Briefs and Reports

Grantee Publication: Advancing Health Equity in the Health Insurance Marketplace

Marketplace review and community stakeholder assessment offer
specific actions to meet remaining challenges

Since the Affordable Care Act became law in 2010, health insurance marketplaces, Medicaid expansion, and other health insurance reforms have reduced the national uninsured rate to a historic low of 9.1%. In Connecticut, the uninsured rate declined to just 4.9% by the end of 2015, among the lowest in the nation. However, racially, ethnically, and linguistically diverse populations continue to have lower insurance rates than whites, making up nearly half (47%) of the remaining nonelderly uninsured. Continuing progress and success for Access Health CT, Connecticut’s health insurance marketplace, will be measured, in large part, by its effectiveness in reaching and enrolling these residents and making sure those already insured stay insured.

To measure Access Health CT’s progress toward reaching diverse communities in its efforts to insure all eligible individuals, the Texas Health Institute, a nonprofit health care research group based in Austin, Texas, with support from the Connecticut Health Foundation and the W.K. Kellogg Foundation, created and administered a Marketplace Health Equity Assessment Tool (M-HEAT). The M-HEAT integrates public and self-reported data from health insurance marketplaces with the experiences and perceptions from community stakeholders and advocates. The results, provided in the new report Advancing Health Equity in the Health Insurance Marketplace: Results from Connecticut’s Marketplace Health Equity Assessment Tool (M-HEAT), identify Access Health CT’s promising actions as well as opportunities to build on significant initial progress to reach, enroll, and retain coverage for all residents, regardless of race, ethnicity, spoken language, and gender identity. Click to view Executive Summary.

“The Connecticut Health Foundation (CT Health) advances health equity by helping people of color gain access to better care because everyone deserves the opportunity for optimal health. We are very proud that Access Health CT explicitly recognizes they must address health disparities. This report provided a tremendous opportunity for growth and development to ensure that coverage results in the connection to quality health that improves their health and well-being,” said Patricia Baker, President and CEO of CT Health.

Findings based on data compiled between October 2015 and April 2016 demonstrate that while Access Health CT maintains a formal commitment to health equity, the public is less aware of this commitment and the financial resources allocated toward it. Likewise, stakeholders stressed the importance of increasing the number of participating health plans, larger networks, and more in-network providers who offer culturally and linguistically appropriate services. Additionally, stakeholders indicated that while Access Health CT does regularly engage community groups, opportunity exists to more fully engage and incorporate feedback from stakeholders representing racially, ethnically, and linguistically diverse populations-many of whom will require more targeted, tailored, and trusted messaging to reach, enroll, and retain in coverage.

Results reinforce findings from the 2015 survey of Access Health CT’s consumers conducted by Acturus that concluded that non-white individuals were less engaged with the health care system than their white counterparts. Blacks, Hispanics, and others were also less likely than whites to have used their health insurance or have a primary care provider. Further, white consumers who left the marketplace were more likely to be covered than were non-whites. This new report points to the importance of investing in coverage to care transitions such as improving individual health insurance literacy by providing additional education and assistance through community health workers, in-person assisters, and others to help newly insured understand their coverage, how to find providers, and when and how to use it to access health care.

“This report documents Access Health CT’s important progress to date in working to reduce disparities in health insurance across the state,” commented Dennis Andrulis, a lead researcher on the project at THI, “At the same time it offers a unique way to compare how stakeholders representing communities of color and Access Health CT view what’s been achieved to date and what still needs to be done to enroll remaining uninsured and assure individuals already insured stay insured.”

Other recommendations include a need to build mutual accountability toward health equity; bridging the communication divide between Access Health CT and its stakeholders; restoring a focus on assisting hard-to-reach individuals where they live, work, pray and play; and improving data and monitoring by race, ethnicity and other measures of diversity.

This report is a part of a major, ongoing initiative at Texas Health Institute known as the Affordable Care Act & Racial and Ethnic Health Equity Series to track, analyze, and report on the implementation progress of health reform in advancing health equity. To access resources mentioned in this article, please visit