How Eliminating Individual Mandate Impacted the Latino Community

After Congress zeroed out the Affordable Care ACct's individual mandate, the Latino community experienced a rise in uninsurance that coincided with a deterioration in other important quality of care indicators, impeding health equity advancements, according to a research letter in JAMA Network Open.

The researchers used data from the National Health Interview Survey (NHIS) spanning from 2011 to 2019. All of the more than 318,000 participants were between the ages of 18 and 64. Using this data, the researchers assigned a weight to different quality of care and access to care measurements for Black individuals, Latino individuals, and White individuals.

Overall, uninsurance dropped from nearly 20 percent pre-implementation of the Affordable Care Act to 12.3 percent in 2016 through 2018 but increased by three percentage points in 2019 when the individual mandate was zeroed-out.

However, in the Latino community, health equity suffered as the difference in the change in uninsurance was much more pronounced. This population witnessed a five percentage point spike in the probability of being uninsured. Whereas one-quarter of the population was likely uninsured when the individual mandate was in place, three out of ten Latino individuals were likely to be uninsured in 2019.

Out of the races that the survey tracked, the Latino community has had the highest uninsurance rate for the past decade. Federal data—which includes children—corroborates this finding, highlighting that American Indians and Alaska Natives have faced the highest uninsurance rate, followed by the Latino community and then by the Black population.

After the Affordable Care Act's individual mandate was zeroed-out, the probability of uninsurance increased among Black individuals and White populations as well, but not as drastically as it did in the Latino community.

The researchers noted that the public charge regulations may have had an impact on insurance uptake in the Latino community in 2019 and may explain the particularly steep increase in the probability of uninsurance when compared with other races. 

Separate studies show that the public charge rule continued having an impact on immigrants’ reliance on government programs even after the Department of Homeland Security stopped enforcing the law in March 2021.

The Latino community experienced the biggest departure from the overall trends when the researchers compared trends in treatment delayed due to lack of affordability. Whereas the Black community, White community, and overall trends dropped after the Affordable Act's individual mandate, the Latino population saw a significant increase.

Before the individual mandate was zeroed-out, the Latino community had an 11 percent likelihood of delaying care due to affordability. In 2019, this population had a nearly 14 percent likelihood of delaying care.

Latino individuals also saw an increase in emergency department visits in 2019 when the individual mandate no longer existed. In the period of time before the Affordable Care Act's individual mandate was eliminated, Latino populations had a 19.0 percent likelihood of being admitted to the emergency department, which increased to 21.4 percent in 2019.

The Black community continued to see the highest probability of being admitted to the emergency department from 2011 through 2019. This population experienced an increase in emergency department visits as well, with the likelihood of admission hovering around 27.0 percent before the individual mandate was eliminated and jumping to 29.5 percent in 2019.

The researchers also found that the probability of having a regular care source increased in the Latino community along with the overall trend.

The results may support efforts to reduce out-of-pocket healthcare spending. 

In particular, the researchers touched on calls from industry leaders to make permanent the American Rescue Plan enhanced premium tax credits. Payers reignited this emphasis in response to the State of the Union address in which President Joe Biden called on policymakers to make the savings permanent.