Among Asian Americans, Many Subgroups Lack Adequate Health Coverage
Asian Americans are often seen as the model minority, with higher rates of education, income, and employment. But this perception might be overshadowing the problems of lack of health insurance coverage among the Asian American community.
In a January 2007 study by Kaiser Family Foundation called “Key Facts: Race, Ethnicity, and Medical Care,” Asian Americans, when compared to other minority groups, had relatively high rates of health coverage. Of the white, non-Hispanic population, 13 percent were uninsured, with Asian Americans falling not far behind, with 19 percent uninsured. In contrast, 34 percent of Hispanics, 32 percent of Native Americans and Alaska Natives, and 21 percent of African Americans were uninsured. Comparatively, Asian Americans were the best-performing minority group in terms of health coverage.
But when separated into different ethnicities, the data for health insurance coverage for Asian Americans becomes shocking, with many subgroups having high rates of uninsured people.
“When we aggregate the data and look at it all together, they do perform better than all other ethnic groups, but when we disaggregate them, we find that lumping Asian Americans together really does mask a lot of problems,” said Cara James, senior policy analyst for Kaiser Family Foundation, who led a study released April 2008 that examined health coverage among Asian Pacific Islanders.
The study found large variations among the Asian American population: Employer-sponsored coverage was as high as 77 percent for Asian Indians, but as low as 49 percent for Koreans. In general, Indians and Japanese had the highest rates of coverage, with just 12 percent of their populations uninsured.
Filipinos followed with 14 percent uninsured, Chinese with 16 percent, other South Asians with 20 percent, Vietnamese with 21 percent, Native Hawaiians and Pacific Islanders with 24 percent, and Koreans, with the highest rate of uninsured, at 31 percent.
James attributed the high rate of uninsured among Koreans to their tendency to work in small businesses which can’t afford employee health insurance. “Koreans tend to work for smaller employers, which partly explains higher rates of uninsured, contrasted to the perception that Koreans tend to be not poor, so though they have high incomes, they have lower rates of insurance,” she said.
The Kaiser Family Foundation study found that 60 percent of nonelderly adult Korean workers are employed at companies with 100 employees or less, compared to less than 40 percent for other Asian and Pacific Islander groups.
One of the major issues uncovered by the study was the effect of grouping Pacific Islanders and Native Hawaiians with Asians: the low rates of health coverage among Pacific Islanders are masked by the influence of the larger populations like Chinese and Filipinos.
Deeana Jang, policy director of Asian and Pacific Islander American Health Forum, who helped with the study, said, “We shouldn’t lump all Asian Americans together. The Pacific Islander number is such small number, it’s really meaningless. We need to separate it out.”
James agreed, especially considering the large disparities in coverage between Asians and Pacific Islanders.
“We tend to talk about Asian Americans collectively, but Native Hawaiians have rates compared to some of the worst-performing minority groups,” James said.
James correlated the rates of health coverage to income, saying that Indians had the highest rate of coverage because they are least likely to be poor, meaning their incomes are well above the federal poverty line. Meanwhile, she pointed out that 43 percent of Native Hawaiians and Pacific Islanders are near poor.
Gem Daus, a Filipino American studies and Asian American sexuality professor at the University of Maryland, who formerly worked with APIAHF, agreed that income is a major factor in getting coverage.
“It’s expensive, and it’s hard to get, especially when you’re not making a lot of money,” he said.
But even beyond issues of low income, are language barriers, which make it difficult for those who don’t speak English well to navigate a health system that is already complicated.
“It’s confusing enough in English,” Daus said.
One unique program in Montgomery County, Maryland is trying to remedy this.
Called the Asian American Health Initiative, the program was established in 2005 to meet the health needs of Asian Americans in the county, which comprise 13.5 percent of the Montgomery County population. The program aims to expand health services available to Asian Americans, outreach to different ethnic groups about the availability of health care, and eliminate barriers for those in the Asian American community to accessing health care. It specifically targets seniors and recent immigrants who are often isolated.
“Asian Americans have the highest linguistic isolation compared to other groups, even Hispanics,” said Julie Bawa, AAHI’s program director.
Often, language barriers can prevent immigrants from seeking health care or understanding how to obtain health insurance. To fix this problem, AAHI has a program called the Patient Navigator Program.
The program identifies health resources for Asian Americans in Montgomery County and helps navigate the health care system for people who otherwise would have been limited by lack of English skills, uninsured or underinsured status, or socioeconomic status. Information specialists speak Hindi, Vietnamese, Chinese, and Korean, languages spoken by 70 percent of the county’s Asian American population. For those who need other languages, language lines are used to translate.
Bawa said that the top question asked is “How do I get insurance?” Questions also range from how to apply for Medicare and Medicaid to simple requests for help filling out forms, showing a gap between the availability of health coverage and general understanding in how to obtain it.
“There needs to be more awareness in general, as well as more effort in having materials in different languages,” Bawa said.
But even beyond language barriers are obstacles for recent immigrants, who must wait five years after arriving in the U.S. to be eligible for public health programs.
“Because Asian Americans are largely an immigrant population, there are still some barriers for immigrants to access public health coverage,” Jang said.
Immigrants also face the problem of conflicting priorities: whether to get health coverage or deal with more immediate needs like finding jobs and providing for the family, said Bawa.
There is also the issue of cultural barriers. Findings from the Commonwealth Fund’s 2001 Health Care Quality Survey found that Asian Americans, as compared to other groups, were “the least likely to feel that their doctor understands their background and values, to have confidence in their doctor, and to be as involved in decision-making as they would like to be.”
Only 56 percent of Asian Americans said they felt involved in decision-making, compared to 78 percent of whites. Only 48 percent reported they felt their doctor understood their background and values, compared to the highest rate of 61 percent for Hispanics.
Jang said she thinks this could be prevented if doctors took the time to find out more about their patients. “In order to have high quality care, you have to be patient-sensitive, you don’t treat patients same. You need to find out about their lives, and ask the right questions,” she said.
Interestingly, the Kaiser Family Foundation study found that Asian Americans who were 3rd plus generation Americans were the most likely to have health insurance, compared to other subgroups, with just 11 percent uninsured.
However, James attributes this not to cultural values, but to the fact that families in the U.S. longer tend to have higher education, income, and jobs, which she says all affect take-up of coverage.
Jang agreed, especially based on her own experience. “My grandma was a garment worker. She didn’t have health coverage. I’m an attorney. So the longer people are here, the next generation gets better jobs that are more likely to provide coverage.”
Still, high un-insurance rates remain a problem, especially in light of Asian Americans’ high susceptibility to cancer and Hepatitis B.
Those without health insurance tend to not seek health care, missing out on preventative screenings for things like cancer. This is especially important because cancer is the leading cause of death for Asian Americans, according to data from 2003 from the National Center of Health Statistics. But for Hispanics, African Americans, and whites, heart disease is the leading cause of death.
Jang said she believes this abnormal trend is due to the fact that Asian Americans are less likely to be screened for cancer, allowing the problem to worsen over time and only be caught later on.
The solution to improving health insurance rates still has yet to be found. Daus believes that universal health care coverage should be expanded, while making sure to outreach to specific communities. Jang believes that more patient navigators should be provided to help Asian Americans who would otherwise be lost trying to understand a complicated system.
But one thing remains clear, despite perceptions of Asian Americans being a model minority, health coverage and access to care are major problems in the community. Access to health insurance needs to be made easier, Daus said.
He said, “Health insurance is a safety net for the future, but if you have more immediate needs and it’s not easy to get, it’s easy to ignore.”
Written by Steffi Lau · Filed Under Health
Credits to Asianweek
