Racial Justice in Health Care: Coverage Disparities

Posted May, 9 2019 by Amanda Dunker

On Tuesday we released an agenda for achieving racial justice in health care in New York. Today we’ll take a closer look at one factor that contributes to inequities in health care – white New Yorkers are more likely to have health insurance than others.

The most recent data on health coverage in the United States comes from the Census Bureau’s Small Area Health Insurance Estimates (SAHIE) for 2017. Right off the bat there are a couple missing pieces. The only racial and ethnic categories available for analysis are White alone, Black alone, and Hispanic (of any race). For one, what about people of Asian descent or who are mixed race? And second, people who say their ethnicity is Hispanic may have very different health care experiences depending on their race. We can’t pick up on something like that using this data-set.

We also can’t look at race and ethnicity at the county level, something that the SAHIE does provide for some other categories. It is especially challenging to get data by race and ethnicity at local government levels because in many counties of New York, the populations are too small to allow enough data points to meaningfully analyze trends.

Examining the available data shows some interesting differences in health insurance coverage depending on race and ethnicity. At every income category, people who said they were Hispanic are much more likely to be uninsured. Overall, about 9 percent of Hispanic people were uninsured, compared to 5.7 percent of people who reported their race as Black and only 3.5 percent of people who reported being White.

Looking at the data by income reveals some interesting differences:

Below 138% of the Federal Poverty Level:

People who reported their race as Black alone and White alone have almost the same likelihood of being uninsured (7.4 percent and 7.8 percent respectively). But for Hispanic (any race), the percent of uninsured at this level is shocking: 14.5 percent.

At this income, most New Yorkers are eligible for Medicaid. Some immigrants are eligible for the Essential Plan, which was created through the Affordable Care Act (ACA). The ACA excludes fewer immigrants from coverage than the Medicaid statute. That means New York was able to use the Essential Plan to cover many immigrants who would be income-eligible for Medicaid otherwise. But there are still many immigrants with very low-incomes who are not allowed to participate in public health programs because of their immigration status.

Between 138 and 400% of the Federal Poverty Level:

At this level there is more of a gap between the Black alone and the White alone categories: 8.2 percent of people who said their race was Black alone were uninsured, compared to 6.3 percent of people who said their race was White alone. People who said they are Hispanic were still uninsured at shockingly high rates: 14.5 percent.

At this income level, people move from eligibility for public coverage through Medicaid to public coverage for the Essential Plan and then into the private market. Essential Plan eligibility goes up to 200 percent of the federal poverty level. Above that, most uninsured New Yorkers can use the New York State of Health to purchase insurance and will be eligible for some level of premium subsidy. There are some glaring exceptions: depending on their type of immigration status, many immigrants are not allowed to purchase insurance on the New York State of Health, even if they use their own money and chose not to receive any assistance.

Above 400% of the Federal Poverty Level:

At this income level the gaps between Black alone and Hispanic (any race) close a bit, but the gaps between those categories and White alone increase. Only 2.2 percent of people who reported being White alone said they were uninsured. For Black alone 5 percent were uninsured and for Hispanic (any race) 6.5 percent were uninsured.

At this income New Yorkers are no longer eligible for any type of public coverage or premium assistance. Native-born New Yorkers and some immigrants can use the New York State of Health to shop for insurance and pay the full premium themselves.

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