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Identifying Vulnerable Asian Americans under Health Care Reform: Working in Small Businesses and Health Care Coverage
Working in small businesses has been identified as a key factor for low coverage rates in immigrant communities. With the Affordable Care Act exempting small employers with fewer than 50 employees from providing health insurance to employees, the disparities in coverage negatively impacting small business owners and employers may persist.
Objective/Purpose
We aimed to identify specific cultural and socioeconomic predictors of Asian Americans who worked in small businesses to identify subgroups at a greater disadvantage than others in accessing health coverage.
Methods
Logistic regression models for all Asian Americans and for each ethnic group were fitted using a sample of 3,819 Asian American small business owners and employers extracted from pooled 2005-2012 California Health Interview Survey data.
Results
Individuals with low income levels, Koreans, U.S.-born Southeast Asians, immigrants without citizenship (particularly those lacking a green card), recent immigration, and limited English proficiency were associated with higher odds of lacking coverage. Low income levels and the lack of green cards among immigrants were common predictors of uninsurance for the Chinese, Koreans, and Filipinos, although nationalized citizens were more likely to be insured than U.S.-born citizens for the Japanese, Filipinos, and Southeast Asians. The odds of being uninsured differed little between small business owners and employees.
Discussion/Conclusions
Asian American small business sector, employers and employees alike, may collectively experience disadvantage in accessing health insurance coverage. In developing policy and community strategies to expand coverage under the ACA, the subgroups at the highest risk of being uninsured—most prominently, individuals with low incomes, Koreans and U.S.-born Southeast Asians—should be prioritized. Future research might investigate the diverse socioeconomic status of Asian ethnic groups and resources they might differentially leverage, as well as specific characteristics of the workplaces they typically work in, to improve understanding the varying degree of uninsurance for them.
Learning Areas:
EpidemiologyProvision of health care to the public
Public health or related research
Learning Objectives:
Discuss the challenges Asian Americans working in small businesses may collectively experience in accessing health care.
Identify the subgroups of Asian American small business owners and employees who are at higher risks of being uninsured than others.
Formulate specific strategies to expand coverage for Asian American small business owners and employees, particularly the more vulnerable subgroups.
Keyword(s): Asian Americans, Health Care Access
Qualified on the content I am responsible for because: I have been conducting research on Asian American health over the past several years, both as Senior Researcher at the Asian & Pacific Islander American Health Forum and as an Associate Scientist at the Alcohol Research Group of the Public Health Institute. My familiarity with Asian American communities and rigorous research on the health and health care access issues that impact these communities position me well to deliver a highly-informative presentation on these topics.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.