Barriers to Health Insurance Enrollment for Black Missourians

As one of the populations with the highest uninsured rate, Black Missourians stood to benefit greatly from the Affordable Care Act (ACA) in regard to health status and access to health care. However, there was a gap in Black enrollment in Missouri during the first ACA Open Enrollment Period (October 1st, 2013 - March 31st, 2014), when compared with other groups. This study seeks to identify and examine barriers Black Missourians faced when enrolling in the Health Insurance Marketplace during the first ACA Open Enrollment Period. Using an anthropological perspective, this thesis seeks to answer the questions: What factors deterred Black Missourians from enrolling in the Health Care Marketplace during the first Open Enrollment Period? What lessons learned during the first Open Enrollment Period can help stakeholders better engage Black Missourians in the future? To identify these barriers, key informants, who were selected based on their role in the rollout and functioning of Missouri’s Health Insurance Marketplace, were interviewed. Data and published reports were used to support the findings. The main barriers identified included health insurance literacy, lack of targeted outreach to African Americans, outreach structure, and affordability. Confounding factors included disparities in health and health care accessibility, misconceptions and stereotypes about the Black population, lack of trust in government and the American medical system, and systemic racism. These findings can help inform future policymakers and make implementation of, and outreach for, the Affordable Care Act more racially equitable in order to better serve Black populations Missouri