Asian American Access to Care in the Affordable Care Act Era: Findings from a Population-Based Survey in California
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Brown University School of Public Health, Providence, RI, USA; 2Providence Veterans Affairs Medical Center, Providence, RI, USA.
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 nonHispanic 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. KEY WORDS: access to care; disparities; minority health; health care reform; health policy.
Prior Presentations This article was presented in Washington, D.C. at the Annual AHRQ NRSA Trainees Research Conference on June 1, 2019 and the Academy Health Annual Research Meeting on June 3, 2019. Received November 5, 2018 Revised May 14, 2019 Accepted August 16, 2019
J Gen Intern Med DOI: 10.1007/s11606-019-05328-5 © Society of General Internal Medicine 2019
INTRODUCTION
Approximately 17.8 million individuals in the USA, comprising 6% of the population, self-identify as Asian American.1 One of the fastest growing populations in the country, Asian Americans are a diverse race, encompassing more than 50 ethnicities and 100 languages spoken.2, 3 The sociodemographic heterogeneity of this racial group h
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