“The market failure in health care, first and foremost is that the sicker you are, the poorer you become because you can’t work. The poorer you become, the sicker you are because you can’t afford health care, and the market simply cannot solve that without some intervention.”

—Nobel Laureate Amartya Sen

As the Affordable Care Act (ACA), commonly called Obamacare, enters a crucial first year under intense political scrutiny, the clock is ticking on a race for the Obama administration to enroll Latinos, the nation’s most likely group to be uninsured, and the program’s most critical customers. Latinos stand to gain the most from the Affordable Care Act. Of the nation’s 48 million non-elderly uninsured, one third, or more than 15 million are Hispanic. According to the U.S. Census, one in three Hispanics (31 percent) under the age of 65 are without insurance, almost double the 16 percent of the overall population.

Coverage Gap Created When Medicaid Not Expanded

When the ACA was passed, it required states to expand Medicaid coverage to everyone at or below 138 percent of the federal poverty line ($15,856 for a household of one and $32,499 for a household of four). Fifty-eight percent, or 9 million uninsured Latinos, would have gained insurance under Medicaid automatically, but the U.S. Supreme Court ruled in 2012 that the Medicaid expansion is voluntary for states. As a result, 21 states, including Hispanic heavy Florida and Texas, chose not to expand their Medicaid programs. The decision by these states to not expand Medicaid programs leaves up to 6.5 million Americans in a coverage gap without insurance, according to the Urban Institute.

Marketplaces Fill Coverage Gap

Hispanics are an ideal target for the marketplaces, which are run by states and the federal government, and offer consumers private insurance plan options, subsidized or unsubsidized, at a variety of different prices regardless of pre-existing conditions. The Obama administration says 10 million Latinos are eligible for the health care program, and 4 million speak Spanish, 69 percent of whom do not understand the law.

Young and Healthy Offset Cost of Insuring Sicker and Older People

The Obama administration said it is looking for about 7 million people to purchase health insurance through the marketplaces. The White House said it needs more than 2.6 million young and healthy people to enroll to keep costs and premiums down for the overall pool of sicker and older people, who cannot be denied coverage. According to the Census, the median age for a Latino in the U.S. is 27. The median age in the U.S overall is 37.

Enrollment Deadline and Penalty for Opting Out

Those who are eligible to buy insurance on the marketplaces, but do not enroll by the deadline, will face a penalty of $95 per adult the first year, $47.50 per child, or 1 percent of family income, whichever is greater. The fines rise to three or four times greater in the years after. A family making $35,000 a year may have to decide whether it will be cheaper to pay a few hundred dollars in penalty or pay $2,500 a year in insurance.

Author: Rizk Law

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