Ethnicity and employer-sponsored insurance as predictive factors of uninsurance among Hispanics in a rural state

Objective: Inform Nebraska policymakers working to expand health coverage by determining correlations among Hispanic ethnicity, ESI, and uninsurance. Significance: Rural states have experienced unprecedented growth of Hispanic populations in recent years and Hispanics are over-represented in jobs without employer-sponsored health insurance (ESI). Methods: The 2004 Nebraska State Planning Grant (NSPG) random-digit-dialed telephone survey (n=3750) and focus groups, also conducted in Spanish, provided data. Bivariate analyses described employment and insurance differences between Hispanics (n=448) and non-Hispanics; multivariate regression analysis detected association among uninsurance, ethnicity, and ESI. Key contacts recruited participants for three Hispanic (n=31) and two employer (n=12) focus groups. Group proceedings were audio-recorded, transcribed, and coded for analysis. Findings: Hispanics were more likely than non-Hispanics to be employed. Ten percent fewer Hispanics than non-Hispanics were enrolled in available ESI. Hispanics (21.7%) and non-Hispanics (20.0%) did not enroll because contributions were “too expensive.” Ethnicity was not a significant predictor of ESI (p=.275) when controlling for age, marital status, and poverty. Uninsurance was more strongly associated with poverty (p=.001) than ethnicity or ESI. Hispanics with jobs not offering ESI were more likely to be uninsured than those with ESI available (OR=1.11). Hispanic focus group participants said they valued ESI, but it was difficult to obtain due to cost and lack of information. Employer participants indicated ESI was not a factor in recruiting and retaining Hispanic employees because they preferred wages over benefits. Conclusions: Uninsurance among Nebraska's Hispanics is due to poverty rather than ethnicity or ESI availability. Policies to mitigate uninsurance among Nebraska's Hispanic population should make ESI affordable for low-wage workers and encourage employers to inform Hispanic employees about ESI. Research is needed to define Hispanics' contribution to the rural economy to support policies that improve health access for this population.