Insuring Latinos against the costs of illness
R. B. Valdez, H. Morgenstern, R. Brown, R. Wyn, C. Wang and W. Cumberland
Department of Health Services, UCLA School of Public Health 90024-1772.
OBJECTIVE--To examine the determinants of health insurance coverage for
Latinos in the United States and how different targeted strategies for
health care reform differentially affect the country's major ethnic groups,
focusing on the implications for the Latino population. DESIGN--Data from
the 1980 and 1990 Current Population Surveys were used to compare the
insurance status of nonelderly (< 65 years) Latinos with the Anglo
(non-Hispanic white), black, and Asian and other populations by estimating
the attributable fraction for selected covariates. The effects of health
care reform strategies on the coverage of the major ethnic groups were
simulated from these data. MAIN OUTCOME MEASURES--Percentage uninsured,
percentage insured by Medicaid, and attributable fraction for covariates.
RESULTS--Latinos have the worst health insurance coverage of any ethnic
group in the country. Approximately 39% of Latinos are uninsured compared
with 13.8% for the Anglo and 24% for the black population. Providing
coverage to all the poor could reduce the uninsured rate for Anglos by
about 23%, whereas the reduction among Latinos could be about 37% and among
blacks about 42%. Similar reductions could be achieved by covering all
workers and their minor dependents. Regardless of the approach to reform,
however, Latinos would remain with high absolute rates of uninsured.
CONCLUSIONS--Differences in Medicaid eligibility, labor force
characteristics, and family composition between Latinos and other ethnic
groups suggest that policy initiatives may affect Latinos differently.
Targeted strategies, such as employer mandates, "pay-or-play" programs, or
Medicaid expansions, can improve coverage, but many Latinos could still
remain uninsured.
