1

lowing question: “Are you of Hispanic, Latino,

or Spanish origin?” Respondents to the

Spanish-language version of the survey were

drawn from an online U.S. Hispanic panel.

Of the 554 Hispanic survey respondents, more

than half (53%) reported being without health

insurance in both 2014 and 2015. (Among

all respondents to our survey, 36% reported

being uninsured in both years.) When we

compared the Hispanic respondents and non-

Hispanic respondents who reported being

uninsured in those years, we found several

similarities: both groups, for example, con-

sisted predominantly of low-income men

between the ages of 30 and 49. However,

health status was better among the Hispanics.1

We also uncovered three factors that appear

to be contributing to the lower enrollment

rates among Hispanics:

Penalty awareness. A slightly higher percent-

age of Hispanics than non-Hispanics report-

ed that they were unaware of the financial

penalty for lacking health insurance (46%

vs. 41%, respectively). Once we informed all

respondents in both surveys about that pen-

alty, however, the Hispanics were significantly

more likely to say that they would purchase

coverage (41% vs. 27%, respectively).

Subsidy awareness. In our surveys, price sen-

sitivity and affordability concerns were high

In the U.S., Hispanics are more likely to lack

health insurance than any other racial or

ethnic group, and enrollment on the individual

health insurance exchanges is disproportion-

ately low among Hispanics—issues that have

been well documented. As payers are pre-

paring for the 2016 open enrollment period

(OEP), we wanted to share new McKinsey

research that sheds light on why Hispanic

enrollment rates continue to be low, and to

offer suggestions on how to address some

of the challenges involved in increasing

Hispanic enrollment.

Between February and April 2015, we survey-

ed 554 adults of Hispanic descent who were

eligible for qualified health plans to better

understand the factors influencing enrollment

rates. All of these respondents reported that

they were U.S. citizens or legally entitled to

live in this country, and that they were not

eligible for Medicare or Medicaid.

The survey, which was conducted in both

English and Spanish, is part of a much

broader research effort we have been con-

ducting into decision-making among health-

care consumers, particularly those shopping

for health insurance on the public exchanges.

(Since November 2013, when we conducted

our first OEP study, we have surveyed more

than 14,000 consumers.) Respondents to this

year’s English-language survey were defined

as Hispanic if they answered “yes” to the fol-

Insights into Hispanics’ enrollment on the health insurance exchanges

New McKinsey research sheds light on why Hispanic enrollment rates continue to be low—and how these numbers could be improved.

Erica Coe, Jenny Cordina, Elizabeth P. Jones, and Suzanne Rivera

1 A wide range of researchers have found that health status is generally better among Hispanic than non-Hispanic Americans, for reasons not entirely under-stood. Average age is much lower among Hispanics than among other Americans, but other factors also appear to be involved. For more information about differences in health status between Hispanics and non-Hispanics, see the CDC report, Summary Health Sta­tistics for the U.S. Population: National Health Interview Survey, 2012, and Population Research Bureau’s post, “Exploring the Paradox of U.S. Hispanics’ Longer Life Expectancy.”

2 McKinsey & Company Healthcare Systems and Services Practice

Decision not to complete a purchase. Lack

of knowledge about penalties and subsidies

helps explain why the Hispanic respondents

to our surveys were almost 30% less likely

than other respondents to shop for insurance

(see Exhibit). However, the Hispanic respon-

dents were also less likely to complete the

purchase once they had started shopping.

Part of the explanation for this may be that

the Hispanic respondents were almost twice

as likely as the non-Hispanic respondents to

report having encountered technical prob-

lems on the public exchanges. For example,

among all survey respondents, independent

of ethnicity. The majority of the respondents,

including the Hispanics, thought health

insurance premiums should be less than

$100 per month. However, awareness of

subsidy eligibility was lower among Hispanics

than among other respondents. For example,

among those who remained uninsured in

both 2014 and 2015, only 5% of the Hispanic

respondents were aware of the size of the

subsidy they were eligible for, compared

with 12% of the non-Hispanic respondents.

[ADD 1 LINE HERE TO ALIGN?]

Shopping behavior on the public exchanges

Web 2015<article slug>Exhibit 1 of 1

Did not shop1

Shopped1

Did not enroll1

Enrolled in a plan1

Hispanics were 9

percentage points

less likely to shop

43% of Hispanics

who shopped did

not enroll, compared

with 26% of the

general population

Enrolled in ACA plan1

Enrolled in non-ACAindividual

plan1

Enrolled innon-individual

plan

% of Hispanic population % of general population

31% 22% 30% 20%

9% 7%

10% 18%

39% 58% 69% 78% 33%20%

Shopping behavior among consumers eligible

1Statistically significant difference between Hispanics (n = 554) and general population (n = 3,006) at 95% confidence level.

Source: McKinsey’s Center for U.S. Health System Reform Hispanic and National 2015 OEP surveys

EXHIBIT Shopping behavior among consumers eligible for qualified health plans

3Insights into Hispanics’ enrollment on the health insurance exchanges

The campaigns should focus on increasing

awareness of the penalty for not having in-

surance, the subsidy levels individuals may

be eligible for, and the carriers offering health

insurance in a given region.

Price transparency should be a central

element of the campaigns. The Hispanic

respondents in our survey, like their counter-

parts in the general population, were very

price sensitive. Messages focusing on the

economic benefits of having coverage may

be compelling to Hispanics because our

research has shown that once indivi duals

obtained health coverage on the exchanges,

Hispanics were more likely than those in

the general population to try to access

healthcare services.

The Hispanic population will continue to

be important to payers, providers, and

government agencies as they work to enroll

the residually uninsured and to understand

how individuals shop for coverage on the

exchanges and use healthcare services.

Increasing enrollment among Hispanics

to equal that in the general population will

require targeted efforts from all of these

organizations.

Erica Coe (erica_coe@mckinsey.com) is a senior expert in the McKinsey Center for US Healthcare Reform. Jenny Cordina (jenny_ cordina@mckinsey.com) is an expert principal in the firm’s Detroit office. Elizabeth P. Jones (elizabeth_jones@mckinsey.com) is a consumer knowledge expert in that office. Suzanne Rivera (suzanne_rivera@mckinsey.com) is a consultant in the firm’s Denver office.

This article was originally published on the

Health Affairs Blog (http://healthaffairs.org/blog/

2015/08/26/insights-into-hispanics-enrollment-

on-the-health-insurance-exchanges/).

16% of the Hispanic respondents, compared

with 9% of the non-Hispanic respondents,

said they were unable to open a user account.

Language barriers may have contributed to

the technical problems in a few cases, but it is

unlikely they were a major factor in most cases.

Just 4% of the Hispanic respondents in our

surveys said they spoke only Spanish at home,

and 6% said they read newspapers and maga-

zines only in Spanish. In contrast, 83% of the

Hispanic respondents reported they spoke

English at home (part or all of the time), and

77% reported they preferred to read in English.

Furthermore, those who preferred Spanish were

more likely to have enrolled in an insurance

plan than were those who preferred English.

Similarly, lack of computer proficiency does

not appear to underlie the technical problems

many of the Hispanic respondents reported.

More than 90% of both Hispanic and non-

Hispanic respondents said they used comput-

ers at home, and use of smartphones and

tablets was higher among Hispanics than

non-Hispanics.

In addition to technical difficulties, another

factor that may have contributed to the low

purchase rates among Hispanics was unfamil-

iarity with health insurance com panies. For

example, 69% of the Hispanic respondents,

compared with 83% of the other respondents,

had heard of their local Blues plans. Aware-

ness of national health insurers was also lower

among Hispanics (54% vs. 63%, respectively).

Moving forward

It appears, therefore, that awareness-

building campaigns are likely to be crucial for

boosting enrollment rates among Hispanics.