Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course
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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.
KeywordsRace Inequality Health insurance Life tables
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.
- Akosa Antwi, Y., Moriya, A. S., & Simon, K. (2014). Access to Health Insurance and the Use of Inpatient Medical Care: Evidence from the Affordable Care Act Young Adult Mandate. Retrieved from http://www.nber.org/papers/w20202
- Aughinbaugh, A., Robles, O., & Sun, H. (2013). Marriage and divorce: patterns by gender, race, and educational attainment. Monthly Labor Review, 136, 1.Google Scholar
- Bureau of Labor Statistics. (2014). Labor force characteristics by race and ethnicity, 2013. Washington, DC: BLS Reports.Google Scholar
- Bureau of Labor Statistics. (2015). Labor Force Statistics from the Current Population Survey. http://www.bls.gov/cps/cpsaat08.htm. Accessed 13 Oct 2016.
- Cohen, R. A., & Martinez, M. E. (2014). Health Insurance Coverage: Early release of estimates from the National Health Interview Survey, January–March 2014. National Center for Health Statistics. http://www.cdc.gov/nchs/nhis/releases.htm.
- Congressional Budget Office. (2003). How many people lack health insurance and for how long?. Washington, DC: Congressional Budget Office.Google Scholar
- D’Angelo, D. V., Le, B., O’Neil, M. E., Williams, L., Ahluwalia, I. B., Harrison, L. L., & Grigorescu, V. (2015). Patterns of health insurance coverage around the time of pregnancy among women with live-born infants—pregnancy risk assessment monitoring system, 29 States, 2009. Atlanta, GA. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6404a1.htm. Accessed 13 Oct 2016
- Das Gupta, P. (1993). Standardization and decomposition of rates: A user’s manual. U.S. Bureau of the Census, Current Population Reports, Series P23–186. Washington, DC: U.S. Government Printing Office.Google Scholar
- DeNavas-Walt, C., Proctor, B. D., Smith, J. C., & Census Bureau, U. S. (2013). Income, poverty, and health insurance coverage in the United States: 2012. Washington, DC: U.S. Government Printing Office.Google Scholar
- Edin, K., & Kefalas, M. (2011). Promises I can keep: Why poor women put motherhood before marriage. Berkeley and Los Angeles, CA: University of California Press.Google Scholar
- Edwards, A. N. (2014). Dynamics of economic well-being: poverty, 2009–2011, current population reports, 70–137, U.S. Census Bureau, Washington, DC.Google Scholar
- Fairlie, R. W., & London, R. A. (2008). Race, ethnicity, and the dynamics of health insurance coverage. IZA discussion paper no. 3708.Google Scholar
- Fairlie, R. W., & London, R. A. (2009). Who is at risk of losing and gaining health insurance? Industrial Relations, 48, 287–310.Google Scholar
- Gamble, V. N. (1993). A legacy of distrust: African Americans and medical research. American Journal of Preventive Medicine, 9, 35–38.Google Scholar
- Grusky, D., Western, B., & Wimer, C. (2011). The Great Recession. New York, NY: Russell Sage Foundation.Google Scholar
- Harrington, M. (1962). The other America. New York: Simon and Schuster.Google Scholar
- Himmelstein, D. U., Warren, E., Thorne, D., & Woolhandler, S. (2005). Illness and injury as contributors to bankruptcy. Health Affairs (Millwood). doi: 10.1377/hlthaff.w5.63.
- Holahan, J., & McGrath, M. (2013). Reversing the trend? Understanding the recent increase in health insurance coverage among the nonelderly population. Report by the Kaiser Commission on Medicaid and the Uninsured. Washington DC.Google Scholar
- Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies of Sciences.Google Scholar
- KFF. (2013). Health care coverage by race and ethnicity: The potential impact of the affordable care act. Washington, DC: Kaiser Commission on Medicaid and the Uninsured.Google Scholar
- Monheit, A., & Schur, C. L. (1988). The dynamics of health insurance loss: A tale of two cohorts. Inquiry, 25, 315–327.Google Scholar
- Neal, D., & Rick, A. (2014). The prison boom and the lack of black progress after smith and welch. NBER Working Paper No. 20283.Google Scholar
- Smith, J. C., & Medalia, C. (2015). Health insurance coverage in the United States: 2014. https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf. Accessed 13 Oct 2016
- Swartz, K., Marcotte, J., & McBride, T. D. (1993). Personal characteristics and spells without health insurance. Inquiry, 30, 64–76.Google Scholar
- Swartz, K., & McBride, T. D. (1990). Spells without health insurance: Distributions of durations and their link to point-in-time estimates of the uninsured. Inquiry, 27, 281–288.Google Scholar
- Willis, P. E. (1977). Learning to labor: How working class kids get working class jobs. New York, NY: Columbia University Press.Google Scholar
- Zuvekas, S. H., & Weinick, R. M. (1999). Changes in access to care, 1977–1996: The role of health insurance. Health Services Research, 34, 271–279.Google Scholar