Understanding the implementation of the Affordable Care Act in vulnerable Latino communities: A phenomenological approach

Background: The passage of the Patient Protection and Affordable Care Act (ACA) represents a major milestone in healthcare reform promising affordable healthcare coverage to the millions of uninsured. While enrollment statistics are encouraging, vulnerable Latino communities have fared worse than others.

Purpose: To investigate the lived experience of seeking healthcare coverage through the ACA by vulnerable Latino populations along the Texas-Mexico border.

Methods: Through a phenomenological approach, in-depth interviews, conducted during the first-open enrollment ACA period, enabled participants to share their lived experience of obtaining or failing to obtain healthcare coverage. Interviews were audio-recorded and transcribed. Phenomenological analysis included extracting themes capturing the core ideas of participants’ experiences followed by a synthesis of all core concepts into main themes.

Results: From the transcribed text of a bank of 20 interviews the following themes emerged: there is much challenge and difficulty in navigating the marketplace; participants have inadequate health insurance literacy and there is a lack of awareness of community resources assisting with the enrollment process; participants are foregoing healthcare or seeking it across the border in Mexico; participants are frustrated with unaffordable premiums and/or not qualifying for subsidies or Medicaid (due to the non-expansion of Medicaid eligibility in Texas).

Conclusion: Vulnerable Latino populations face major challenges to obtaining health insurance under the ACA. Resources need to be allocated to these communities during future enrollment periods. Policymakers must also address the healthcare coverage dilemma for individuals in states that did not expand Medicaid eligibility.