Following the passage of the Affordable Care Act (ACA) in 2010, the rate of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) without health insurance dropped to 9%—a rate essentially equal to that of whites (8.8%), according to a new study by researchers from Harvard T.H. Chan School of Public Health and colleagues. Although the coverage gap between whites and nonwhites shrank for adults in all major racial and ethnic groups under the ACA, AANHPIs are the only group for which the disparity was eliminated.
The study will be published online April 30, 2018, in JAMA Internal Medicine.
It is the first study to look at coverage gains for AANHPIs. The fastest growing racial and ethnic group in the U.S., they represent more than 50 ethnicities and speak 100 languages.
"The ACA appears to have levelled disparities in health insurance coverage between minority groups, while also ensuring that we can collect this data in the first place," said first author John Park, MPH '17 at Harvard Chan School. "The ACA requires that all federally funded health surveys of self-reported information collect disaggregated data for racial minorities who may have been invisible in the past."
The researchers analyzed data from the American Community Survey, which collects demographic data from 295,000 households annually. They calculated changes in the uninsured rate among adults before the ACA's major coverage expansions (2009-2013) and after (2015-2016).
People in all AANHPI subgroups saw coverage gains under the ACA. Reductions in uninsured rates ranged from -14.3 percentage points in the Guamanian or Chamorro subgroup to -4.1 in the Japanese subgroup.
"The notable gains in health insurance coverage for AANHPI groups represent valued progress toward health equity," said senior author Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard Chan School and Harvard Kennedy School.
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"Health Insurance for Asian Americans, Native Hawaiians, and Pacific Islanders Under the Affordable Care Act," JAMA Internal Medicine (2018). DOI: 10.1001/jamainternmed.2018.1476