Georgia Latino Enrollment in the Affordable Care Act: A Qualitative, Key Informant Analysis Open Access

McCulloch, Audrey Gardner (2015)

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Prior to the implementation of the Affordable Care Act (ACA), one in three Latinos in the United States were uninsured. In Georgia, a state that implemented a federal Marketplace, nearly half of Latinos lacked health insurance coverage going into the initial enrollment period of October 1st, 2013 to April 15th, 2014. The ACA provided an opportunity for these uninsured Latinos to gain health insurance coverage, thus increasing their access to necessary medical services. A series of fourteen in-depth interviews with key informants from Georgia's Latino community, such as nonprofit leaders, media professionals and community health promoters, were conducted between June and September 2014. From the perspective of these key informants, this qualitative project explores Georgia Latino knowledge surrounding the ACA and perceived barriers to successful enrollment in Marketplace health insurance coverage. Participants described various barriers to successful enrollment, such as lack of health literacy education regarding health insurance and the time-consuming nature of the enrollment process. Recommendations for outreach, education and enrollment targeting Georgia Latinos include organization of one-on-one services in locations of familiarity and comfort to Georgia Latinos, as well as the hiring and training of Spanish-speaking enrollment professionals. The findings of this study may serve to inform future design and provision of culturally competent outreach, education and enrollment services.

Table of Contents

Abstract. iv

Acknowledgements. vi

Chapter 1: Introduction. 2

Chapter 2: Comprehensive Review of the Literature. 5

2.1 Introduction. 6

2.2 Overview of the ACA and implications for Latinos nationwide. 7

2.3 Access to health insurance, a human rights issue. 9

2.4 Overview of the ACA in Georgia, a state-specific context. 11

2.5 Considerations for Latinos in Georgia. 15

2.6 Special Considerations. 16

2.7 Conclusion. 19

Chapter 3: Manuscript. 21

Contribution of Student. 22

Abstract. 23


Methods. 25

Results. 27

Discussion. 33

Manuscript References. 37

Chapter 4: Conclusions, Recommendations and Future Research. 38

4.1 Conclusions and key recommendations. 39

4.2 Gaps addressed by this project. 45

4.3 Opportunities for future research. 45

Thesis References. 47

Appendix A: Semi-Structured Interview Guide.50

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