Asian American Access to Care in the Affordable Care Act Era: Findings from a Population-Based Survey in California

Abstract

BACKGROUND: Though Asian Americans made gains in coverage following the Affordable Care Act (ACA), substantial variations in access to care remain across different ethnic subgroups. Several states are considering adoption of policies to collect health data for Asian Americans that is disaggregated by ethnic subgroup, which may identify disparities in access to care. OBJECTIVE: We examined coverage and access to care between non-Hispanic White and Asian American adults following the ACA in California. We first compared outcomes in non-Hispanic White adults with all Asian Americans in our sample, and then evaluated whether we detect disparities when data is disaggregated into five of the most populous ethnic subgroups (Chinese, Korean, Filipino, Vietnamese, and Japanese). DESIGN: Cross-sectional California Health Interview Survey data were collected between January 2014 and December 2016. PARTICIPANTS: Our sample included 19,201 non-Hispanic White and 3077 Asian American non-elderly adults age 18 to 64 living in California. MAIN MEASURES: Our outcomes were (1) being uninsured, (2) having a usual source of care, (3) delaying necessary medical care, and (4) delaying necessary prescription medications. Using multivariable logistic regression models, we examined our outcomes, adjusting for predisposing, enabling, need, and acculturation factors. KEY RESULTS: Compared with non-Hispanic Whites, some subgroups of Asian Americans reported significantly worse access to care: disaggregated, adjusted analyses revealed that Koreans were significantly less likely to report a usual source of care (adjusted odds ratio [AOR] = 0.31, p < 0.01) relative to non-Hispanic Whites. Chinese (AOR = 0.42, p < 0.01) and Vietnamese (AOR = 0.34, p < 0.01) adults were significantly less likely to delay necessary care. CONCLUSIONS: Disaggregated analyses identified differences in access to care for Asian American subgroups following the ACA. State policies to collect disaggregated health data for Asian Americans may reveal heterogeneity in experiences of care and inform specific policies to reduce disparities in access to care.

Variation in Usual Source of Care in Asian American, Native Hawaiian, and Other Pacific Islander Adult Medicaid Beneficiaries

“…The difference in reporting a USC between AANHPI (in the aggregate) and non-Hispanic White Medicaid beneficiaries, while statistically significant, was modest in magnitude. Prior studies using the California Health Interview Survey have identified larger gaps in reporting a USC among Asian American patients, suggesting that among low-income people, Medicaid coverage may mitigate White-AANHPI disparities in access to care 20,21. However, findings observed in California may not generalize nationally.…”

“…AANHPI beneficiaries who reported multiple ethnic subgroups (eg, Korean and Vietnamese) were included in the analyses but are not reported separately in disaggregated estimates. Consistent with prior work, we included non-Hispanic White beneficiaries as a referent group and excluded multiracial AANHPI people 20,23…”

“…In particular, several studies suggest that AANHPI patients seeking care at health centers do so, in part, because of the availability of enabling services (such as financial counseling or interpretation services) 18,19. Compared with White patients, Chinese and Filipino patients in California were more likely to report a clinic or health center as a usual site of care 20. Whether this variation is consistent in a national sample of Medicaid beneficiaries, however, is unknown.…”

In Pursuit of Health Equity in Pediatrics

“… 41 , 42 The call for disaggregated data collection applies to Black and Asian communities as well, given the heterogeneity of experience and existence of health disparities that may also exist within racial/ethnic subgroups according to country of origin or other measures. 43 Similarly, the use of traditional categories of gender in existing datasets has obscured the health needs of non-cisgender and other sexual minority individuals, which contribute to entrenchment of inequities among LGBTQ communities. 39 , 44 …”

Three studies on psychological distress, health-risk behaviors, and health care access among Chinese, Filipino, and Asian Indian American Subgroups

“…Second, past research has relied on aggregated data, concealing essential differences in access to health care services among different Asian American subgroups (Holland & Palaniappan, 2012). Disaggregating Asian American data in the study of health care access is relatively new, and it remains to be entirely determined (Fang, 2018;Nguyen & Trivedi, 2019). Third, previous literature on Asian Americans that used Andersen's model to frame their work on health care access did not extensively include acculturation.…”