Health Coverage and Access to and Use of Care

Overall, Black, Hispanic, and AIAN people fared worse compared to White people across most examined measures of health coverage and access to and use of care for which data were available (Figure 5). Experiences for Asian people were mostly similar to or better than White people across these examined measures. Lack of data for nearly half of the examined measures limited the ability to understand experiences of NHOPI people. Several measures for AIAN people were also lacking sufficient data for a reliable estimate.

Despite gains in health coverage across racial and ethnic groups since implementation of the Affordable Care Act (ACA) coverage expansions, nonelderly AIAN, Hispanic, NHOPI, and Black people remain more likely to be uninsured compared to their White counterparts. All racial and ethnic groups experienced increases in coverage since the ACA Medicaid and Marketplace coverage expansions took effect in 2014. However, disparities in health coverage persisted as of 2019. Nonelderly AIAN and Hispanic people had the highest uninsured rates at 22% and 20%, respectively (Figure 6). Uninsured rates for nonelderly NHOPI (13%) and Black (11%) also were higher than the rate for their White counterparts (8%). Nonelderly White and Asian people had the lowest uninsured rates at 8% and 7%, respectively.

Comparable health coverage data for the trends presented above are not available for 2020. However, other data suggest that the number of people who were uninsured and the uninsured rate held steady in 2020, with similar patterns by race/ethnicity. These data show that most groups did not experience significant changes in uninsured rates from 2018 to 2020, although the uninsured rate among nonelderly Black people increased from 11% to 12% and the rate for Asian people decreased from 8% to 6% over the period (Figure 7). As of 2020, Hispanic, Black and AIAN people all had significantly higher uninsured rates than White people.

Nonelderly adults of color are more likely than nonelderly White adults to report not having a usual doctor or provider and going without care. Over four in ten Hispanic adults (42%), over a third of AIAN (34%) and NHOPI (34%) adults, and over a quarter of Asian (26%) and Black (25%) adults reported not having a personal doctor or health care provider compared to 23% of White adults (Figure 8). In addition, Hispanic (18%), AIAN (17%) and Black (15%) adults were more likely than White adults (10%) to report not seeing a doctor in the past 12 months because of cost, while Asian adults (8%) were less likely to say they went without a doctor visit due to cost. Asian (35%) and Hispanic (34%) adults were more likely than White adults (29%) to say they went without a routine checkup in the past year, while Black adults (20%) were less likely to report going without a checkup. In contrast, all adults of color were more likely than White adults to report going without a visit to a dentist or dental clinic in the past year.

In contrast to the patterns among adults, there are no racial disparities in receipt of routine check-ups or dental visits in the past 12 months for children. Across racial and ethnic groups for which data were available, 5% or less of children went without a routine health care visit in the past year (Figure 9). Higher shares of children went without a dental visit in the past year, but there were no significant differences in likelihood of going without a dental visit by race/ethnicity. Disaggregated data for AIAN and NHOPI children were not available for these measures.

Hispanic and Black adults and children are more likely than their White counterparts to go without some immunizations (Figure 10). Roughly, six in ten Hispanic (61%), Black (60%), and AIAN (59%) adults went without a flu vaccine in the 2020-2021 season, compared to less than half of White adults (45%). Similar racial disparities have been observed in COVID-19 vaccinations, although they have narrowed over time and closed for Hispanic people. Among children, more than half (51%) of Black children went without a flu vaccine compared to four in ten White children (40%), while Asian children were less likely than White children to go without the flu vaccine (31% vs. 40%). Black (35%) and Hispanic (34%) children were more likely than White (25%) children to have not received all recommended childhood immunizations; data were not available to assess childhood immunizations among AIAN and NHOPI children.

Experiences across racial/ethnic groups are mixed regarding receipt of recommended cancer screenings (Figure 11). Among those recommended for screening by the U.S. Preventive Services Task Force (USPSTF) as of 2020, Black people were less likely than White people to go without a recent mammogram or pap smear (15% vs 22% and 17% vs. 22%, respectively). In contrast, AIAN people were more likely than White people to go without a mammogram (31% vs. 22%); Hispanic people also were more likely than White people to go without a pap smear (24% vs. 22%). For colorectal cancer screening, Hispanic, Asian, and AIAN people are more likely than White people to not be up-to-date on their screening, while there were no significant differences for Black and NHOPI people compared to White people. (Since, 2020, colorectal cancer screening recommendations have been expanded to begin at age 45.)

Summary Health Status, Outcomes, and Behaviors

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