Health Insurance Gap Persists Among Latino, Black and White Americans

Drop in Employer Health Coverage for Latinos Suggests Economic Downturn Took Greater Toll; Wide Gaps in Access to Care Between Minorities and Whites Remain

News Release
Oct. 28, 2004

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Alwyn Cassil: (202) 264-3484

ASHINGTON, D.C.—The health insurance gap among Latino, black and white Americans persisted in 2003, with one in three Latinos, one in five blacks and one in 10 whites under age 65 lacking health insurance, according to a national study released today by the Center for Studying Health System Change (HSC).

Overall health insurance rates changed little between 2001 and 2003 among nonelderly blacks, whites and Latinos, but sources of coverage shifted—especially for Latinos—from job-based to public coverage, suggesting the economic downturn took a greater toll on Latinos, according to findings from HSC’s 2003 Community Tracking Study Household Survey, a nationally representative survey involving information on about 47,000 people. Increases in public coverage—primarily Medicaid and the State Children’s Health Insurance Program-among all three ethnic and racial groups helped offset declines in employer health coverage.

The proportion of nonelderly Latinos with employer health coverage declined more than 7 percentage points between 2001 and 2003, from 47.8 percent to 40.4 percent. In comparison, 53.9 percent of nonelderly blacks and 73.5 percent of whites had employer health coverage in 2003, according to the study. The drop in employer coverage was especially striking among Latino children, with employer coverage declining from 43.3 percent of Latino children in 2001 to 34.5 percent in 2003.

"Increased reliance on public coverage can be viewed either as an encouraging development—a result of expanded eligibility and outreach—or a worrisome one—minorities disproportionately losing job-based coverage," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

Shifting sources of health coverage had little effect on access to medical care between 2001 and 2003. With the sole exception of decreased access to specialists among blacks—the percentage of blacks whose last doctor visit was to a specialist declined from 24.4 percent in 2001 to 19.8 percent in 2003—access to care measures did not change significantly.

However, significant gaps in access to care persisted among racial and ethnic groups, with Latinos and blacks consistently reporting lower levels of access than whites. For example, Latinos and blacks are less likely than whites to have a regular caregiver, less likely to see a physician and more likely to see physicians in emergency rooms. When they do see physicians, blacks and Latinos are less likely than whites to see a specialist.

"As long as blacks and Latinos have greater problems getting medical care, it’s unlikely that health disparities will diminish significantly," said J. Lee Hargraves, Ph.D., author of the study and an HSC consulting researcher and associate professor at the University of Massachusetts Medical School.

The study is detailed in a new HSC Tracking Report—Trends in Health Insurance Coverage and Access Among Black, Latino and White Americans, 2001-2003. Other key findings include:

• Employer coverage for nonelderly, low-income Latinos-defined as income below 200 percent of the federal poverty level, or $36,800 for a family of four in 2003-declined from 28.3 percent in 2001 to 22.9 percent in 2003. At the same time, employer coverage for low-income whites declined from 46.3 percent to 41.8 percent, while employer coverage remained steady for low-income blacks-about a third had employer coverage in 2003.
• The proportion of nonelderly Latinos with public coverage increased from 15.6 percent in 2001 to 22.5 percent in 2003. The proportion of nonelderly whites with public coverage increased from 5.9 percent in 2001 to 8.1 percent in 2003, while the rate of blacks with public coverage in 2003 was 22.6 percent-statistically unchanged from 2001.
• Among low-income people, shifts toward public coverage were even more pronounced among Latinos and whites. Low-income Latinos with public coverage increased from 24.8 percent in 2001 to 33.4 percent in 2003, while, at the same time, public coverage rates for low-income whites increased from 20.5 percent to 27.1 percent.
• Between 1997 and 2003, less than two-thirds of blacks (65.8%) and a somewhat more than half of Latinos (55.4%) reported having a regular health care provider, compared with three-quarters of whites (76.3%). Latinos and blacks also are less likely than whites to have had a doctor visit in the last 12 months. With the exception of a slight increase in 1999, less than three in four nonelderly blacks (73.8%) and slightly more than three in five Latinos (62.8%) saw a doctor, compared with four in five whites (79%).
• Gaps in access to care also persisted among insured and uninsured nonelderly blacks, Latinos and whites. For example, 80.1 percent of insured blacks in 2003 reported seeing a doctor in the past year, compared with 48 percent of uninsured blacks. Similarly, 74.8 percent of insured Latinos and 82.6 percent of insured whites in 2003 saw a doctor, compared with 38.5 percent of uninsured Latinos and 50.3 percent of uninsured whites.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.