II. Barriers to Access to Health Care

A. Availability of Insurance

      Studies have repeatedly shown that persistent barriers to health care access are a major cause of the poor health status of people of color.   Because health care is expensive, the main determinant to accessing health care is the availability of insurance.  In the United States, availability of insurance is almost inextricably tied to employment.   Because people of color, and especially women, are stereotyped into marginal, low or no-skilled, low paying jobs, or are unemployed, they represent a disproportionate number of the uninsured population.   For example, the uninsured rate for Hispanics is 35% and 32.8% for Native Americans.   For African Americans and Asian Pacific Islanders, the rates are 22.8% and 22%, respectively.   In contrast, the uninsured rate for Caucasians is 12.7%.

      Financing health care for the Native American community is a significant problem, despite the federal government's responsibility to provide health care for American Indians and Alaska Natives from federally recognized tribes.   This is because financing for Native American health programs is dependent upon adequate congressional appropriations, and Congress has consistently failed to provide resources sufficient to address the health care needs of the Native American community.

      An additional insurance barrier for racial and ethnic minorities is immigration status.   Recent changes to Medicaid, a public insurance program, deny services to immigrants, even though they are legal residents.   Moreover, immigrants are less likely to have employer-sponsored health insurance because they often work in low-wage, low-benefit jobs.   This issue is especially important for the immigrant-dominant, Hispanic, and Asian Pacific Islander populations.

      For those minorities fortunate enough to have insurance, additional barriers exist with respect to the type of insurance typically purchased by minorities.  Studies show that “racial and ethnic minorities are more likely than whites to be enrolled in ‘lower-end’ health plans.” These plans generally have fewer resources and place more restrictions on services covered by the policies.