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

Popul Res Policy Rev (2017) 36:181201

DOI 10.1007/s11113-016-9416-y

Received: 12 April 2016 / Accepted: 7 October 2016 / Published online: 15 October 2016 Springer Science+Business Media Dordrecht 2016

Abstract 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-specic 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-specic patterns of disparity prior to the Affordable Care Act (ACA). A formal decomposition on incrementdecrement 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.

Keywords Race Inequality Health insurance Life tables

Introduction

Racial and ethnic disparities in health insurance coverage rates account for a sizable share of the difference in access to health care (Lillie-Blanton and Hoffman 2005). African American and Hispanic individuals in the United States are more likely to

& Heeju Sohn [email protected]

1 Department of Health Policy and Management, UCLA Fielding School of Public Health, 650

Charles E. Young Dr. S. 31-269, Los Angeles, CA 90095, USA

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be uninsured throughout adulthood compared to non-Hispanic individuals (Kirby and Kaneda 2010). Without insurance, people face considerable barriers in receiving health services. Many health care providers require insurance coverage from their patients or charge a prohibitively high fee (Himmelstein et al. 2005; Institute of Medicine 2003; Kasper et al. 2000; Nelson et al. 1999; Zuvekas and Weinick 1999)....