Health Insurance of Minorities in the United States

Presentation HEALTH INSURANCE OF MINORITIES IN THE UNITED STATES PAMELA FARLEY SHORT, Ph.D. LLEWELLYN J. CORNELIUS, Ph.D. DONALD E. GOLDSTONE, M.D., M.P.H. Division of Intramural Research Agency for Health Care Policy and Research U.S. Department of Health and Human Services Americans who are not covered by some type of health insurance are exposed to health and financial risks. Most of the population is protected from these risks by private insurance, generally obtained as an employment benefit. Public programs such as Medicare and Medicaid protect certain populations among the remainder without private insurance. However, one out of every six Americans under the age of 65 is uninsured, and the number of uninsured persons has increased by 40 percent over the last decade. Blacks and Hispanics accounted for a large portion (50 percent) of the additional 13 million persons who were uninsured in 1987 compared to 1977. Several factors contributed to the rapid increase in the number of uninsured persons in these minority groups. First, the number of blacks and Hispanics in the U.S. population grew more rapidly over the decade than the number of whites. Between 1977 and 1987, the white population under 65 increased about 4 percent. The black population increased 17 percent, more than four times as fast as the number of whites. The Hispanic population increased 65 percent, more than 16 times faster than whites. Consequently, even if the proportion of blacks and Hispanics without coverage were the same as the proportion of uninsured whites, the number of uninsured persons in these minority groups would have increased more rapidly. In reality, relatively more blacks and Hispanics than whites were uninsured in 1977, and the disparities grew even more pronounced over the decade. The views expressed in this paper are those of the authors. No official endorsement by the Department of Health and Human Services or the Agency for Health Care Policy and Research is intended or should be inferred. Journal of Health Care for the Poor and Underserved, Vol. 1, No. 1, Summer 1990 IC)_____________________Health Insurance of Minorities_______________________ The increasing number of uninsured Americans generally, and uninsured minorities particularly, is a major public concern. There is evidence that being uninsured makes a difference in the use of health services and probably in health status as well. Compared to persons with private or public insurance, the uninsured are less likely to have a usual source of care. They use fewer ambulatory and hospital services than insured persons in similar health, and they are more likely to report needing medical help that they were unable to obtain.1-3 Uninsured children in low-income families make fewer visits to physicians than otherwise similar children who have public or private insurance .* Furthermore, despite using fewer services, the uninsured often spend as much or more out-of-pocket for their care." Research studies also indicate that lack of insurance coverage helps discourage the use of some preventive services. For example, uninsured women are more likely than other pregnant women to delay prenatal care until the third trimester,8 and uninsured newborns appear to run a higher risk of birth complications and death.9 Uninsured adults are less likely to have their blood pressure checked and are more likely to have elevated blood pressure.1"2 In recent years, both federal and state legislatures have given a great deal of attention to the problem of extending coverage to some or all of the uninsured. The political support for these efforts arises partly out of recognition of the increase in the uninsured population and sympathy for the problems that the uninsured confront in obtaining services. There is also a growing appreciation of the social and long-term costs that may be associated with limiting access to medical care. Two facts about the uninsured have greatly shaped these legislative initiatives. First, three-quarters of the uninsured are in families where there is at least one working adult, although most workers and their families are covered by employer-sponsored plans. Second, the majority of the uninsured are in poor or low-income families. The first observation has given impetus to efforts to expand employee health benefits—by mandating...