enrollment data may be low because of the statutory special monthly enrollment period and potential eligibility for Indian Health Service.

Variation by State

The racial/ethnic distribution of the persons who have selected a Marketplace plan through the FFM differs by state, reflecting variation in underlying state-level demographics.52 The following analysis is based on data for Marketplace plan selections where race/ethnicity is known (unknown/other is excluded); see Appendix Table C3 for additional details:

  • Whites: In nearly all FFM states, Whites represent the largest share of Marketplace plan selections, though their proportion of enrollment ranges from 95.9 percent in Maine to 33.3 percent in Mississippi.
  • Latinos: Border states have the highest shares of Latinos among Marketplace plan selections, with Texas at 33.6 percent, New Mexico at 31.1 percent, Arizona at 24.2 percent, followed by Florida at 19.2 percent.
  • African-Americans: The highest concentration of African-American Marketplace plan selections is in Southern states, with Mississippi at 59.5 percent, Georgia at 38.6 percent, Louisiana at 37.9 percent, and Alabama at 29.9 percent.
  • Asians: The highest concentration of Asians Marketplace plan selections is in Virginia at 17.7 percent, New Jersey at 16.3 percent, and Georgia at 14.8 percent.
  • American Indians and Alaska Natives: The highest concentration of American Indians and Alaska Natives is in two states: Wyoming at 3.5 percent and Oklahoma at 3.1 percent.
  • Native Hawaiians and Pacific Islanders: The highest concentration of Native Hawaiians and Pacific Islanders is in Alaska at 0.6 percent and Utah at 0.6 percent.

SBM States

While this report does not include race and ethnicity data from most of the 15 State-based Marketplace states, California, Washington, and Nevada have publicly reported information on the racial and ethnic makeup of individuals who have selected Marketplace plans during the initial open enrollment period.

  • California: For Covered California, 35 percent of the persons who have selected a Marketplace plan are White; 28 percent are Latino; 21 percent are Asian; 6 percent are of mixed race; 4 percent are of unknown race (non-Latino); 3 percent are African-American; 3 percent are of Other races; and less than 1 percent each are American Indian and Alaska Native, and Native Hawaiian and other Pacific Islander.53 The share of Latino Marketplace plan selections in California increased over the course of the initial open enrollment period: Latinos represented 18 percent of enrollees through December,54 and 26 percent of cumulative enrollment through February.55
  • Washington: The state of Washington reported that among the 152,753 individuals who selected a Marketplace plan through March 31, 2014, 6.8 percent were of Latino ethnicity, 27.1 percent were non-Latino, and 66 percent did not declare their ethnicity. Race was reported separately from ethnicity, and 21.3 percent of enrollees did not provide their race. The reported race categories were: American Indian (0.6 percent of total), Asian (10.3 percent), African-American (2.4 percent), Other race (3.4 percent), Pacific Islander (1.7 percent), White (60.0 percent), Alaska Native (0.1 percent), and Hawaiian (0.1 percent). 56
  • Nevada: In Nevada's Health Link, 17.8 percent of private plan enrollees have reported their ethnicity as Hispanic, according to a media report.57

Growth in the FFM

Data on race and ethnicity available from mid-February to the end of open enrollment show that enrollment among racial and ethnic minorities grew faster than those who reported themselves as White (see Figure C4).

Figure C4.

Growth in Marketplace Plan Selections in the FFM by Race/Ethnicity, 2-22-2014 to 3-29-2014

Figure C4: Growth in Marketplace Plan Selections in the FFM by Race/Ethnicity, 2-22-2014 to 3-29-2014

Notes: Represents the weekly growth rate (percentage increase) in the number of unique individuals who have been determined eligible to enroll in a plan through the FFM, and have selected a plan (with or without the first premium payment having been received by the issuer) by race/ethnicity.

Source: Centers for Medicare & Medicaid Services, as of 4-29-2014


Conclusion

The Department will continue to develop outreach strategies to reach the eligible uninsured and encourage coverage through the Health Insurance Marketplace, including racial and ethnic minorities who are more likely to be uninsured. As we continue to assess the initial open enrollment period for the Marketplace, we will evaluate the lessons learned to work to improve outreach efforts and coverage rates in the 2014-2015 open enrollment period.

Based on experience with the Children’s Health Insurance Program (CHIP), we expect participation in the Marketplace to increase steadily over time across all racial and ethnic groups. The rate of participation among low-income children in CHIP, which was launched in 1997, has steadily increased among eligible children of all racial and ethnic groups over the past 15 years. We expect that concerted outreach efforts and a growing awareness of coverage options will increase the rate of insurance coverage across all populations for the Marketplace as well.

Appendix Table C2. Number of Individuals Who Selected a Marketplace Plan through the FFM, by State and by Race/Ethnicity (Unknown/Other included)

10-1-2013 to 3-31-14, Including Additional SEP Activity through 4-19-14

State Number of Individuals Who Selected a Marketplace Plan through the FFM (Oct. 1, 2013 – March 31, 2014, Including SEP Activity through 4-19-14)
TOTAL American Indian/ Alaska Native Asian Native Hawaiian/ Pacific Islander African-American Latino White Multiracial Unknown/ Other
Idaho (1) 76,061 279 1,197 92 276 4,779 47,330 737 21,371
New Mexico (1) 32,062 566 857 16 395 7,146 13,684 349 9,049
Alabama 97,870 269 4,708 40 23,035 1,126 46,927 984 20,781
Alaska 12,890 115 1,011 62 272 393 8,001 290 2,746
Arizona 120,071 514 6,207 135 3,474 21,718 55,979 1,820 30,224
Arkansas 43,446 201 1,160 23 4,453 1,114 27,618 427 8,450
Delaware 14,087 14 859 * 2,204 665 6,688 198 3,453
Florida 983,775 890 34,333 763 109,985 106,647 297,353 5,625 428,179
Georgia 316,543 302 33,184 146 86,631 8,183 93,078 3,041 91,978
Illinois 217,492 217 15,808 91 17,370 15,691 114,356 2,054 51,905
Indiana 132,423 153 4,693 * 9,908 3,185 79,240 1,124 34,081
Iowa 29,163 48 727 * 698 901 19,932 252 6,594
Kansas 57,013 241 2,427 32 2,937 3,148 33,826 966 13,436
Louisiana 101,778 279 4,970 * 24,023 1,415 31,769 820 38,475
Maine 44,258 94 504 * 246 210 32,809 330 10,053
Michigan 272,539 680 8,063 * 22,593 4,256 135,713 2,588 98,587
Mississippi 61,494 40 2,235 * 25,856 535 14,441 315 18,066
Missouri 152,335 340 4,727 95 14,095 2,470 87,426 1,750 41,432
Montana 36,584 521 373 19 80 564 28,125 469 6,433
Nebraska 42,975 167 1,020 19 1,369 1,979 27,578 417 10,426
New Hampshire 40,262 39 1,183 * 330 374 27,465 325 10,537
New Jersey 161,775 124 17,422 124 14,127 7,215 66,632 1,263 54,868
North Carolina 357,584 1,565 12,295 140 58,313 7,563 166,469 3,139 108,100
North Dakota 10,597 82 156 * 120 112 7,950 120 2,054
Ohio 154,668 131 4,544 * 13,142 1,995 92,306 1,688 40,824
Oklahoma 69,221 1,638 3,588 51 4,762 3,952 36,960 1,793 16,477
Pennsylvania 318,077 250 21,353 121 28,965 8,047 172,849 2,977 83,515
South Carolina 118,324 217 4,051 58 24,020 1,653 51,810 959 35,556
South Dakota 13,104 271 153 * 119 172 9,889 154 2,336
Tennessee 151,352 203 5,090 * 21,107 2,320 84,093 1,421 37,073
Texas 733,757 1,287 67,479 447 70,337 171,648 192,990 6,547 223,022
Utah 84,601 307 2,148 342 567 4,100 50,790 941 25,406
Virginia 216,356 294 26,298 145 33,098 4,294 81,568 2,748 67,911
West Virginia 19,856 21 280 * 459 108 14,856 132 3,996
Wisconsin 139,815 393 3,298 * 6,513 3,510 94,340 1,029 30,680
Wyoming 11,970 309 114 * 55 444 7,832 120 3,096
FFM TOTAL 5,446,178 13,061 298,515 3,282 625,934 403,632 2,360,672 49,912 1,691,170

Notes:

* Asterisks denote less than 0.1% or 10 or fewer Marketplace plan selections; however, the data for these states are included in the FFM total. Racial/ethnic categories are mutually exclusive. All individuals reporting Latino or Hispanic ethnicity are counted in the “Latino” column.

(1) Idaho and New Mexico are Federally supported SBMs for 2014; they are using the FFM platform for 2014.

 

Appendix Table C3. Distribution of Individuals Who Selected a Marketplace Plan through the FFM, by State and by Race/Ethnicity (Unknown/Other excluded)

10-1-2013 to 3-31-14, Including Additional SEP Activity through 4-19-14

State Distribution of Individuals Who Selected a Marketplace Plan through the FFM (Oct. 1, 2013 – March 31, 2014, Including SEP Activity through 4-19-14) Excluding Unknown/Other
TOTAL Where Race/ Ethnicity is Known American Indian/ Alaska Native Asian Native Hawaiian/ Pacific Islander African-American Latino White Multiracial
FFM TOTAL 3,755,008 0.3% 7.9% 0.1% 16.7% 10.7% 62.9% 1.3%
Idaho 54,690 0.5% 2.2% 0.2% 0.5% 8.7% 86.5% 1.3%
New Mexico 23,013 2.5% 3.7% 0.1% 1.7% 31.1% 59.5% 1.5%
Alabama 77,089 0.3% 6.1% 0.1% 29.9% 1.5% 60.9% 1.3%
Alaska 10,144 1.1% 10.0% 0.6% 2.7% 3.9% 78.9% 2.9%
Arizona 89,847 0.6% 6.9% 0.2% 3.9% 24.2% 62.3% 2.0%
Arkansas 34,996 0.6% 3.3% 0.1% 12.7% 3.2% 78.9% 1.2%
Delaware 10,634 0.1% 8.1% * 20.7% 6.3% 62.9% 1.9%
Florida 555,596 0.2% 6.2% 0.1% 19.8% 19.2% 53.5% 1.0%
Georgia 224,565 0.1% 14.8% 0.1% 38.6% 3.6% 41.4% 1.4%
Illinois 165,587 0.1% 9.5% 0.1% 10.5% 9.5% 69.1% 1.2%
Indiana 98,342 0.2% 4.8% * 10.1% 3.2% 80.6% 1.1%
Iowa 22,569 0.2% 3.2% * 3.1% 4.0% 88.3% 1.1%
Kansas 43,577 0.6% 5.6% 0.1% 6.7% 7.2% 77.6% 2.2%
Louisiana 63,303 0.4% 7.9% * 37.9% 2.2% 50.2% 1.3%
Maine 34,205 0.3% 1.5% * 0.7% 0.6% 95.9% 1.0%
Michigan 173,952 0.4% 4.6% * 13.0% 2.4% 78.0% 1.5%
Mississippi 43,428 0.1% 5.1% * 59.5% 1.2% 33.3% 0.7%
Missouri 110,903 0.3% 4.3% 0.1% 12.7% 2.2% 78.8% 1.6%
Montana 30,151 1.7% 1.2% 0.1% 0.3% 1.9% 93.3% 1.6%
Nebraska 32,549 0.5% 3.1% 0.1% 4.2% 6.1% 84.7% 1.3%
New Hampshire 29,725 0.1% 4.0% * 1.1% 1.3% 92.4% 1.1%
New Jersey 106,907 0.1% 16.3% 0.1% 13.2% 6.7% 62.3% 1.2%
North Carolina 249,484 0.6% 4.9% 0.1% 23.4% 3.0% 66.7% 1.3%
North Dakota 8,543 1.0% 1.8% * 1.4% 1.3% 93.1% 1.4%
Ohio 113,844 0.1% 4.0% * 11.5% 1.8% 81.1% 1.5%
Oklahoma 52,744 3.1% 6.8% 0.1% 9.0% 7.5% 70.1% 3.4%
Pennsylvania 234,562 0.1% 9.1% 0.1% 12.3% 3.4% 73.7% 1.3%
South Carolina 82,768 0.3% 4.9% 0.1% 29.0% 2.0% 62.6% 1.2%
South Dakota 10,768 2.5% 1.4% * 1.1% 1.6% 91.8% 1.4%
Tennessee 114,279 0.2% 4.5% * 18.5% 2.0% 73.6% 1.2%
Texas 510,735 0.3% 13.2% 0.1% 13.8% 33.6% 37.8% 1.3%
Utah 59,195 0.5% 3.6% 0.6% 1.0% 6.9% 85.8% 1.6%
Virginia 148,445 0.2% 17.7% 0.1% 22.3% 2.9% 54.9% 1.9%
West Virginia 15,860 0.1% 1.8% * 2.9% 0.7% 93.7% 0.8%
Wisconsin 109,135 0.4% 3.0% * 6.0% 3.2% 86.4% 0.9%
Wyoming 8,874 3.5% 1.3% * 0.6% 5.0% 88.3% 1.4%

Notes:

* Asterisks denote less than 0.1% or 10 or fewer Marketplace plan selections. Racial/ethnic categories are mutually exclusive. All individuals reporting Latino or Hispanic ethnicity are counted in the “Latino” column.

(1) Idaho and New Mexico are Federally supported SBMs for 2014; they are using the FFM platform for 2014.


29 Answer options under the race/ethnicity questions on the Marketplace application are based on collection standards under Section 4302 of the Affordable Care Act. For more information, see: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=208

30 The optional race question on the Marketplace application is not used for determining eligibility for special health insurance benefits and protections for American Indians and Alaska Natives.

31 The race/ethnicity categories used in this analysis correspond to the six minimum categories for the combined format of race/ethnicity reporting according to standards maintained by the U.S. Office of Management and Budget, plus categories for Multiracial and Unknown/Other. For more information, see: http://www.whitehouse.gov/omb/fedreg_1997standards

32 ASPE correspondence with U.S. Census and the National Center for Health Statistics regarding the American Community Survey, the Current Population Survey, and the National Health Interview Survey; February 2014.

33 José J. Escarce, Rita Carreón, German Veselovskiy, and Elisa H. Lawson, “Collection of race and ethnicity data by health plans has grown substantially, but opportunities remain to expand efforts,” Health Affairs, vol. 30, no. 10 (2011).

34 Ibid.

35 Aetna, “Aetna’s Commitment,” accessed April 25, 2014. Available at: http://www.aetna.com/about-aetna-insurance/initiatives/racial-ethnic-equ...

36 Nancy R. Kressin, Bei-Hung Chang, Ann Hendricks, and Lewis E. Kazis, “Agreement between administrative data and patients’ self-reports of race/ethnicity,” American Journal of Public Health, vol. 93, no. 10 (2003), p. 1734-1739.

37 Susan L. Arday, David R. Arday, Stephanie Monroe, and Jianyi Zhang, “HCFA's racial and

ethnic data: current accuracy and recent improvements,” Healthcare Financing Review, vol. 21, no. 4 (2000).

38 P.W. Eggers, and L. G. Greenberg, “Racial Differences in Hospitalization Rates among Aged Medicare Beneficiaries,” Health Care Financing Review, vol. 21, no. 4 (1998), p. 1-15.

39 DR. Waldo, “Accuracy and Bias of Race/Ethnicity Codes in the Medicare Enrollment Database,” Health Care Financing Review, Winter 2004-2005/Volume 26, Number 2.

40 Alan M. Zaslavsky, John Z. Ayanian, and Lawrence B. Zaborski, “The validity of race and ethnicity in enrollment data for Medicare beneficiaries." Health services research 47, no. 3 (2012), p. 1300-1321.

41 Celia Eicheldinger, and Arthur Bonito, “More accurate racial and ethnic codes for Medicare administrative data,” Health care financing review 29, no. 3 (2008).

42 Arthur Meltzer, Arthur J. Bonito, Celia R. Eicheldinger, and Christian Evensen, “Health Disparities: Measuring Health Care Use and Access for Racial/Ethnic Populations,” Centers for Medicare and Medicaid Services and RTI International, 2005.

43 Wynia R. Hasnain, Clark K. Taylor, and Ayodola Anise, “Collecting race, ethnicity, and language data to identify and reduce health disparities: perceptions of health plan enrollees,” Medical Care Research and Review 68, no. 3 (2011): 367-381.

44 “National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice,” Office of Minority Health, U.S. Department of Health and Human Services, April 2013.

45 Wynia R. Hasnain, Clark K. Taylor, and Ayodola Anise, “Collecting race, ethnicity, and language data to identify and reduce health disparities: perceptions of health plan enrollees,” Medical Care Research and Review 68, no. 3 (2011): 367-381.

46 Column A is based on total Marketplace plan selections through the FFM, including those for whom race/ethnicity is unknown. Column B is based on total FFM Marketplace plan selections with known data on race/ethnicity (i.e., excluding those for whom race/ethnicity is unknown).

47 We use the term “eligible uninsured” to refer to those who are potentially eligible for coverage through the Marketplace and Medicaid/CHIP. For more information about eligibility to purchase coverage in the Marketplace, see https://www.healthcare.gov/immigration-status-and-the-marketplace/. The estimates contained in this brief do not take into account certain Marketplace coverage and Medicaid/CHIP eligibility requirements, such as those relating to other minimum essential coverage or tax filing requirements, and thus the populations described in this brief should be construed as “potentially” eligible, subject to these other requirements.

48 We make the simplifying assumption in this analysis that all children with incomes below 250 percent of the FPL would be eligible for Medicaid/CHIP rather than the Marketplace. Actual CHIP income thresholds vary by state.

49 Section 1402(d) of the Affordable Care Act.

50 This number is for the number of persons who selected Marketplace plans through the FFM for the period October 1, 2013 to April 21, 2014.

51 Of the total 5.4 million people who selected a plan through the FFM, 34.8 percent did not report race, and 31.1 percent reported neither race nor ethnicity.

52 This discussion does not include data from the 15 State-Based Marketplaces: California, Colorado, Connecticut, District of Columbia, Hawaii, Kentucky, Massachusetts, Maryland, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont, and Washington.

53 Covered California, “Covered California Enrollment Statistics, April 17, 2014, http://3.bp.blogspot.com/-Ir_3Vrs61_o/U1BpfBRhu2I/AAAAAAAAAZM/QqRUOE0rng...

54 Chad Terhune and Soumya Karlamangla, “More Latinos enrolling in Covered California health plans,” Los Angeles Times, February 19, 2014. Available at: http://www.latimes.com/business/la-fi-exchange-enrollment-20140220,0,507....

55 “Covered California Begins Countdown to Final Days to Enroll in Health Plans,” March 13, 2014. Available at: http://news.coveredca.com/2014/03/covered-california-begins-countdown-to....

56 Washington Health Benefit Exchange, “Health Coverage Enrollment Report: October 1, 2013 – March 31, 2014,” April 23, 2014. Available at: http://wahbexchange.org/files/4513/9821/1124/WAHBE_End_of_Open_Enrollmen...

57 Jennifer Robison, "Hispanic enrollment in state health insurance exchange proves disappointing," Las Vegas Review-Journal, April 26, 2014. Available at: http://www.reviewjournal.com/business/hispanic-enrollment-state-health-i....

 

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