Exploring Race & Ethnicity Health Insurance Coverage Differences: Results from the 2011 Oregon Health Insurance Survey

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1 Office for Oregon Health Policy and Research Exploring Race & Ethnicity Health Insurance Coverage Differences: Results from the 2011 Oregon Health Insurance Survey September 2012

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3 Table of Contents Race & Ethnic Population... 1 Uninsurance Rates... 2 Twelve-month Gap in Insurance Coverage... 4 Twelve-month Lack of Insurance... 5 Uninsurance Rates by FPL... 6

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5 Exploring Race & Ethnicity Health Insurance Coverage Differences Results from the 2011 Oregon Health Insurance Survey This brief is the third in a series of reports exploring health uninsurance in Oregon from data gathered in the 2011 Oregon Health Insurance Survey (OHIS). The OHIS, conducted by the Oregon Health Authority during the first four months of 2011, provides detailed information on the health coverage, access, and utilization of Oregon s residents. The survey interviewed over 10,500 households. For overall health insurance coverage results, regional coverage results, or survey methodology, visit the Office for Oregon Health Policy and Research (OHPR) Health Insurance Coverage webpage 1. This brief explores differences in the uninsurance rate of Oregonians of various racial and ethnic groups in Oregon. 2 Exploring race and ethnicity characteristics in Oregon is difficult due to the relatively small population of minority groups in the state. According to the 2010 Census, Oregon s population is roughly 3.8 million residents with the vast majority self-described as White non-hispanics. 3 Figure 1 details Oregon s racial and ethnic makeup captured in the 2010 Census. 4 Figure 1: Oregon's Race & Ethnic Population, 2010 non-hisp Multiple Race, 2.9% Hispanic or Latino (any race), 11.7% non-hisp Asian/PI, 4.0% non-hisp Other, 0.1% non-hisp American Indian/Alaska Native, 1.1% non-hisp Black / AA, 1.7% non- Hispanic White, 78.5% To account for small populations, the OHIS conducted additional sampling of racial and ethnic groups to guarantee basic health insurance statistics were available. 5 In addition, this analysis will combine specific race and ethnic groups into the more general categories where detailed analysis is not possible. Tables provide 95% confidence interval upper and lower bounds of the estimate, as well as the number ( n ) of respondents surveyed within the characteristic The race and ethnic health insurance estimates provided in this report originate from the person-level OHIS dataset. The person-level data set is used in the regional uninsurance report and this report and results vary slightly from OHIS reports sourced from the more detailed household target dataset. Information on the different data sets is available in the methodology report. 3 The 2010 Census redistricting data summary file, table QT-PL, supplied the distribution on race and ethnicity for Oregon. 4 The racial and ethnic categories provided in this report differ from the more inclusive categories used in the OHPR analysis of Race and Ethnicity in the statewide uninsurance report. Categories used in this report are: non-hispanic White only, Hispanic / Latino (of any race), non-hispanic Black/African American (AA) only, non-hispanic Asian & Pacific Islander (API) only, non- Hispanic American Indian / Alaska Native (AIAN) only, non-hispanic Other only, and non-hispanic multiple race (which includes individuals indicating more than one of the previous racial categories). Race and Ethnicity is self-reported in the OHIS as well as 2010 Census. 5 For more information on the role of sampling racial and ethnic groups, see the methodology report on the Oregon Health Insurance Coverage webpage: Oregon Health Policy and Research - Page 1

6 Point-in-time uninsurance estimates show higher uninsurance rates for African American and Hispanics/Latino adults when compared to Whites. Overall, the OHIS (Figures 2) shows large differences in the uninsurance rates between workingage adults and children in Oregon. For working-aged adults (age 19-64), the uninsurance rates vary substantially across race and ethnic groups. Statistically significant differences exist in the uninsurance rates of working-aged African Americans as well as Hispanic/Latinos when compared to Whites. 6 Approximately one out of every three working-aged African American surveyed was uninsured. More than four out of every ten working-aged Hispanic/Latino were uninsured, more than twice the rate of Whites. No significant difference is seen in the uninsurance rates for Oregon s children (18 and under) of different racial and ethnic backgrounds. Small numbers of African American and American Indian/Alaska Native (AIAN) alone individuals are reflected in the large lower and upper bounds of the uninsurance estimate seen in table % 40.0% 35.0% Figure 2: Uninsurance Rates by Race/Ethnicity, Ages 0-18 Ages % 30.0% 25.0% 32.8% 20.0% 15.0% 10.0% 5.0% 5.7% 19.2% 5.4% 6.9% 21.0% 12.0% 24.3% 5.8% 21.7% 9.1% 0.0% White Alone Black API AIAN Multi Hispanic 6 The racial category of other alone is excluded from the analysis due to its small sample size. 7 In the survey, a large number of respondents in the multiple race category indicated being of African American/Black and/or American Indian/Alaska Native along with one or more racial categories. 8 We exclude Oregonians 65 and over from the analysis due to Medicare covering over 90 percent of the age group. Page 2 - Office for Oregon Health Policy and Research

7 Age Cat Uninsurance Rates by Race & Ethnicity, 2011 Race/Ethnicity Uninsurance Rate Lower Bound Upper Bound s.e. 9 n 0-18 White Alone 5.7% 4.6% 6.8% Black / African American Alone 5.4% --% 12.7% Asian / Pacific Islander Alone 6.9% 0.9% 12.9% American Indian / Alaska Native Alone 12.0% 2.0% 22.0% Multi-racial 5.8% 1.8% 9.8% Hispanic / Latino 9.1% 6.3% 12.0% White Alone 19.2% 18.2% 20.1% Black / African American Alone 32.8% 24.3% 41.4% Asian / Pacific Islander Alone 21.0% 15.3% 26.7% American Indian / Alaska Native Alone 24.3% 17.4% 31.2% Multi-racial 21.7% 16.6% 26.8% Hispanic / Latino 42.3% 37.9% 46.6% In addition to the point-in-time uninsurance estimates, 10 this brief also presents alternative measures of uninsurance such as the rate of racial and ethnic groups that had a gap in health insurance coverage in the past year. Prior research has shown that individuals who experience a gap in insurance coverage are less likely to obtain preventative care as well as more likely to experience inefficient care. 11 African American, American Indian/Alaska Native, and Hispanic/Latino adults were more likely to experience gaps in insurance coverage in the previous year than were White adults. The same is true for Hispanic/Latino children when compared to White children. Figures 3 show that for working-aged adults African Americans, American Indian/Alaska Natives, and Hispanic/Latinos all have statistically significantly higher uninsurance rates than Oregonians identified as White alone. Nearly half of all Hispanic working-aged adults had a gap in health insurance coverage within the past 12 months and almost four in ten African American working-aged adults lacked insurance coverage at some point over the previous year. Unlike the point-in-time estimates of Figures 2 which did not show a statistically significant difference among children from different race and ethnicity groups, Figure 3 shows a significant difference in the likelihood of uninsurance at some point in the past 12 months between White only children (age 0-18) and Hispanic/Latino. Hispanic/Latino children were more than 50% more likely to experience a gap in coverage. 9 Standard error, in numerical format, included throughout the report s tables. 10 The point-in-time estimate measures whether the survey respondent has health insurance at the time the survey is conducted. Most health insurance surveys use this measure as the primary measure of uninsurance. For more on this topic see OHPR s uninsurance technical brief: 11 R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance: An All-American Problem, The Commonwealth Fund, April 2006 Oregon Health Policy and Research - Page 3

8 Figure 3: Gap in Insurance Coverage within Past 12 months by Race/Ethnicity, % 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Ages 0-18 Ages % 22.3% 7.8% 39.8% 10.2% 23.7% 14.3% 31.1% 9.6% 27.5% 14.5% 45.2% White Alone Black API AIAN Multi Hispanic Gap in Insurance Coverage within Past 12 months by Race/Ethnicity, 2011 Age Cat Race/Ethnicity Uninsurance Rate Lower Bound Upper Bound s.e. n 0-18 White Alone 9.1% 7.7% 10.5% Black / African American Alone 7.8% --% 16.3% Asian / Pacific Islander Alone 10.2% 3.3% 17.1% American Indian / Alaska Native Alone 14.3% 3.9% 24.7% Multi-racial 9.6% 4.9% 14.3% Hispanic / Latino 14.5% 10.8% 18.1% White Alone 22.3% 21.3% 23.3% Black / African American Alone 39.8% 31.5% 48.2% Asian / Pacific Islander Alone 23.7% 17.8% 29.6% American Indian / Alaska Native Alone 31.1% 24.2% 38.0% Multi-racial 27.5% 21.9% 33.1% Hispanic / Latino 45.2% 40.8% 49.6% More than one in four African American and one in three Hispanic/Latino adults of working-age surveyed had been uninsured for one year or more. Figures 4 show another alternative uninsurance measure long-term uninsurance (12 months or more). Long-term uninsurance is statistically more common for Hispanic/Latino and African American working-aged adults than White working-aged adults. Research has found that individuals who experience long-term uninsurance are more often less healthy and have lower household incomes. 12 No difference is seen in the rates of long-term uninsured children across racial or ethnic designations. 12 S Rhoades, J. A., and Cohen, S. B. The Long-Term Uninsured in America, (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65. Statistical Brief #335. July Agency for Healthcare Research and Quality, Rockville, MD.http://www.meps.ahrq.gov/mepsweb/data_files/publications/st335/stat335.pdf Page 4 - Office for Oregon Health Policy and Research

9 40.0% 35.0% 30.0% Figure 4: 12-Month Lack of Insurance by Race/Ethnicity, 2011 Ages 0-18 Ages % 25.0% 20.0% 15.0% 10.0% 5.0% 4.1% 15.5% 3.5% 25.5% 3.2% 14.1% 6.2% 23.4% 4.8% 20.0% 6.8% 0.0% White Alone Black API AIAN Multi Hispanic 12-Month Lack of Insurance by Race/Ethnicity, Month Age Cat Race/Ethnicity Uninsured Rate Lower Bound Upper Bound s.e. n 0-18 White Alone 4.1% 3.1% 5.1% Black / African American Alone 3.5% --% 10.3% Asian / Pacific Islander Alone 3.2% --% 7.1% American Indian / Alaska Native Alone 6.2% --% 13.8% Multi-racial 4.8% 1.1% 8.6% Hispanic / Latino 6.8% 4.5% 9.0% White Alone 15.5% 14.6% 16.4% Black / African American Alone 25.5% 17.3% 33.7% Asian / Pacific Islander Alone 14.1% 9.4% 18.9% American Indian / Alaska Native Alone 23.4% 16.7% 30.2% Multi-racial 20.0% 15.0% 25.0% Hispanic / Latino 36.3% 31.9% 40.6% More than half of Hispanic/Latino adults below 200% FPL are uninsured compared to approximately one in three White and racial minority adults. Figure 5 focuses back to the point-in-time estimate of uninsurance. However, due to small sizes for a number of racial categories, we choose to combines all racial groups into a single category Racial Minority. This approach allows the analysis to continue to break out age groups and isolate Hispanic/Latinos separately by Federal Poverty Level (FPL). Significant differences are found in the rate of uninsurance for those at 200% FPL and below between working-aged White and working-aged Hispanic/Latino Oregonians. This significant difference is also prevalent for those over 200% FPL percent of FPL equates to roughly $44,000 for a family of four in Oregon Health Policy and Research - Page 5

10 Additionally, White and racial minority children are two to three times more likely to be uninsured if their families are at or below 200% FPL, Hispanic/Latino children have the same likelihood of uninsurance regardless of whether or not their family earns less or more than 200% FPL % 50.0% 40.0% Figure 8: Uninsurance Rates by Minority Status & FPL Ages 0-18 Ages Ages 0-18 Ages % 200 FPL & Below 201 FPL & Above 30.0% 20.0% 10.0% 0.0% 8.9% 33.0% White only 12.6% 36.1% Racial Minority 9.2% 3.7% 12.1% 3.6% 14.0% Hispanic White only Racial Minority 8.9% 26.8% Hispanic Race/Ethnicity Uninsurance Rates 200FPL and Below, 2011 Age /Cat Race/Ethnicity Uninsurance Rate Lower Bound Upper Bound s.e. n 0-18 White Alone 8.9% 6.6% 11.3% Racial Minority (includes AA, API, AIAN, Multiple, and Other) 12.6% 6.4% 18.9% Hispanic / Latino 9.2% 5.7% 12.7% White Alone 33.0% 30.9% 35.0% Racial Minority (includes AA, API, AIAN, Multiple, and Other) 36.1% 30.5% 41.8% Hispanic / Latino 52.8% 47.3% 58.3% Race/Ethnicity Uninsurance Rates 201FPL and Above, 2011 Age /Cat Race/Ethnicity Uninsurance Rate Lower Bound Upper Bound s.e. n 0-18 White Alone 3.7% 2.7% 4.7% Racial Minority (includes AA, API, AIAN, Multiple, and Other) 3.6% 1.1% 6.1% Hispanic / Latino 8.9% 4.0% 13.8% White Alone 12.1% 11.1% 13.0% Racial Minority (includes AA, API, AIAN, Multiple, and Other) 14.0% 10.7% 17.3% Hispanic / Latino 26.8% 19.7% 33.9% Further analysis attributes this higher rate of uninsurance for Hispanic/Latino children in families over 200FPL to primary be the result of a concentration of incomes the lower end of the 200FPL and over category. For White only and Racial Minority children the distribution of income for this category is more evenly distributed across higher incomes. Page 6 - Office for Oregon Health Policy and Research

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