Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course


Health insurance coverage varies substantially between racial and ethnic groups in the United States. Compared to non-Hispanic whites, African Americans and people of Hispanic origin had persistently lower insurance coverage rates at all ages. This article describes age- and group-specific dynamics of insurance gain and loss that contribute to inequalities found in traditional cross-sectional studies. It uses the longitudinal 2008 Panel of the Survey of Income and Program Participation (N = 114,345) to describe age-specific patterns of disparity prior to the Affordable Care Act (ACA). A formal decomposition on increment–decrement life tables of insurance gain and loss shows that coverage disparities are predominately driven by minority groups’ greater propensity to lose the insurance that they already have. Uninsured African Americans were faster to gain insurance compared to non-Hispanic whites, but their high rates of insurance loss more than negated this advantage. Disparities from greater rates of loss among minority groups emerge rapidly at the end of childhood and persist throughout adulthood. This is especially true for African Americans and Hispanics, and their relative disadvantages again heighten in their 40s and 50s.

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Fig. 1

Data source: SIPP 2008, CDC/NCHS, National Vital Statistics System

Fig. 2

Data source: SIPP 2008

Fig. 3

Data source: SIPP 2008, CDC/NCHS, National Vital Statistics System

Fig. 4

Data source: SIPP 2008, CDC/NCHS, National Vital Statistics System

Fig. 5

Data source: SIPP 2008, CDC/NCHS, National Vital Statistics System


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This research received support from the Population Research Training Grant (NIH T32 HD007242) awarded to the Population Studies Center at the University of Pennsylvania by the National Institutes of Health’s (NIH)’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Agency for Healthcare Research and Quality (AHRQ).The author also benefited from facilities and resources provided by the California Center for Population Research at UCLA (CCPR), which receives core support (R24-HD041022) from NICHD.

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Correspondence to Heeju Sohn.

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Sohn, H. Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course. Popul Res Policy Rev 36, 181–201 (2017).

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  • Race
  • Inequality
  • Health insurance
  • Life tables