Reliance on public health insurance or having no health insurance of any form is more common among racial/ethnic minorities as compared to white Americans. Findings from the 2005 Current Population Survey (CPS) show that in 2004, 32.7% of Latinos, 19.7% of blacks, and 16.8% of Asians in the U.S. lacked health insurance in comparison to 11.3% of non-Latino whites (DeNavas-Walt, Proctor, and Lee 2005
). While this pattern in insurance coverage appears consistently, racial/ethnic minority populations in the U.S. with large numbers of immigrants encounter additional obstacles to accessing insurance, such as ineligibility for government-sponsored programs and language barriers. This paper presents new data from the National Latino and Asian American Study, fielded in 2002/2003, to examine factors that influence health insurance coverage for Latinos and Asians in the U.S.
Asian Americans and Latinos each are growing rapidly as a share of the U.S. population. In 2000, Latinos numbered approximately 35.3 million people, or 12.5% of the U.S. population (Guzman 2001
), and Asian Americans numbered 11.6 million people or 4.2% of the population (Reeves and Bennett 2004
). Latinos already account for more than half of the newborns in California (Murphy 2003
) and soon will account for one of every three people born in the U.S. (Ginzberg 1991
). Asian Americans are the fastest-growing ethnic category in the U.S. in terms of percentage increase; their numbers are expected to triple to more than 20 million by the year 2025 (Lee 1998
). Between 14 million and 16 million immigrants have entered the U.S. in the last decade, coming primarily from Latin America (54%) and Asia (26%) (Capps and Passel 2004
), with projections for an additional 15 million for the next decade. This accelerated growth of the Latino and Asian immigrant population has not been matched with policies to meet the social and economic needs of these populations.
Understanding the similarities and differences in how Asian and Latino populations access health insurance and health care are critical for making policy decisions and planning service delivery that are appropriate for the different groups. Although Latinos and Asian Americans are both ethnic minorities in the U.S. and share experiences that include a recent immigration history, and language and acculturation issues, health insurance rates differ dramatically between the two groups. This makes the Asian and Latino comparison potentially telling for identifying the factors that influence coverage for new minorities.
lists studies conducted to date that have examined health insurance status among Latinos and Asians in the U.S. Data from the 1996 Medical Expenditure Panel Survey (MEPS) demonstrated that after controlling for demographic factors, Latinos were .39 times as likely, Asians were .64 times as likely, and blacks were .70 times as likely to have health insurance compared to non-Latino whites. While large differences in rates of insurance coverage have been found between Latinos and Asians, further analyses within these two subgroups have shown an even wider range of disparities in coverage. For example, data from the National Health Interview Survey (NHIS) in the early 1990s showed that among Asian Americans, Japanese Americans and Filipino Americans had the highest rates of insurance (79.0% and 73.4%, respectively), while Korean Americans had the lowest (51.9%). Similarly, in a study of Latinas who participated in the 1982-1984 Hispanic Health and Nutrition and Examination Survey (HHANES), 81% of Cuban women, 81% of Puerto Rican women, and only 73% of Mexican women reported being insured.
Study Description: Rates of uninsurance for Latino and Asian subgroups
While research conducted to date provides compelling evidence that Latinos and Asians disproportionately lack health insurance coverage compared to their white, U.S.-born counterparts, these analyses have been conducted predominantly with the same four datasets: the Current Population Survey, the Medical Expenditure Panel Survey, the National Health Interview Survey, and the National Survey of American Families (see for detailed information). Some of these surveys are conducted only in English and offer limited generalizability to subgroups within the Latino and Asian populations. This paper presents analyses based on new data from the National Latino and Asian American Study (NLAAS), an epidemiological and service use study of Latinos and Asian Americans that employs a national sampling frame to select interview respondents. The NLAAS uses recently collected data with good measures of factors related to lack of insurance coverage, and has large numbers of respondents from Asian and Latino ethnic subgroups (Puerto Rican, Mexican, Cuban, and other Latinos; Chinese, Vietnamese, Filipino, and other Asians). In addition, interviews for the NLAAS were conducted in English as well as four other languages (Spanish, Mandarin, Tagalog, and Vietnamese) to ensure respondents could be interviewed in their native language. Data from the NLAAS provide the opportunity to document and explore explanations for subgroup differences in insurance outcomes among a representative sample of Latinos and Asians residing in the U.S.
Access to health insurance for Latinos and Asians in the U.S. often depends upon many of the same factors as for white Americans. However, with a high proportion of immigrants and foreign-born people, Latino and Asian populations in the United States often face additional barriers to securing coverage beyond those related to labor market and socioeconomic factors. These include finding that the American health care system differs substantially from that in their home countries (Feld and Power 2000
). Furthermore, depending on their country of origin, Asian and Latino immigrants often differ in resources, including human and social capital (Ryu, Young, and Kwak 2002
; De la Torre, Friis, and Hunter 1996
), both of which may shape the types of jobs they obtain as well as the compensation and benefits provided by their employer. Limited English proficiency also may compound the difficulties confronted by foreign-born Latinos and Asians in securing health insurance (Perkins 2003
). These outcomes may be a product of limited options for obtaining jobs that offer coverage and of language barriers to navigating the health insurance and medical systems effectively.
Public policies, such as the 1996 welfare reform, also have restricted access to public insurance programs, resulting in declines in Medicaid coverage (Wang and Holahan 2003
). However, even among Latino and Asian families who are eligible to enroll in Medicaid and other publicly funded insurance programs, under-enrollment has occurred due to misunderstandings over policy requirements as well as persistent rumors that receipt of Medicaid benefits may jeopardize immigrant residency status (Capps, Ku, and Fix 2002
). Additionally, various citizenship and immigration categories confer different rights. Whereas those qualifying for refugee status (e.g., Vietnamese, Cambodians) have options for health insurance coverage through public programs for seven years after their arrival, most other immigrants (e.g., undocumented immigrants or legal permanent residents) must either obtain insurance through an employer, purchase individual insurance, or go without insurance (Ku and Matani 2001
Finally, state variations in coverage policies also may affect access to insurance. For example, the federal government defines broad categories of Medicaid eligibility criteria. However, states may expand the scope of their programs or find separate programs to provide insurance coverage to individuals who may be ineligible for other public programs (Zimmermann and Tumlin 1999). Access to employer-based insurance also may depend upon local labor markets. Differences in state Medicaid and other public insurance programs and in local labor market conditions are reflected in state uninsured rates, which vary from 8% in Minnesota to a high of 24% in Texas (Mills and Bhandari 2003
). Regionally, the South and West have high proportions of uninsured as compared to the Midwest and Northeast (Institute of Medicine 2002
). Recent analyses from the Kaiser Commission on Medicaid and the Uninsured (Kaiser Commission on Medicaid and the Uninsured 2003
) showed that among the four states with the greatest immigrant populations (California, Florida, New York, and Texas), Texas had the highest rates of uninsurance of noncitizens (56%), while California and New York had lower rates (46%).
The pervasiveness of uninsurance among certain subgroups of the population underscores the importance of identifying factors linked to these negative outcomes and corresponding leverage points that may decrease uninsurance for different minority groups. This study contrasts insurance outcomes for Asian Americans and Latinos, including analyses of subgroups. We also compare differences in uninsurance rates across states, regions, types of occupation, household income, education, and level of English language proficiency in an effort to guide public policy and service planning.