2022 Marketplace Enrollment Grew Significantly for Black, Latino Enrollees

Marketplace enrollment through HealthCare.gov grew significantly between 2020 and 2022, with Latino and Black enrollees seeing the highest respective increases of 53 percent and 49 percent, according to a report from the US Department of Health and Human Services (HHS).

The extended Special Enrollment Period (SEP), the expansion of marketplace outreach and Navigator funding, and enhanced premium subsidies under the American Rescue Plan Act (ARPA) helped increase marketplace enrollment for all racial groups.

However, marketplace administrative data often lacks self-reported race and ethnicity information because it is optional for enrollees to report. In addition, brokers or agents that help with marketplace enrollment may not ask for this data.

To account for missing data, HHS’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) used imputation, using existing self-reported race and ethnicity data to predict the probability of racial and ethnic identity.

Researchers analyzed data from HealthCare.gov on plan selections made during open enrollment periods from 2015 to 2022 and imputed values for missing race and ethnicity data.

Between 2015 and 2022, there were 71.6 million plan selections on HealthCare.gov. Self-reported race and ethnicity data were missing for 23.3 million plan selections (32.5 percent).

After imputation, the percentage of 2022 enrollees increased among Asian American and Native Hawaiian/Pacific Islanders (AANHPI) (2.4 percentage points), Black enrollees (5 percentage points), Latino individuals (8 percentage points), and White enrollees (16.3 percentage points).

Marketplace enrollment grew for all racial and ethnic groups between 2020 and 2022. Black and Latino enrollees saw the steepest increases. The number of Black enrollees increased by 49 percent from 0.9 million to 1.3 million, while Latino enrollees rose 53 percent from 1.7 million to 2.6 million.

Enrollment also increased significantly for Black and Latino populations between 2021 and 2022 alone, growing by nearly 40 percent for both groups.

American Indians and Alaska Natives saw a 32 percent enrollment growth between 2020 and 2022, going from 52,000 to 68,000 enrollees. The number of AANHPI increased from 0.82 million to 0.87 million (6 percent increase) and White enrollees grew from 4.7 million to 5.2 million (11 percent increase).

“Access to high-quality, affordable health care is top priority of the Biden-Harris Administration, and the Affordable Care Act is central in our efforts to increase access for America’s families,” HHS Secretary Xavier Becerra said in a press release.

“This report shows that our efforts are working, including among Black, Latino, and American Indian and Alaska Native consumers.  The uninsured rate is at a record low in the country, but we know we have more to do to close gaps in coverage and increase equity.  That’s why HHS is focused on building on these coverage gains during this next Open Enrollment Season starting on November 1.”

The enrollment growth among Black and Latino populations led to a higher share of marketplace enrollment represented by these groups. For example, the percentage of marketplaces enrollees that were Black rose from 10.5 percent in 2020 to 12.7 percent in 2022. Similarly, the share of enrollees that were Latino grew from 20.4 percent in 2020 to 25.3 percent in 2022.

Meanwhile, the share of enrollees that were White and AANHPI decreased in 2022.

As the 2023 open enrollment period nears, the Biden Administration expects more Americans to have access to marketplace plans.

The Inflation Reduction Act has extended ARPA premium subsidies through 2025, which will likely increase access to affordable coverage, leading to continuous enrollment gains on the marketplace.

In addition, HHS recently finalized a rule that aims to fix the family glitch by allowing people to be eligible for marketplace premium subsidies if they cannot afford employer-sponsored coverage for their entire family.