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New Report Highlights Wide Differences in Health Coverage Rates Across — and Within — Racial and Ethnic Groups

The U.S. has made significant progress toward universal health coverage since the enactment of the Affordable Care Act (ACA). But over 26 million people remain uninsured, and uninsured rates vary substantially between and within racial and ethnic groups. A new CBPP report includes an in-depth analysis of this variation and explores drivers of health coverage inequities.

Many factors contribute to whether a person has health coverage, including socioeconomic status, immigration rules and experiences, English language proficiency, and state laws and processes that limit or bolster access to Medicaid for those who need it. These factors are correlated with differences in uninsured rates both among and within racial and ethnic groups. (Details are available in this chart.)

It is critical to examine differences not only between racial and ethnic groups but also within those groups. Taking a close look at the data could illuminate ways to expand health coverage to people who remain uninsured, from dismantling barriers to eligibility and enrollment to improving the scope and accessibility of outreach and enrollment assistance.

Data from the Census Bureau’s American Community Survey (ACS) show that uninsured rates fell across all racial and ethnic groups from 2010 to 2022, and disparities in uninsured rates narrowed, but the patterns of racial inequities in health coverage have persisted.

A marked decline in uninsured rates occurred from 2014 through 2016 during large-scale implementation of the ACA’s major provisions. Some reversal of that progress occurred from 2017 through 2019, coinciding with policies that limited access to health coverage. But uninsured rates fell again and the overall uninsured rate reached a record low in 2022 thanks to federal relief provisions first enacted in the COVID-19 pandemic.

 

Uninsured Rates Fell Across Racial and Ethnic Groups Between 2010 and 2022
Rates shown among people up to age 64

Note: Rates can vary greatly among subgroups within these categories. We describe some of the data for Asian and Latino subgroups below. Estimates are for people up to age 64, in non-institutionalized settings. See Appendix II for details.

Source: CBPP analysis of American Community Survey, 2010-2022

Data from broad racial and ethnic categories can conceal the diversity of experiences within those larger groups. For example, the overall uninsured rate among Asian people in 2022 was 5.9 percent, lower than any broad racial group. However, uninsured rates vary more than threefold across the ten Asian countries of origin with the largest U.S. populations:

 

Asian Groups' Uninsured Rates Fell Between 2010 and 2022
Rates shown among people up to age 64

Note: Estimates are for people up to age 64, in non-institutional settings. See Appendix II for details.

Source: CBPP analysis of American Community Survey, 2010-2022

As with Asian groups, disaggregation of Latino health coverage data reveals diverse experiences. In 2022 the uninsured rate among Latino people was 17.8 percent, but rates varied fivefold among the ten countries of origin with the largest U.S. populations:

 

Latino Groups' Uninsured Rates Fell Between 2010 and 2022, But Remain High for Many
Rates shown among people up to age 64

Note: Estimates are for people up to age 64, in non-institutional settings. See Appendix II for details.

Source: CBPP analysis of American Community Survey, 2010-2022

To read more about racial inequities in health coverage and potential policy solutions to combat drivers of these inequities, access the full report here.