In Colorado, a Hispanic adult is nearly twice as likely not to have health insurance as a non-Hispanic adult.
That fact led the Colorado Health Institute to research and write our latest brief – “Analyzing Lower Rates of Health Insurance Among Colorado’s Hispanic Adults: Factors Associated with the Disparity” – a statistical regression analysis based on data from the 2013 Colorado Health Access Survey (CHAS).
The question that guided our research: Can we try to determine, and even quantify, the specific factors associated with the 14.5-point gap between Hispanic and non-Hispanic’s health coverage?
Studies suggest that having health insurance helps lead to better health. Care is generally more affordable, allowing people with insurance to make more appropriate and timely use of health care, including regular preventive care.
Colorado’s ability to create an environment in which all Colorado residents have the opportunity to be as healthy as possible – a goal outlined by Governor Hickenlooper in his “The State of Health” plan a year ago - will depend, in part, on shrinking this coverage gap.
Nationally, the gap in coverage based on race and ethnicity mirrors the Colorado finding. Yet few studies have quantitatively explored the factors associated with the disparity. These findings can help state leaders and policy-makers to more precisely understand and address the issue.
It’s important to note that regression modeling measures the statistical relationships between variables in a model. So we can conclude that certain individual characteristics are associated with health inequities, but we can’t conclude that they cause those inequities.
While this is an important limitation, the findings are still illuminating.
Citizenship status is the largest factor associated with the coverage gap in Colorado, at about a third of the disparity. This probably won’t be much of a surprise to most people following the national debate on this issue.
There are a couple reasons for this finding. Lawfully present immigrants sometimes have limited access to public health insurance, including a five-year wait for Medicaid eligibility. And undocumented immigrants are not eligible for public insurance programs, including Medicare, Medicaid and Child Health Plan Plus (CHP+). Also, undocumented immigrants are prohibited under the Affordable Care Act from purchasing insurance through Connect for Health Colorado, the insurance exchange. These policies tend to impact Hispanics more than non-Hispanics.
Of the other factors associated with the coverage gap, self-reported health status comes in second, followed by the availability of employer-sponsored insurance and family income. Marital status, self-reported disability status and gender are, to a small degree, factors as well.
Yet about 40 percent of the coverage gap is attributed to factors that aren’t measured by the CHAS, including country of origin, English proficiency, familiarity with the U.S. health system and level of trust in that system. Such variables tend to be complex and difficult to quantify, but we turned to previous studies to delve into them in our paper.
The CHAS, which is funded by The Colorado Trust and fielded, analyzed and disseminated by the Colorado Health Institute, is a unique source of information about health insurance coverage, as well as access to health care and use of health care. More CHAS data and analyses are available here.