Disparities in Health Insurance and the Intersection of Race/Ethnicity, Sexuality, and Gender Identity

Abstract

Abstract: Status characteristics including race, sexuality, and gender identity play a significant role in people's access to health and healthcare coverage. Despite documented disadvantages across these individual statuses (e.g., race), little research has investigated how the intersection of statuses affect health coverage. Drawing on an intersectional framework, this study uses data from the 2021 Behavioral Risk Factor Surveillance System to examine the association between health insurance and the intersections of race-ethnicity, sexual orientation, and gender identity (n=206,338). This study offers three important contributions to the research literature. First, this study represents one of the first to examine the intersection of important social status characteristics and health insurance status. Second, this study examines three indicators of healthcare coverage including status (i.e., insured or not), type (i.e., public, private, employer-based, or none), and denial of coverage (i.e., insurance refused to pay for cancer treatment). Third, we investigate healthcare disparities using data representative of thirty-two states that more holistically assess people's healthcare status and allow for greater generalizability. Findings show that Hispanic straight cismen are the least likely group to have insurance. White trans adults appear to be more likely to have insurance than many other groups. Trans adults are more likely to have public insurance if they are ethnoracially marginalized. Straight Black women have high likelihoods of their insurance denying coverage. These findings highlight critical gaps in access to healthcare and myriad disadvantages in coverage. Efforts to improve population health would benefit from an intersectional lens that focuses on how multiple status characteristics shape people's access to healthcare across the life course.