How Race/Ethnicity Shapes Health Care Coverage, Costs and Access

by Natalia Deeb-Sossa

In Olga Khazan’s article “All the Reasons Women Don’t Go to the Doctor, Other than Money,” published in The Atlantic, she highlighted, using a 2013 Kaiser Family Foundation survey of 2907 women and 700 men ages 18 to 64, how women were more likely than men to delay health care due to cost; cost which uninsured women were more likely to face than either insured women or those on Medicaid.

The author also noted how women across income levels also forgave health care needs because they couldn’t get off work, although poor women were significantly more likely to report that they can’t get time off work, get childcare or arrange transportation to go to the doctor.

Thus, the author argues, “it’s clear that women who want to take care of themselves face obstacles beyond health insurance. You can send someone an Aetna card in the mail, but you can’t send them affordable daycare.”

However, race and ethnicity determines in large part if a women will ever be sent an Aetna card in the mail, as well as the additional challenges that they will face that might force them to either delay or forgo health care. Latina and Black women bear a disproportionate burden of being uninsured and postpone or go without health care because of cost and lack of flexibility at work, problems with childcare and difficulty securing transportation.

Some of the poorest women in the U.S. do not qualify for Medicaid or health insurance assistance because they reside in a state that is not expanding Medicaid (i.e., Alabama, Alaska, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin and Wyoming) or because they are undocumented immigrants. Undocumented immigrants are excluded from all state Marketplace plans and Medicaid.

According to the Kaiser Family Foundation survey, Latina women have the highest rate of uninsurance (36%), followed by Black women (22%), compared to 13% of White women (here, pg 11).

But as noted above, not all women have access to Medicaid or the federal tax credit subsidies under the Affordable Care Act. Most women who are recent immigrants do not qualify for Medicaid for at least 5 years after entering the U.S. legally, as a matter of federal law. Undocumented women do not have any coverage as they are barred both from Medicaid and from purchasing a plan or receiving subsidies through the state based Marketplaces.

Other access challenges, in addition to coverage, affect whether or not Black and Latina women actually obtain health care. These include health care costs, provider availability and capacity, as well as transportation and finding time to make it to the appointments.

According to the Kaiser Family Foundation survey, for Black and Latina women, who are more likely to be uninsured, health costs can be a considerable barrier to care (here, pg. 14). One-fourth of Latina women and Black women reported that cost was a reason they postponed preventive services or skipped medical tests and treatments, a rate that was one-fifth among White women.

Health care is a basic human need and right. In light of the characteristics of women in the U.S. today (here, pg. 1)—nearly one in three women ages 18 to 64 live in households below 200% the federal poverty level; one in three identify as racial and ethnic minorities, 15% report their health is fair or poor; and 43% have a health condition that requires monitoring and treatment—access to quality and affordable health care is essential. An effective health care system that covers everyone—regardless of gender, race, documentation status and economic status—is critical for gender equality, public health, safety and economic security. Health care for all and comprehensive immigration reform are the civil rights movements of our time.

Natalia Deeb-Sossa is associate professor in Chicana/o Studies at the University of California, Davis.


5 thoughts on “How Race/Ethnicity Shapes Health Care Coverage, Costs and Access

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