Dominican Independence Day and the ACA


Earlier this month we explored an intriguing similarity between Major League Baseball players and Americans without coverage: the proportion of foreign-born.  Slightly more than 28% of players in the Majors were born outside of the United States.   As a fascinating coincidence, roughly the same proportion of uninsured adults age 20 to 40 (the age range of MLB players) is foreign-born. 

 But there is another interesting wrinkle to explore today on Dominican Independence Day.  The Dominican Republic claims the highest number of players in the Majors (89) of any country other than the U.S.   So, we wanted to take this moment to look more closely at the fifth largest Hispanic group by origin and the implications for the ACA.

 Exactly what is the connection to health care?  Easy: Dominican Americans have one of the highest rates of coverage (78%) among all groups of Hispanic origin.  But let’s put that in context: persons of Dominican origin are still disproportionately uninsured compared to the average for the U.S.  Among Hispanic groups, though, only Puerto Ricans have a higher rate of health coverage

 Aside from the higher rate of coverage among Hispanic groups, what unique demographics characterize the Dominican American population?  Not much: Dominicans Americans are generally comparable to other Hispanic groups in terms of educational attainment, English proficiency, and proportion in poverty.  Their median age of 29 compares to 27 for Hispanics overall, and 70% are citizens as compared to 74% for Hispanics overall.  These similarities make the relatively higher coverage rate all the more interesting – and more difficult to explain.

 So what does this mean for the ACA?   Turns out, it may be hard to further reduce the uninsured among Dominican Americans.  Persons of Dominican origin are highly concentrated: about 80% live in the Northeast, with almost half living in New York alone.  Looking at the epicenter of the Dominican community in Bronx County, New York, these individuals live in a state that expanded Medicaid and successfully launched a state-based Marketplace, New York.  But New York has a different challenge: prior to 2014, it already ranked 14th among states in terms higher coverage rates – so New York must make an even larger efforts relative to other states to achieve substantial enrollment gains.  And it must do so in one of the most expensive media markets in the United States.

 With 33 days remaining in open enrollment, we are watching New York and the Dominican population there particularly closely to learn what may happen.  As with baseball, anything is possible – and one can never give up hope!

 Please feel free to contact me at or 615-761-6929 if I can be helpful in any way.





 Brian Haile

 Senior Vice President for Health Policy

 Jackson Hewitt Tax Service Inc.

 (615) 761-6929 | | Twitter: @haile_brian

 JH logo