Profile of Pre-retirement Age Hispanics in the Medicaid and Private Insurance Markets: Expanding vs. Non-expanding States

Abstract

Although the Affordable Care Act (ACA) affects many parts of our health care system, a central element of the new law is expanding insurance coverage. This is accomplished through the establishment of exchanges and the expansion of Medicaid. For Hispanics close to retirement, the expansion of Medicaid is particularly important because the current older Hispanic cohort in the United States has more favorable mortality rates than other racial and ethnic groups, despite generally lower levels of education and income. However, lower mortality means that aging Hispanics, whom often have diabetes and other chronic diseases, live with higher morbidity and low quality of life. Therefore, adequate insurance prior to Medicare participation and access to health care is critical for healthful aging. The Kaiser Foundation reports that up to 24 states are not participating in the Medicaid expansion. The characteristics of the ‘soon to be insured through Medicare’ are understudied. Further, how their characteristics differ from states not participating in the program is largely unknown. The 2011 Medicaid Expenditure Panel Survey provides new data on health status, race and ethnicity, age and demographics. With restricted data, we examine how characteristics of uninsured individuals near retirement age, but eligible for Medicaid under the ACA, differ by whether or not states choose to participate in Medicaid expansion. Our results reveal that the majority of Hispanics in expanding states already had Medicaid before ACA. Other than differences that result from their status as immigrant, the health characteristics do not greatly differ between Hispanic and non-Hispanic whites, although Hispanics in the Medicaid market are slightly healthier than non-Hispanic whites. We end with a discussion of the implications of our findings as they pertain to the potential of the ACA to remove disparities in the Medicaid program and insurance exchanges.