The role of citizenship, employment, and socioeconomic characteristics in health insurance coverage among Asian subgroups in the United States

Abstract

Background: Asians are the third largest and one of the fastest growing minority groups in the United States.

Objective: We present health insurance data for the 6 largest national subgroups: Chinese, Filipino, Indian, Korean, Vietnamese, and Japanese. We also contrast the characteristics that result in differences in coverage, including the role of citizenship.

Research design: Cross-sectional analysis of data from the 2006 Current Population Survey.

Measures: We used responses to questions on nativity and parental nativity to categorize Asian respondents into subgroups.

Subjects: The 2006 CPS sampled 8918 Asians including 1923 Chinese, 2210 Filipino, 1302 Indian, 951 Korean, 903 Vietnamese, and 808 Japanese.

Results: Koreans had the highest proportion lacking coverage at 29.8%, followed by Vietnamese at 21.5% and Chinese at 16.8%. Indians, Filipinos, and Japanese had rates of coverage similar to or better than non-Hispanics whites (NHWs). The proportion of US-born Chinese with employer coverage (65%) was similar to NHWs, but only 50% of Chinese noncitizens had employer coverage and 27% of these were uninsured. Among Koreans and Vietnamese, noncitizens were most vulnerable, with 41% and 31%, respectively, being uninsured. In contrast, 70% of noncitizen Indian had employer coverage and only 15% were uninsured. Gaps in coverage among Koreans and Vietnamese were largely due to employment in service industry and blue collar occupations as well as small firms, which are less likely to provide coverage.

Conclusions: The current system of employer coverage is not succeeding in covering Asian groups equitably. Distinct initiatives to expand health coverage would have variable effects on these diverse subgroups.