Health Disparities and Insurance Coverage, Where We Are and Moving Forward

When it comes to health insurance, not everyone has access to equitable healthcare in the U.S. Education and visibility about healthcare equity issues are increasing, but more must be done to continue improved health outcomes for all. Here’s a look at where we are and ways to make improvements in health insurance coverage and health disparities in the U.S.

Health Insurance Coverage in the U.S.

Looking at the data about health insurance in the U.S., Black, Indigenous, and People of Color (BIPOC) groups are much more likely to be without health insurance. According to a 2018 study that examined health insurance for different groups in the U.S., 94.6 percent of non-Hispanic whites had health insurance coverage compared to 93.6 percent of Asians, 90.3 percent of Blacks, and 82.2 percent of Hispanics. 

While health insurance coverage has shown improvements for BIPOC groups since the institution of the Affordable Care Act (ACA), the coverage increase has been slow. Change has been especially lacking in the Southern U.S. where states have not taken action to make Medicare changes to improve coverage for uninsured and underinsured individuals.

Taking a closer look at income levels, a study found that income was a major predictor for health insurance coverage. Race or ethnicity was linked to a lack of health insurance coverage in this study. And when the combination of low-income along with a BIPOC person with bad health were combined, the study showed that these individuals were 68 percent less likely to have health insurance compared to high-income White people in good health. However, it should be noted that the study on income and racial disparities in U.S. health insurance coverage lacked data to make a causal relationship between socioeconomic status and health insurance coverage; had limited data to examine risky behaviors like alcohol use, smoking, and drug abuse; and did not break out separate BIPOC groups like Asians.

Health Disparities in the U.S.

When it comes to health disparities, there are some notable ones for BIPOC patients. The mortality rates for Black women and Black infants in comparison to white women and  infants are a stark contrast. Looking at Black infant mortality and white infant mortality before 12 months of age, Black babies died at a rate of 11.4 per 1,000 babies compared to white babies at a rate of 4.9 percent  per 1,000. Black women are far more likely to succumb from pregnancy or childbirth-related causes at a rate of 42.8 per 100,000 compared to white women who die at a rate of 13 per 100,000.

Breast cancer incidence rates are higher, BIPOC breast cancer is diagnosed at a later stage more frequently, and the more aggressive and difficult-to-treat triple-negative breast cancer subtype is diagnosed in Black women at almost two times the rate than in white women. Statistical data on prostate cancer finds that Black men have the highest prostate cancer death rate of all groups, which is 2.2 times higher compared to non-Latino white men. And when looking at bone marrow transplants, mixed race individuals only make up 4 percent of the bone marrow donor database for potential transplants – leaving many mixed race individuals with no option for life-saving bone marrow transplants.

How Can Health Insurance and Health Disparities Be Addressed?

Unfortunately, some well-regarded medical professionals, including Dr. Ben Danielson formerly of Odessa Brown Children’s Clinic, have resigned from their positions to raise awareness about continuing issues that must be corrected. Yet it’s important for BIPOC medical professionals and administrators to take key leadership roles to move action forward toward health equity.

Other steps can help with improvements to improve health equity. Continued use and insurance coverage for telemedicine can help increase annual health check-ups for proactive care. Feeling comfortable or forming a connection with healthcare professionals is also an important piece of the puzzle of addressing health disparities. Many BIPOC patients say they would feel more at ease receiving care from someone who looks like them, and more BIPOC people need education and training in medical and healthcare fields to serve as healthcare professionals and advocates for underserved patients. 

Communication and depth of patient knowledge are two more integral pieces of the health disparities puzzle. Providing patient services such as translation services and patient navigators are also key to providing adequate information to patients. With a stronger foundation about their health and medical conditions, BIPOC and other underserved patients can be empowered to advocate for their own healthcare.

Participation by BIPOC patients in clinical trials is vital to improve knowledge about which cancer treatments and other treatments work best for specific groups. Clinical trials offer the standard of care at a minimum and help improve quality of life and survival rates for cancer patients.

Health insurance coverage and health disparities need several improvements to move the bar higher for BIPOC, mixed race, and low-income patients in the U.S. With more visibility on the issues and taking action to help underserved patients, progress can be made. Perhaps the words of Martin Luther King, Jr. can help motivate patient advocacy work, “Life’s most persistent and urgent question is, ‘What are you doing for others?’”

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Sources

Christen Linke Young. There are clear, race-based inequalities in health insurance and health outcomes. Brookings Institution website. Accessed August 12, 2021. https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2020/02/19/there-are-clear-race-based-inequalities-in-health-insurance-and-health-outcomes/

De-Chih Lee, Hailun Liang, and Leiyu Shi. The convergence of racial and income disparities in health insurance coverage in the United States. International Journal  for Equity in Health. BioMed Central website. Accessed August 12, 2021. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01436-z