Uninsurance Is Not Just a Minority Issue: White Americans Are a Large Share of the Growth from 2000 to 2010

Uninsurance Is Not Just a Minority Issue: White Americans Are a Large Share of the Growth from 2000 to 2010ACA Implementation—Monitoring and TrackingFrederic BlavinJohn HolahanGenevieve M. KenneyMegan McGrathThe Urban InstituteNovember 2012 Uninsurance Is Not Just a Minority Issue: White Americans Are a Large Share of the Growth from 2000 to 20102INTRODUCTIONHealth services researchers have long documented differences in health insurance coverage among racial and ethnic groups (Selden and Pylypchuk 2008; Smedley, Stith, and Nelson 2003). In 2010, uninsurance rates among nonelderly Hispanics (32.1%) and blacks (22.3%) were 2.3 and 1.6 times higher, respectively, than for non-Hispanic whites (13.8%). However, recent trends indicate that the difference in coverage between Hispanics and whites is shrinking: From 2007 to 2010, when nearly 10 million Americans lost employer-sponsored insurance (ESI) and the number of uninsured increased by 5.7 million, the uninsured rate did not change among nonelderly Hispanics but increased by approximately 2 percentage points among nonelderly whites and blacks (Holahan and Chen 2011). Full implementation of the Patient Protection and Affordable Care Act (ACA) in 2014 is expected to substantially increase health insurance coverage across the United States, as individuals gain subsidized coverage through Medicaid and newly created health insurance exchanges. Medicaid eligibility can be expanded at state option to 138 percent of the federal poverty level (FPL) for all nonelderly citizens, with federal matching rates of 100 percent for 2014 through 2016. Low- and moderate-income individuals and families not eligible for Medicaid coverage with incomes up to 400 percent of FPL will also be eligible for federal subsidies to purchase coverage in the exchanges, if they do not have access to an affordable offer of ESI.1Microsimulation models project that the ACA could reduce the share of nonelderly uninsured whites and blacks by over 50 percent, but would only reduce the share of nonelderly uninsured Hispanics by 37 percent. The smaller relative gains in coverage for Hispanics are driven partly by the restriction of Medicaid to legal immigrants who have been in the country for more than five years and the exclusion of undocumented immigrants in the ACA’s coverage provisions. Among the 26 million individuals projected to be uninsured under the full implementation of the ACA, more than 5 million are undocumented immigrants, 82 percent of whom are Hispanic (Clemans-Cope et al. 2012). This brief compares changes in health insurance coverage from 2000 to 2010 across racial and ethnic groups in the United States. By focusing on these trends, this analysis expands on three prior briefs that documented declines in coverage among various subpopulations targeted by the ACA (Blavin et al. 2012a, b; Holahan and Chen 2012). We examine trends for whites, blacks, Hispanics, and a residual group comprising Asian/Pacific Islander, American Indian/Aleutian/Eskimo, and multiracial (referred to as Asian/other) individuals, using the “ACA-relevant” income measure—modified-adjusted gross income (MAGI)—to categorize individuals below 138 percent of the federal poverty level (FPL) who could become newly eligible for Medicaid, individuals with income between 138 and 400 percent of FPL who could become eligible for subsidies in the newly established health insurance exchanges, and individuals at or above 400 percent of FPL. We find that ESI deteriorated among all racial and ethnic groups, with whites and blacks experiencing larger percentage point declines relative to Hispanics and the Asian/other group. We also find that the number of uninsured increased by 12.9 million from 2000 to 2010, nearly half of whom (6.3 million) are white. The uninsured rate increased by nearly four percentage points among nonelderly whites and blacks, with larger percentage increases occurring among whites. In contrast, the uninsured rate remained constant for the Hispanic and Asian/other populations, as Medicaid/CHIP enrollment gains were large enough to offset ESI declines for these groups. These general patterns across racial and ethnic groups were found across all income groups, with more pronounced deterioration in coverage among those with income below 400 percent of FPL. DATA AND METHODSThis brief uses the 2001 and 2011 cross-sections of the Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC).2 The CPS collects monthly employment statistics as well as information on the demographic status of the population, including health insurance coverage and race/ethnicity. The CPS is a large cross-sectional survey that samples the entire civilian noninstitutionalized population. The 2010 CPS has a sample size of 95,958 households (204,983 individuals) and is one of the most frequently cited national surveys Uninsurance Is Not Just a Minority Issue: White Americans Are a Large Share of the Growth from 2000 to 201