Recorded presentation

Stephen Zuckerman¹, Yu-Chu Shen, PhD², and Tim Waidmann, PhD¹. (1) The Urban Institute, 2100 M Street NW, Washington DC, DC 20037, (2) Graduate School of Business and Public Policy, Naval Postgraduate School, 555 Dyer Road, Monterey, CA 93943, 831-656-2951, yshen@nps.edu

African Americans and Hispanics lag behind whites in having any insurance coverage, mostly due to lower rates of employer sponsored health insurance. Despite the large number of studies of racial/ethnic disparities in coverage, little is known about the relative contribution of factors that affect the demand for and supply of health insurance (e.g., health status, income, labor market conditions or provider supply) in explaining coverage disparities. If these disparities are influenced by factors that are in policymaker’s control, understanding why disparities exist may suggest options for closing the observed gaps in coverage.

In this analysis we identify factors that explain the gaps in private and public insurance coverage between African Americans, Hispanic citizens, Hispanic non-citizens, and non-Hispanic whites and quantify their relative importance. Using data from the 1999 and 2002 National Surveys of America’s Families, we estimate linear probability models of private and public coverage for each race/ethnicity group that we compare to whites. The parameters from these models are used to predict the overall gap in private and public insurance between each race/ethnicity group and whites as well as the gap that would exist if only one factor differed between each race/ethnicity group and whites. For example, we ask and answer the question, “what would the private coverage rate be for African Americans if, for example, their income distribution were the same as whites?”

We find that demand side factors dominate supply side factors (workplace characteristics, local labor market conditions) in explaining coverage gaps for all race/ethnicity groups. Among the demand side factors, income is the most important factor. Over 2/3 of White citizens have income above 400% of federal poverty line (FPL), while less than 45% of African-American and Hispanic citizens and only 15% of Hispanic non-citizens are above this income threshold. As such, income accounts for 40-50% of the explained difference between White and the three minority groups. Education also plays an important role, especially in the case of Hispanic non-citizens where only 5% of this population has a college degree compared to 30% of the white population. In addition, African Americans are four times more likely than whites to be single parents and three times more likely to be eligible for public coverage, both factors are associated with lower private coverage and higher public coverage. Lastly, local provider characteristics influence people’s choice of insurance coverage and contribute to the coverage gap between white and the three race/ethnicity groups.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Identify and articulate the factors contributing to the racial and ethnic disparity in private and public health insurance coverage.
• Discuss policy options for closing the observed racial and ethnic gaps in insurance coverage

Keywords: Health Insurance, Health Disparities

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation