Health Care Disparities Among Asian, Native Hawaiian, and Other Pacific Islander (NHOPI) People
Asian, Native Hawaiian, and Other Pacific Islander (NHOPI) people are a diverse and growing population in the U.S. (Figure 1). Asian people are the fastest-growing racial or ethnic group in the United States, rising 81% from 10.5 million to 18.9 million between 2000 and 2019.1 In this data note, we use 2019 American Community Survey (ACS) data to examine how demographic characteristics as well as measures of health coverage and other social and economic factors that drive health and health care vary for Asian and NHOPI people overall and by subgroups. 2020 ACS data were not used since the quality of data was impaired by disruption to data collection in 2020 due to the COVID-19 pandemic.2 Examining experiences among Asian and NHOPI people is important since broad data for Asian and NHOPI people often mask underlying disparities among subgroups of the population.3 Understanding the experiences of Asian and NHOPI is particularly important at this time given growing levels of racism and discrimination amid the COVID-19 pandemic, including a significant uptick in hate incidents against Asian people.4
The majority of Asian and NHOPI people in the U.S. are citizens, adults, and are parents or living in multigenerational households (Figure 2). Asian and NHOPI people include larger shares of noncitizens relative to White people (26% and 15% vs. 2%). Roughly one in five Asian (20%) and White (20%) people are children, while about one in four (25%) NHOPI people are children. Larger shares of Asian and NHOPI people live in households comprised of parents with children or multigenerational households as compared to White people (59% and 66% vs. 45%). However, these demographics vary by subgroup. For example, the share who are noncitizens ranges from between 1% among Native Hawaiian and Guamanian or Chamorro people to 62% among Malaysian people. Similarly, the share who are children ranges from 10% of Japanese people to 44% of Marshallese people. Household composition also varies by group, with the proportion living in households that are comprised of parents with children or multigenerational households ranging from 35% for Japanese people to 87% for Bhutanese people.
As of 2019, among the nonelderly population, 7% of Asian people and 13% of NHOPI people were uninsured (Figure 3). The uninsured rate for Asian people was similar to the rate for White people (8%), while the rate for NHOPI people was higher. Across both groups, uninsured rates were lower for children compared to nonelderly adults. The shares of Asian people covered by private coverage and Medicaid, were similar to the share for White people. In contrast, NHOPI people are less likely to have private coverage and more likely to be covered by Medicaid, with half (50%) of NHOPI children being covered by Medicaid or the Children’s Health Insurance Program (CHIP). Coverage patterns also vary by state Medicaid expansion status, with Medicaid and CHIP covering larger shares of Asian and NHOPI people in states that have adopted the Affordable Care Act Medicaid expansion to low-income adults compared to states that have not expanded, contributing to lower uninsured rates for these groups in expansion states. For example, in non-expansion states, over one in five (21%) NHOPI children are uninsured compared to 5% in states that have expanded.
There are wide variations in uninsured rates among Asian and NHOPI people (Figure 4). As of 2019, among the nonelderly, uninsured rates ranged from 4% for Japanese people to 32% for Mongolian people. Uninsured rates further varied by citizenship status, with higher uninsured rates for noncitizens across most groups. Among nonelderly noncitizens, uninsured rates varied from 4% for Japanese people to 42% for Mongolian people.
A variety of social and economic factors influence individuals’ access to health coverage, their ability to access health care, and their overall well-being. While Asian people often fare similar to or better than White people across many of these measures, some subgroups fare worse.
Data show wide variations in socioeconomic measures among nonelderly Asian and NHOPI people, which may contribute to the differences in health coverage (Figure 5). There is more than a 70-percentage point difference in the share of people who have received a bachelor’s degree or higher among nonelderly Asian and NHOPI people 25 years of age and older, with 11% of Marshallese people having a bachelor’s degree or higher as compared to 84% of Taiwanese people. The share of households with at least one full-time worker also varies by subgroup. Across groups, at least half of nonelderly people live in a household with at least one full-time worker, but the share ranges from about half (52%) among Tongan people to 89% among Asian Indian people. Similarly, household income among Asian and NHOPI subgroups varies widely. The share of nonelderly people who live in a low-income household (below 200% of the federal poverty level or $42,660 for a family of 3 in 2019), ranged from to 62% for Burmese and Marshallese people to 11% for Asian Indian, Taiwanese, Filipino, and Japanese people. Some of these differences can be explained by citizenship and visa status. For example, those entering the U.S. with work visas likely have higher median household incomes compared to those that entered as asylees and/or refugees. Many Burmese people immigrate to the U.S. as refugees fleeing war in their home country, which could contribute towards their lower household incomes.5 On the other hand, higher earning groups such as Asian Indians usually immigrate through work visas.6
Experiences with Racism and Discrimination
Understanding the experiences of Asian and NHOPI people is of particular importance at this time, given growing levels of racism and discrimination amid the COVID-19 pandemic, including a significant uptick in hate incidents against Asian people. Anti-Asian racism is not new within the United States.7 However, between 2019 and 2020, the Federal Bureau of Investigation (FBI) documented a 77% increase in hate crimes against Asian people in the United States with a majority of Asian Americans citing the previous administration and COVID cases being first reported in China as major reasons for this increase in discrimination.8 During this time many Asian Americans reported deteriorating mental health due to both the pandemic and violence against Asian people. A 2021 KFF survey of Asian community health center patients found that 1 in 3 respondents reported experiencing more discrimination since the COVID-19 pandemic began and that many reported a range of negative experiences due to their race or ethnicity, ranging from receiving poor service to being verbally or physically attacked (Figure 6).9 Some also reported immigration-related fears, likely reflecting public charge and other policy changes implemented under the Trump Administration.10 Over four in ten (44%) said they worry a lot of some that a family member could be detained or deported, and one in four (25%) said they or a household family member decided not to apply for or stopped participating in a government program to help pay for health care, food, or housing in the past year due to immigration-related fears.
The federal government has taken several actions in response to the rise in Asian hate and anti-Asian violence. Last year, Congress passed the COVID-19 Hate Crimes Act in response to the increase in anti-Asian violence during the pandemic.11 During that time, the Biden Administration also released Executive Order 14031 “Advancing Equity, Justice, and Opportunity for Asian Americans, Native Hawaiians, and Pacific Islanders,” which established the White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders (WHIAANHPI).12 The WHIAANHPI is committed to advancing equity for Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) by investing in AANHPI communities and responding to the spikes in anti-Asian violence.13
The Biden Administration has also charged the government with addressing the systemic lack of disaggregated AANHPI data in federal statistical systems.14 In addition, the National Science Foundation (NSF) was tasked with funding research that seeks to identify, understand, and prevent discrimination, including against the AANHPI community. The Interagency Working Group on Equitable Data in collaboration with the WHIANHPI is also working to improve research on policy and program outcomes for AANHPI communities.15
Enhancing availability and quality of disaggregated data for Asian and NHOPI people will be important for efforts to advance health equity. Asian and NHOPI communities are diverse groups with varying characteristics and experiences that influence their health and health care. The findings presented here illustrate how broad data for Asian and NHOPI people may mask disparities and challenges facing subpopulations in the community. These differences point to the importance of having disaggregated data for Asian and NHOPI groups to identify disparities and direct efforts to address them.16 In addition to broad data masking disparities among Asian and NHOPI people, data are often missing to identify and address disparities. Moving forward, a deeper understanding of the nuances of experiences for Asian and NHOPI people can help bring to light the experiences of smaller population groups, including Asian immigrants who are often invisible in public data sources. As the federal government implements initiatives and legislation to address these data gaps, centering equity in their efforts will be key to addressing health disparities among these groups.
Budiman, A., Ruiz, N.G. (2021), “Asian Americans are the fastest-growing racial or ethnic group in the U.S.”, https://www.pewresearch.org/fact-tank/2021/04/09/asian-americans-are-the-fastest-growing-racial-or-ethnic-group-in-the-u-s/, accessed May 6, 2022.
U.S. Census Bureau (2021), “Pandemic Impact on 2020 American Community Survey 1-Year Data”, https://www.census.gov/newsroom/blogs/random-samplings/2021/10/pandemic-impact-on-2020-acs-1-year-data.html, accessed May 17, 2022.
Hill, L., Artiga, S., & Haldar, S. (2022), “Key Facts on Health and Health Care by Race and Ethnicity”, https://www.kff.org/report-section/key-facts-on-health-and-health-care-by-race-and-ethnicity-health-status-outcomes-and-behaviors/, accessed May 17, 2022.
Stop AAPI Hate (2022), “National Report (Through December 31, 2021)”, https://stopaapihate.org/national-report-through-december-31-2021/, accessed May 17, 2022.
Centers for Disease Control and Prevention (2021), “Burmese Refugee Health Profile”, https://www.cdc.gov/immigrantrefugeehealth/profiles/burmese/index.html, accessed May 6, 2022.
Hanna, M., & Batalova, J. (2021), “Immigrants from Asia in the United States”, https://www.migrationpolicy.org/article/immigrants-asia-united-states-2020, accessed May 6, 2022.
The Conversation (2020), “The long history of US racism against Asian Americans, from ‘yellow peril’ to ‘model minority’ to the ‘Chinese virus’”, https://theconversation.com/the-long-history-of-us-racism-against-asian-americans-from-yellow-peril-to-model-minority-to-the-chinese-virus-135793, accessed May 12, 2022.
Findling, M., Blendon, R.J., Benson, J., & Koh, H. (2022), “COVID-19 Has Driven Racism And Violence Against Asian Americans: Perspectives From 12 National Polls”, https://www.healthaffairs.org/do/10.1377/forefront.20220411.655787, accessed May 12, 2022.
Artiga, S., Hill, L., Corallo, B., & Tolbert, J. (2021), “Asian Immigrant Experiences with Racism, Immigration-Related Fears, and the COVID-19 Pandemic”, https://www.kff.org/report-section/asian-immigrant-experiences-with-racism-immigration-related-fears-and-the-covid-19-pandemic-findings/, accessed May 17, 2022.
Pillai, D., & Artiga, S. (2022), “2022 Changes to the Public Charge Inadmissibility Rule and the Implications for Health Care”, https://www.kff.org/racial-equity-and-health-policy/issue-brief/2022-changes-to-the-public-charge-inadmissibility-rule-and-the-implications-for-health-care/, accessed May 20, 2022.
117th U.S. Congress (2021), “S.937 – COVID-19 Hate Crimes Act”, https://www.congress.gov/bill/117th-congress/senate-bill/937, accessed May 12, 2022.
U.S. Federal Register (2021), “Advancing Equity, Justice, and Opportunity for Asian Americans, Native Hawaiians, and Pacific Islanders”, https://www.federalregister.gov/documents/2021/06/03/2021-11792/advancing-equity-justice-and-opportunity-for-asian-americans-native-hawaiians-and-pacific-islanders, accessed May 12, 2022.
U.S. Department of Health & Human Services (2022), “White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders (WHIAANHPI)”, https://www.hhs.gov/about/whiaanhpi/index.html, accessed May 12, 2022.
The White House (2021), “FACT SHEET: President Biden Establishes the White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders”, https://www.whitehouse.gov/briefing-room/statements-releases/2021/05/28/fact-sheet-president-biden-establishes-the-white-house-initiative-on-asian-americans-native-hawaiians-and-pacific-islanders/, accessed May 12, 2022.
The White House (2022), “The Release of the Equitable Data Working Group Report”, https://www.whitehouse.gov/ostp/news-updates/2022/04/22/the-release-of-the-equitable-data-working-group-report/, accessed May 12, 2022.
Artiga, S. (2021), “Advancing Health Equity Requires More and Better Data”, https://www.kff.org/policy-watch/advancing-health-equity-requires-more-better-data/, accessed May 6, 2022.