Racial Wealth Inequality and Access to Care with High-Deductible Health Insurance

Abstract

This paper evaluates racial inequalities in health-care affordability between high-deductible and conventional insurance. Using the 2011-2017 National Health Interview Survey, the study finds that Blacks in high-deductible plans are not disproportionately higher income, nor more engaged in other savings vehicles, unlike their White counterparts, indicating they may be income constrained rather than desiring to partially self-insure. Furthermore, conditional on income, wealth explained more of the racial disparity in health-care access among high-deductible enrollees than conventional enrollees, consistent with the hypothesis that benefit designs relying on households' cash reserves would yield greater disparities due to the magnitude of racial inequalities in assets.