How States Can Improve, Increase Race and Ethnicity Data Collection

Affordable Care Act marketplaces could play a crucial role in race and ethnicity data collection,  but may states are failing to collect such information, according to a blog post from Commonwealth Fund.

While both federal and state-based marketplaces often request that enrollees submit race and ethnicity information in their health insurance applications, there is no standardized way to capture this data. 

Additionally, states cannot require applicants to enter this information in order to enroll and many enrollees choose not to disclose race and ethnicity data. 

Four out of ten enrollees on the federal health insurance marketplace decline to reveal race data (38 percent) and three out of ten did not offer ethnicity data (29.6 percent). On state health insurance marketplaces, nearly a quarter of enrollees withheld either race or ethnicity data (22.6 percent).

Medicaid has established a metric for assessing how concerning a gap in race or ethnicity data might be and how likely the gap is to impact a state’s analyses. Using this metric, the researchers analyzed which state-based marketplaces had the most concerning lack of race and ethnicity data during the 2022 open enrollment season.

Missing data for ten percent of enrollees or less presents low levels of concern. When data is missing for 10 to 20 percent of the population, the concern is mid-level and when 20 to 50 percent of the population declines to share race or ethnicity data, the risk of data gaps impeding analyses is high.

Given these metrics, Commonwealth Fund found that Colorado and Vermont had the highest levels of concern, missing 47.4 percent and 47.1 percent of their enrollees’ race or ethnicity data, respectively. 

The state that had the lowest concern in the Commonwealth Fund assessment was New York, which was missing almost 10 percent of its enrollees’ race and ethnicity data on its state-based marketplace.

Payers face many challenges when trying to collect race and ethnicity data, but states have options for improving their processes and results.

In order to reduce enrollees’ fears of discrimination, states can follow the example of New York’s health insurance marketplace. States can explain how the information will be used, add more categories for race and ethnicity including multi-race options, or make the question mandatory but allow respondents to answer “don’t know” or “choose not to answer.”

Fear of discrimination can also influence race and ethnicity data collection outside of enrollees’ experiences. Assisters and brokers may fail to ensure data collection when supporting enrollment processes if states do not emphasize the importance of this question. States can offer a sample script in order to support enrollment assisters and brokers.

“State-based marketplaces also can enlist insurers to fill gaps,” the blog explained. “Insurers can collect race and ethnicity data during routine contacts (e.g., customer service calls, website account registration), targeted outreach, and from providers.”

Private payers are also working to improve data collection in this area. Blue Cross Blue Shield Association has outlined the next steps for the industry as it moves toward standardizing race and ethnicity data collection processes.