Eliminating the Gap: The Impact of the Affordable Care Act on Asian Americans

Abstract

Research ObjectiveThis study looks at the coverage impact of the Affordable Care Act (ACA) on Asian Americans and Asian American subgroups. Asian Americans are the fastest growing minority group in the United States. There is a growing, but still deficient, set of literature looking at health access issues for the broader Asian American population and the distinct subgroups. Furthermore, in the past they have often been defined as a single population and inappropriately grouped with other populations, such as Alaskan Natives, American Indians, and Pacific Islanders, for data purposes. This characterization ignores the dozens of unique subpopulations under the Asian American umbrella, and the socioeconomic disparities and immigration status challenges within those subgroups.Study DesignData for this study come from the National Health Interview Survey, 2010‐2018.Population Studied: Our sample population consists of approximately 50 000 adults aged 19‐64 for each survey year. In order to increase sample size and precision, we combined years of data together: 2010‐11, 2012‐13, 2014‐16, and 2017‐18.Principal FindingsOver the past decade, Asian Americans experienced the largest proportional decline in uninsurance (58%) among all races, and by 2017‐2018, Asians were less likely to be uninsured compared to whites, with an uninsured rate of 8%. Still, these gains varied among different Asian subgroups, with Chinese experiencing a 61% reduction, Indians experiencing a 57% reduction, “other” Asians experiencing a 54% reduction, and Filipinos experiencing a 42% reduction. By 2017‐2018, Asian Americans who earned between 100 and 399 percent of poverty had the lowest uninsured rate (11%) and the largest drop in uninsurance (59%) compared to whites, blacks, and Hispanics in the same income band. When we look at coverage by citizenship status, 9% of Asian citizens were uninsured compared to 17% of noncitizens by 2017‐2018. The Asian noncitizen coverage trends differed significantly from the Hispanic noncitizen trend.ConclusionsThe Affordable Care Act eliminated the insurance coverage gap between Asian Americans and whites. Their outsized progress within the 100‐399 percent of poverty range helps explain their larger coverage gains under the ACA which were driven by gains through the individual market and Medicaid. We also find that citizenship status has a significant impact on insurance coverage among the Asian populations.Implications for Policy or PracticeThere are four main policy implications from this study: Our findings show the heterogeneity of different subgroups within the Asian American population and the importance of consistently collecting this demographic information in order to inform policies. Strong community‐based outreach/navigation efforts with cultural and language‐specific strategies are likely critical, as Asian Americans have closed the coverage gap with whites through the individual market and Medicaid. Medicaid expansion has had an outsized effect on the Asian American population, as at least 80 percent of Asians Americans live in states that expanded their Medicaid program. Data indicate that immigrants are using fewer public services in the face of the Administration’s public charge rule—and as this population is the fastest growing minority group, the Administration’s actions could reverse the coverage gains made by this group. Primary Funding SourceThe Commonwealth Fund.