Story at a glance
- A new study shows that the health insurance coverage gap between Asian Americans and white Americans has narrowed since the passage of the Affordable Care Act.
- Some subgroups, however, lag behind others, according to a demographic breakdown of the data.
- The study’s authors credit some of the progress to the expansion of Medicaid coverage in some states.
Since the passage of the Affordable Care Act (ACA) a decade ago, the gap in health coverage between Asian Americans and white Americans has closed, a new study shows.
Across the board, uninsured rates have dropped by nearly half in the past 10 years. In 2010, nearly 20 percent percent of Asian Americans between 19 and 64 were uninsured, according to data from the American Community Survey, compared to about 15 percent of white Americans. By 2018, that number had dropped to just 7.9 percent of Asian Americans and 8.5 percent of white Americans.
“The combination of Medicaid expansion and improving marketplaces have dramatically improved coverage among whites and people of color,” said Sarah Collins, one of the authors of the study conducted by the Commonwealth Fund, adding that this corresponds with a general improvement of the economy.
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Still, nearly a quarter of American Indian and Hispanic populations and 14.2 percent of Black Americans remain uninsured. Collins said that one reason for this disparity is the disproportionate representation of Asian Americans in states that have expanded their Medicaid programs, compared to other populations. Just 6.5 percent of Asian Americans in states that have expanded Medicaid are uninsured, compared to 12.3 percent in states that have not expanded the program.
The study also broke down the Asian American population into subgroups, and separated it entirely from Pacific Islanders, a population it is often combined with in research.
“We looked at these different groups and saw that they’re really different. They’re on two ends of the spectrum when it comes to uninsurance rates,” said Munira Gunja, another one of the study’s authors. “We knew that if we combined these groups we would be conflating the numbers.”
Korean Americans have maintained the highest uninsured rate, dropping from just more than 30 percent to now about 11 percent, followed by Vietnamese and "other" Asian Americans. In comparison, Chinese, Filipino and Indian Americans were more likely to be insured, with just a 5.4 percent uninsured rate among Indian Americans, the lowest of all subgroups. Gunja said there are a number of potential reasons to explain the disparities, including cultural stigma, inability to access certain technologies and language barriers.
But the study doesn’t take into account the effect of the coronavirus pandemic on the economy and health insurance coverage. In May, the unemployment rate for Asian Americans soared to 15 percent, and more than half of minority-owned businesses are owned by Asian Americans, putting their livelihoods and coverage at risk. While a higher percentage of Asian Americans are covered by private market or Medicaid insurance than white Americans, a majority are still covered by employer-sponsored insurance.
Collins said that now, more than ever, both the state and federal governments need to expand Medicaid coverage, extend marketplace subsidies and provide funding for outreach and assistance for undercovered populations.
The study also said that coverage gains have generally stalled since 2016, when President Trump was elected, blaming a lack of Medicaid expansion in 14 states, affordability barriers and immigration policies that have reduced enrollment. An estimated 1.7 million Asian Americans are undocumented, making them ineligible for coverage.
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