New Report Details Characteristics of Uninsured Adult Men by Race/Ethnicity

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In a new data brief from the Office of Minority Health, analysis of the 2012 American Community Survey Public Use Microdata Sample found disparities remain for ethnic minority adult males aged 19-64. Key findings from the report include:

  • Across all age groups, Latinos had the highest percentage of uninsured compared to African- Americans, Asians, and non-Hispanic Whites.
  • Approximately 40 percent of African-American and Latino males aged 35 and younger are uninsured.
  • Over 70 percent of African-American and non-Hispanic White males, and 60 percent of Asian and Lation males who are uninsured have a high school diploma.
  • Almost half of Asian uninsured male adults are married.
  • Among uninsured adult males, 28 percent Asian and 24 percent Latinos live in Limited English Proficient households.
  • Approximately 60 percent of African-American, 39 percent Latino,  39 percent non-Hispanic White, and 38 percent Asian report a family household income at 100 percent Federal Poverty Level.
  • African-American and non-Hispanic White uninsured adult males report highest percentages of disability.

Based on these findings, the data brief’s authors recommend using this data to better inform targeted outreach and enrollment efforts towards this uninsured population. Additionally, the Affordable Care Act and ability for young adults up to the age of 26 to obtain coverage from their parents’ insurance can help reduce this uninsurance gap.

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health

 

 

 

New Report Details Adult Californians’ health by race and ethnicity

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The UCLA Center for Health Policy Research released findings from analyses of 2011-12 California Health Interview Survey on various health indicators among adult Californians, including insurance status, nutrition, clinical health outcomes, health behaviors, food insecurity, and English proficiency. Health profiles were published for all racial groups (Non-Hispanic White, Lation, Black, Asian, and American Indian/Alaska Native) and provided disaggregated data for the Asian and Latino communities.

Among the Asian community,

  • 60 percent had employer-based health insurance (compared to 50% of Californian overall). After disaggregating by ethnicity, 39.8% of Koreans had employer-based insurance, 43.6% of Vietnamese, 60.6% Chinese, 66.3% Filipino, 69.8% Japanese, and 73.6% South Asian. “Other Asian” were 47.6% employer-based insured.
  • 21.5% engaged in binge drinking, with the highest percentage among Filipino (31.1%) and lowest percentage among Vietnamese (13.9%).
  • Eight percent reported having food insecurity, with the highest percentage among Vietnamese (15.6%) and the lowest among Japanese (2.5%).

Within the Latino population,

  • Fewer than 40% had employer-based health insurance, with Guatemalans having a 20% employer-based insurance percentage.
  • Greater than 70% of adult immigrant Mexicans had household incomes below 200% Federal Poverty Level (translating into $46,100 or below for a family of four). U.S.-born Mexicans had a lower percentage of 44.3%.
  • Latinos had one of the highest rates of walking regularly on a weekly basis, with Salvadoran being the most frequent walkders at 41%.
  • Almost 27% reported being food insecure, with the highest percentage reported by Salvadorans (37%) and the lowest percentage being reported by South Americans (9.0%)

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health

Limited English Proficient Communities Remain At-Risk for being Uninsured

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A new report from the Robert Wood Johnson Foundation provides state-level estimates for health insurance status among Limited English proficient (LEP) communities. Using data from the 2012 American Community Survey, the report‘s authors examined data for LEP people aged 5 years and older (e.g., did not speak English very well). Being LEP is common among the insured population, with at least 30 states and the District of Columbia having 10% of its state populations as LEP; California, New Jersey, and New York have nearly one-third of its uninsured population aged 5 and older as LEP.

Report findings indicate that a significant portion of the LEP population remains un- or under-insured. Among the estimated 24.5 million LEP population (approximately 8.6% of the total population aged 5 and above), more than 1/3 were uninsured (9.5 million). Approximately 7.3 million of the LEP population have employer-sponsored insurance, yet this population comprises of only 4.5% of the total population aged 5 and older with employer-sponsored insurance. Clost to 2 million people with LEP purchased insurance directly from an insurer, but this population comprises only 5% of the total population that purchased insurance directly in the individual market. Finally, at least 12% of the Medicaid population aged 5 and above are LEP, with 13 states having a Medicaid LEP population exceeding 10% and two states exceeding 20%).

The authors also highlight that LEP uninsured communities are at higher risk of not enrolling in public insurance or marketplace plans due to limited information provided for recent and undocumented immigrants. Furthermore, many LEP individuals that are uninsured remain at risk of not receiving appropriate in-language services and medical care. Thus, recommendations for health plans, providers, and policy makers include ensuring language assistance services that improve access to care for un and under-insured LEP populations.

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health

New report estimates the effect of ACA on 14 large and diverse US cities

The Affordable Care Act (ACA) is estimated to provide increased federal funding to all states, but the amount is heavily influenced by the extent of Medicaid expansion and enrollment in federal marketplaces. States that decide not to expand Medicaid will forgo additional federal funds and need to address the needs of their uninsured populations.  Additionally, the ACA will reduce Medicare reimbursement as well as disproportionate hospital share payments. This will pose challenges for areas that serve the uninsured across a wide region. 

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The Urban Institute recently released a report on the ACA’s effect on 14 large and diverse cities. The following cities expanded Medicaid: Los Angeles, Chicago, Seattle, Columbus,  Phoenix, Denver, and Detroit. In these seven cities: 

  • the percentage of uninsured could decrease by 57% on average by 2016
  • enrollment into Medicaid and Children’s Health Insurance Programs (CHIP) will increase 38.5% 
  • a large percentage of those remaining uninsured are undocumented (41.4% in Houston, 28.4% in Charlotte, and 35.2% in Miami)

The following cities did not expand Medicaid: Charlotte, Houston, Philadelphia, Indianapolis, Memphis, Atlanta, and Miami. In these seven cities: 

  • the percentage of uninsured could decrease by 30% on average by 2016 (27% less than the average estimated decline among the seven Medicaid expansion cities).
  • enrollment into Medicaid and Children’s Health Insurance Programs (CHIP) will increase 10.7% (27.8% less than expansion cities) 
  • a large percentage of those remaining uninsured are undocumented (41.4% in Houston, 28.4% in Charlotte, and 35.2% in Miami)

The ACA will impact each city differently based on income, race/ethnicity, and immigration status. For example, approximately 80% of the uninsured population in Miami is Latino while more than 75% of the uninsured in Detroit are Black. Policymakers and researchers will need to observe how ACA will impact each area and address issues as it relates to each different population. 

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health

New study shows Massachusetts health reform did not reduce barriers to heart related procedures

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In a new article published in American Heart Association’s journal “Circulation“, researchers from Brigham and Women’s Hospital and Howard University of Medicine examined hospital claims data and found that Massachusetts health insurance expansion did not have impact whether an individual aged 21 – 64 received coronary treatments by ethnicity, gender, or socioeconomic status. Data for more than 44,937 discharges related to heart disease was analyzed, with 82% categorized as White, 4.1% black, 4.8% Hispanic, 1.3% Asian, and 7.8% patients with missing or other race/ethnicity.

In particular:

  • For Black and Latino populations, there was no difference in likelihood to receive coronary revascularization (an important procedure that restores blood flow through the heart, such as bypass) 1-year post-health reform (30% and 16%, respectively). These communities were also less likely than the White population to receive this procedure. In this study, Asians (29%) were more likely to receive this procedure compared to Whites post-health reform, which conflicts with previous literature.
  • Patients residing in areas that had a higher proportion of high school graduates were more likely to receive coronary revascularizations pre- and post-reform.

These findings are important, especially in the midst of Affordable Care Act implementation, as this study provided early evidence that insurance expansion did not reduce barriers in receiving procedures like coronary revascularization. Furthermore, this study provided further evidence that insurance expansion alone does not eliminate health disparities as it relates to race/ethnicity and socioeconomic status. The authors recommend interventions to focus more on subgroups and for continued efforts to address disparities shaped by social determinants of health.

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health

Health Access and Quality Disparities Remain among all Ethnic Groups

Recently, the Agency for Healthcare Research and Quality (AHRQ) released its annual report on healthcare access, quality, and disparities within the US Healthcare System and included data points on over 200 measures on healthcare process, access, and outcomes from 2001-02 to 2010-11. This report also focused on disparities in healthcare delivery among different racial/ethnic groups and socioeconomic status. 

Overall, this report found quality of care to be fair (i.e. 70% of the patient population received recommended care) and varying greatly between different states, with poorer quality of care more distributed in in West South Central and East South Central states. Individuals with low socioeconomic status also received poorer care than those with higher socioeconomic status on 60% of the quality-related measures. However, access was found to have become worse, with 26% of the patient population not having difficulties receiving care (prior to Affordable Care Act implementation). Disparities were found not to have changed during the time period, with fewer gaps in disparities data among major racial groups, but disparities becoming greater in cancer screening and maternal and child health. Gaps in disparities data did remain for Native Hawaiians and Pacific Islanders. 

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Selected highlights among disparities in healthcare quality between different racial/ethnic groups include:

    • Blacks and Latinos received worse care than Whites for about 40% of quality measures.
    • There were worsening disparities between Blacks and Whites, with Blacks doing worse on measures related to late-stage breast cancer diagnosis among women aged 40 and older, maternal deaths, and patients aged 40 and older who lived with diabetes and received at least 2 hemoglobin A1C measurements annually. 
    • There was a worsening disparities between Latinos and Whites, particularly with a smaller proportion of the Latino population experiencing improved mobility among its adult home healthcare patients. 
    • Asians received worse care than Whites for about one-quarter of quality measures
    • There was a worsening disparity between Asians and Whites, with Asian adults aged 18-64 receiving pneumonia-related vaccinations if they are at high risk for chronic obstructive pulmonary disease. 
    • Native Hawaiians have higher mortality across the lifespan (40% higher compared to Whites).
    • American Indians/Alaska Natives received worse care than Whites for approximately one-third of quality measures.

 The report‘s authors indicated that the US healthcare system must focus on preventive care and chronic disease management in order to improve access to care and disparities, while also accelerating improvements in healthcare quality. The authors also called for quicker and more efficient dissemination of information and data to all stakeholders in ensuring that patients receive accessible and quality healthcare. 

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health

Native Hawaiian and Pacific Islanders Face Challenges in Education, Healthcare, Employment, and Housing

The Native Hawaiian and Pacific Islander (NHPI) population has grown by 40% in the past decade (2000-2010), the third fastest growing ethnic group after Asian Americans and Latinos. There are currently over 1.2 million NHPIs living in the United States, with an expected increase to over 2 million by 2030. According to the 2010 US Census, ethnic groups in the NHPI population include Native Hawaiian, Samaon, Tongan, Guamanian or Chamorro, Fijian, Marshallese, Tahitian, Papua New Guinean among others. 

Despite being one of the fastest growing racial groups as well as an increasing percentage of Native Hawaiian and Pacific Islander (NHPI)-owned businesses (30% between 2002 -2007), these communities continue to face challenges. In a new report that provides disaggregated data for NHPI communities, NHPI are shown to face challenges in accessing higher education, attaining affordable and quality healthcare, stabilizing jobs, and securing affordable housing.

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Highlights from the report include: 

  • Only 18% of NHPI have a bachelor’s degree, which is similar to the percentage for Blacks/African Americans. In 2011, about 38% of youth were enrolled in college, which is below the national average. Furthermore, only 23% of NHPI undergraduates completed their degree within 4 years compared to 45% for Asian and Pacific Islander students (an aggregated percentage). 
  • NHPI have higher rates of obesity and diabetes than the average, and also had an increase by 170% in suicide deaths between 2005 to 2010. Despite these selected statistics, only 1 in 7 NHPI have health insurance, and 18% of NHPI did not see a doctor because of healthcare costs. 
  • The number of unemployed NHPI increased 123% between 2007-2011, which is a percentage higher than any other racial/ethnic group. Simultaneously, the number of NHPI living in poverty increased by 56% during the same time period. 
  • The number of incarcerated NHPI increased 144% between 2002 and 2010. 

To address these disparities, the report had the following recommendations: 

  • Develop culturally appropriate education retention and recruitment programs that also encourage enrollment into higher education institutions. 
  • Increase social safety net programs. 
  • Create living-wage jobs. 
  • Fund programs that address homeownership, small business ownership, and employment disparities. 
  • Employ culturally appropriate strategies for outreach, education, and preventive services directly through venues that service NHPI communities, such as federally qualified health centers. 
  • Provide culturally competent training for law enforcement about NHPI communities and histories. 

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health