Addressing Structural Racism: A Study of Efforts to Promote Health Insurance Coverage and Improve Racial Equity (Report)

Addressing Structural Racism: A Study of Efforts to Promote Health Insurance Coverage and Improve Racial Equity (Report)

Published: Oct 31, 2022
Publisher: Mathematica
Associated Project

Jessica Rosenblum

Tobi Yanez Tandeciarz

Mona Shah

Lori Grubstein

Key Findings
  • Funded partners indicated that historically under-represented and under-resourced groups require innovative strategies to reach and enroll them in health insurance.
  • Partners cited trust as a critical factor to facilitating outreach and enrollment. Community power organizations serve as trusted messengers to communities; often bring a unique understanding of communities’ needs and cultural identities; and help elevate community voice and lived experience.
  • Structural racism manifests before and after enrollment into coverage. While funded partners and community power organizations shared some strategies for addressing structural racism in outreach and enrollment processes, lasting change requires broader systemic action.
  • Outreach and enrollment partners are not consistently measuring their efforts, making it difficult to assess their contributions. They requested more guidance and support in this area.

Historical inequities, which are grounded in systematic and structural racism, present challenges to enrolling people from under-resourced communities in health insurance. The Robert Wood Johnson Foundation (RWJF) has a long history of investing in national organizations, known as funded partners, to support Affordable Care Act and Medicaid/Children’s Health Insurance Program outreach and enrollment (OE) efforts for under-resourced communities. RWJF’s funded partners collaborate with grantees and community power organizations that serve local communities to educate uninsured individuals and families about enrollment into applicable health insurance programs and then connect and assist them with those programs. Many of these organizations focus on historically underrepresented populations and communities where inequities persist. This report presents Mathematica’s evaluation of RWJF’s funded partners’ health insurance OE efforts in the 2022 Marketplace open enrollment period, including strategies to engage community power-building organizations, address structural racism in OE, align OE and COVID-19 outreach efforts, and measure equity within OE efforts.

Find an executive summary to this report here.

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