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Racial and Ethnic Disparities in Health Insurance Coverage in the USA: Findings from the 2018 National Health Interview Survey

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Abstract

Under the broad context of health care reforms, I explored racial and ethnic disparities in health insurance coverage as well as potential mechanisms that might contribute to these disparities for an extensive list of groups. The study used the 2018 National Health Interview Survey to analyze the effects of race/ethnicity on uninsurance, with adjustment for other predisposing characteristics (age, gender, marital status, and immigration status), enabling resources (education, income, language proficiency, and region), and need (self-reported health status). Results from the study documented an average uninsured rate of 13%, with substantial variations across different racial and ethnic groups, ranging from over 30% among Native Americans and Mexicans to less than 10% among whites and Asian subgroups. Enabling resources significantly reduced uninsurance among African Americans, Puerto Ricans, and Cubans compared to whites. On the other hand, these confounding factors only partially contributed to uninsurance among Native Americans, Mexicans, Mexican Americans, Dominicans, and other Central and South Americans. This study revealed substantial racial/ethnic disparities in uninsured rates, with Native Americans and a few Hispanic subgroups (Mexicans, Mexican Americans, and Dominicans) having higher and Asian Indians having lower rates than whites in uninsurance. Pathways leading to coverage varied by race/ethnicity. The main findings yielded empirical, theoretical, and policy implications that contributed to health care disparity research.

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References

  1. Crowley R, Daniel H, Cooney TG, Engel LS. Envisioning a better U.S. health care system for all: coverage and cost of care. Ann Intern Med. 2020;172(2 Suppl):S7–S32.

  2. Tikkanen R, Abrams MK. U.S. Health care from a global perspective, 2019: Higher spending, worse outcomes? Commonwealth Fund. 2019. Available at: https://www.commonwealthfund.org/sites/default/files/2020-01/Tikkanen_US_hlt_care_global_perspective_2019_OECD_db_v2.pdf. Accessed 16 Feb 2022.

  3. Fein R. On achieving access and equity in health care. Milbank Q. 2005;83(4):10.

    Article  PubMed Central  Google Scholar 

  4. Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283(19):2579–84.

    Article  CAS  PubMed  Google Scholar 

  5. Williams DR, Rucker TD. Understanding and addressing racial disparities in health care. Health Care Financ Rev. 2000;21(4):75–90.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Institute of Medicine. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington (D.C.): The National Academies Press; 2003.

  7. Obama B. United States health care reform: progress to date and next steps. JAMA. 2016;316(5):525–32.

    Article  PubMed  PubMed Central  Google Scholar 

  8. VanGarde A, Yoon J, Luck J, Mendez-Luck CA. Racial/ethnic variation in the impact of the Affordable Care Act on insurance coverage and access among young adults. Am J Public Health. 2018;108(4):544–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chen J, Vargas-Bustamante A, Mortensen K, Ortega AN. Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Med Care. 2016;54(2):140–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Austin A. Obamacare reduces racial disparities in health coverage. Center for Global Policy Solutions. Available at: http://globalpolicysolutions.org/resources/obamacare-reduces-racial-disparities-in-health-coverage/2015. Accessed 3 Oct 2021.

  11. Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the affordable care act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D, Fazlul I. The three-year impact of the affordable care act on disparities in insurance coverage. Health Serv Res. 2019;54(S1):307–16.

    Article  PubMed  Google Scholar 

  13. Caraballo C, Massey D, Mahajan S, et al. Racial and ethnic disparities in access to health care among adults in the United States: a 20-year National Health Interview Survey analysis, 1999–2018. medRxiv [Preprint]. 2020. Available at: https://pubmed.ncbi.nlm.nih.gov/33173905/. Accessed 2 Jan 2022.

  14. Adepoju OE, Preston MA, Gonzales G. Health care disparities in the post–Affordable Care Act era. Am J Public Health. 2015;105(S5):S665–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Griffith K, Evans L, Bor J. The Affordable Care Act reduced socioeconomic disparities in health care access. Health Aff. 2017;36(8):1503–10.

    Article  Google Scholar 

  16. Lantz PM, Rosenbaum S. The potential and realized impact of the Affordable Care Act on health equity. J Health Polit Policy Law. 2020;45(5):831–45.

    Article  PubMed  Google Scholar 

  17. Dabbous M, François C, Chachoua L, Toumi M. President Trump’s prescription to reduce drug prices: from the campaign trail to American patients first. J Market Access & Health Policy. 2019;7(1):1579597.

    Article  Google Scholar 

  18. Thompson FJ, Gusmano MK, Shinohara S. Trump and the Affordable Care Act: congressional repeal efforts, executive federalism, and program durability. Publius: The J Federalism. 2018;48(3):396–424.

  19. Institute of Medicine. Care without coverage: too little, too late. Washington (D.C.): The National Academies Press; 2002.

  20. Rice T, Unruh LY, van Ginneken E, Rosenau P, Barnes AJ. Universal coverage reforms in the USA: from Obamacare through Trump. Health Policy. 2018;122(7):698–702.

    Article  PubMed  Google Scholar 

  21. Sommers BD. Why health insurance matters—and why research evidence should too. Acad Med. 2017;92(9):1228–30.

    Article  PubMed  Google Scholar 

  22. McWilliams JM. Health consequences of uninsurance among adults in the United States: recent evidence and implications. Milbank Q. 2009;87(2):443–94.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Powers M, Faden R. Racial and ethnic disparities in healthcare: an ethical analysis of when and how they matter. In: Institute of Medicine. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington (D.C.): The National Academies Press; 2003.

  24. Artiga S, Hill L, Orgera K, Damico A. Health coverage by race and ethnicity, 2010–2019. KFF, 2021. Available at: https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/. Accessed 2 Jan 2022.

  25. Buchmueller TC, Levy HG. The ACA's impact on racial and ethnic disparities in health insurance coverage and access to care. Health Affairs. 2020;39(3):395–402.

  26. Frean M, Shelder S, Rosenthal MB, Sequist TD, Sommers BD. Health reform and coverage changes among native Americans. JAMA Intern Med. 2016;176(6):858–60.

    Article  PubMed  Google Scholar 

  27. National Center for Health Statistics. 2018 National Health Interview Survey (NHIS) public use data release. Hyattsville, Maryland: National Center for Health Statistics; 2019. Available at: https://www.cdc.gov/nchs/nhis/nhis_2018_data_release.htm. Accessed 1 Feb 2021.

  28. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  29. Barger SD, Gallo LC. Ability of ethnic self-identification to partition modifiable health risk among U.S. residents of Mexican ancestry. Am J Public Health. 2008;98(11):1971–8.

  30. Stata Corporation. Stata survey data reference manual. Release 17. College Station, TX: STATA Corporation; 2021.

  31. National Center for Health Statistics. NCHS fact sheet. Available at: https://www.Cdc.Gov/nchs/data/factsheets/factsheet_health_insurance_data.Pdf. Accessed 3 Oct 2021.

  32. Witter D. 2019. U.S. Uninsured rate rises to four-year high. Available at: https://news.gallup.com/poll/246134/uninsured-rate-rises-four-year-high.aspx. Accessed 3 Oct 2021.

  33. Steffie W, et al. Public policy and health in the Trump era. The Lancet. 2021;397(10275):705–53.

    Article  Google Scholar 

  34. Hadley J. Sicker and poorer—the consequences of being uninsured: a review of the research on the relationship between health insurance, medical care use, health, work, and income. Med Care Res Rev. 2003;60(2 Suppl):3S–75S.

  35. Alspaugh A, Lanshaw N, Kriebs J, Van Hoover C. Universal health care for the United States: a primer for health care providers. J Midwifery Womens Health. 2021;66(4):441–51.

    Article  PubMed  Google Scholar 

  36. Clancy CM, Eisenberg JM. Outcomes research: measuring the end results of health care. Science. 1998;282(5387):245–6.

    Article  CAS  PubMed  Google Scholar 

  37. Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984;100(2):258–68.

    Article  CAS  PubMed  Google Scholar 

  38. Pescosolido BA, Boyer CA. Understanding the context and dynamic social processes of mental health treatment. In: Scheid TL, Brown TN, editors. A handbook for the study of mental health: Social contexts, theories, and systems. 2nd ed. Cambridge: Cambridge University Press; 2009. p. 420–38.

    Chapter  Google Scholar 

  39. Pescosolido BA, Olafsdottir S. The cultural turn in sociology: can it help us resolve an age-old problem in understanding decision making for health care? Sociol Forum. 2010;25(4):655–76.

    Article  Google Scholar 

  40. Phillips KA, Morrison KR, Andersen R, Aday LA. Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization. Health Serv Res. 1998;33(3):571–96.

    CAS  PubMed  PubMed Central  Google Scholar 

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  1. Department of Sociology, Ball State University, Muncie, IN, 47306, USA

    Fang Gong

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  1. Fang Gong
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Correspondence to Fang Gong.

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Gong, F. Racial and Ethnic Disparities in Health Insurance Coverage in the USA: Findings from the 2018 National Health Interview Survey. J. Racial and Ethnic Health Disparities 10, 651–659 (2023). https://doi.org/10.1007/s40615-022-01253-2

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