Background: Racial and ethnic minorities in the U.S. are more likely to be uninsured than non-Hispanic Whites. The Affordable Care Act (ACA) reduced these disparities; however, previous work has focused on broad racial-ethnic categories that inadequately address the heterogeneity existing within minority communities.
Goal: This study investigates the interplay between socio-demographic factors and ethnicity for six major Asian-American subgroups related to continued post-ACA disparities.
Objectives: 1. Describe the socio-demographic variations between Asian-American ethnic subgroups related to health insurance status. 2. Assess existing disparities in health insurance coverage within the Asian-American population after the implementation of the Affordable Care Act.
Approach: Using the American Community Survey, we examined relative changes in health insurance coverage rates for non-elderly non-Hispanic Whites compared to Chinese, Japanese, Filipino, Indian, Korean, and Vietnamese Americans between 2012-2016 (before and after major provisions of the ACA were implemented). We then used a regression framework to examine the contribution of demographics (e.g. age, family structure), socioeconomic status (e.g. education, income), and community characteristics (e.g. concentration of local ethnic populations) on coverage disparities in the post ACA period (2014-2016).
Results: We observed n=5,275,791 non-elderly individuals in our analytic sample. Overall, between 2012-2016, there was a substantial decline in the absolute percentage-point disparity in uninsurance for Chinese, Vietnamese, and Koreans. In 2014-2016, Vietnamese and Koreans still had 2.3-5.6 percentage-points higher uninsured rates (p<0.05) than non-Hispanic Whites. The disparities for Vietnamese, but not for Koreans, were explained by their socio-demographic characteristics. Further results are upcoming.
Importance to public health: Results suggest the ACA reduced uninsured rates for major Asian-American subgroups, yet Koreans continue to experience disparities in insurance status. This highlights the need to use disaggregated data for further investigations into the impact of health policies across diverse racial and ethnic groups.