The Convergence of Racial and Income Disparities in Health Insurance Coverage in the United States

Abstract ObjectiveThis study applies the vulnerability framework and examines the combined effect of race and income on health insurance coverage in the US. Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage.Data sourcesThe household component of the US Medical Expenditure Panel Survey (MEPS-HC) in 2017 was used for the study.Study designLogistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or partially insured, partially insured only, and uninsured only, respectively.Data collection/extraction methodsWe constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findingsWhile income was a significant predictor of health insurance coverage (a difference of 6.1%-7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 66% less odds of being insured instead of uninsured or partially insured than high-income Whites with good health.ConclusionsPolicymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and are racial/ethnic minorities.