Intra-Ethnic Coverage Disparities among Latinos and the Effects of Health Reform
Analyses of a variety of national surveys have demonstrated that the Affordable Care Act (ACA) open enrollment periods and Medicaid expansion have resulted in increased insurance coverage and access to care since 2014. Previous studies have typically investigated racial and ethnic variation between Whites, Blacks, non-White Latinos, and a catch-all Other Category, but rarely explore differences within pan-ethnic classifications. These broad categories may mask the notably different structural barriers to health insurance faced by different sub-groups. Our study examines the patterns of coverage disparities within 9 Latino sub-groups and assesses the impact of the ACA on these disparities in 2014, using the Census Bureau’s American Community Survey.
First, using pre-ACA data (2010-2013), we explore the baseline coverage differences among Latino groups for non-elderly adults (19-64) and then use multivariate regression models to identify which sociodemographic factors help explain the disparities in coverage between these groups compared to white non-Latinos. Then we evaluated the effects of the ACA’s first full year of coverage expansion in 2014 on coverage rates among these groups.
At baseline, we find large disparities in coverage between Latino sub-groups that in fact are greater than the disparity between non-Latino Whites and Latinos as a whole. Pre-ACA coverage rates varied from 18.3% for Spanish adults and 22.7% for Puerto Ricans, to 47.7% for Mexicans and 55.0% for Central Americans, compared to 15.7% for Whites. Furthermore, we find that the sources of disparity vary across sub-groups of Latinos. High rates of non-citizenship account for nearly half of the white-Latino coverage gap among Mexicans and Central Americans, but it has almost no impact on Puerto Ricans. Lower income and educational levels also explain a portion of the disparities for most sub-groups.
After 2014, we find significant reductions in the uninsured rates for all Latino sub-groups. Increases in coverage were greatest among Cubans, Central Americans, Mexicans, and South Americans, who all experienced gains between 4 and 5 percentage points. Coverage gains were smallest among Puerto Ricans, Spanish, and Dominicans (1 to 2 percentage points).
Our results highlight that while pan-ethnic classifications allow for simplified analyses of disparities–and also enable straightforward multivariate adjustment for race/ethnicity–different sub-groups of Latinos show very marked heterogeneity in baseline coverage rates and responses to the ACA. More nuanced analyses can allow for more targeted policy efforts for particular populations that may otherwise be overlooked.