This study suggests that low levels of health insurance literacy predict no or poor knowledge of the ACA in a low-income, predominantly Hispanic population along the Texas-Mexico border, independent of sociodemographic factors and health status. Overall, awareness of the ACA was very low in an underserved Hispanic community. Even after the conclusion of two ACA enrollment periods, over two-thirds of participants still reported knowing nothing or very little about the health reform law. This lack of awareness was more pronounced among those with lower levels of health insurance literacy, as measured by two scales reflecting confidence choosing health plans and comparing health plans. Those with low income levels were also more likely to have no or little knowledge of the ACA while those who had a diabetes diagnosis were less likely to have no or little ACA knowledge.
The low level of ACA knowledge, though more pronounced in our sample, is consistent with other findings in the literature. In an analysis of a nationally-representative sample conducted a few weeks before the introduction of the health insurance exchanges, 24% of respondents knew a great deal/fair amount about the ACA compared to 14% in our sample. When comparing ACA knowledge among the uninsured, a group that is expected to be more interested in obtaining healthcare coverage, the corresponding awareness numbers were surprisingly lower