Asians and Pacific Islanders In Crisis: Living Without Health Insurance in Los Angeles

Table of contents

1. Introduction

2. Asian and Pacific American Population Growth

3. Socio-demographic Characteristics

4. Who Are the Medically Uninsured?

5. The Problem of Uninsured Asian Americans

6. The Prevalence of Disease in the Asian American Community

7. Poorer Medical Outcomes for the Uninsured

8. Conclusion

9. Notes

10. References

1. Introduction

What are the health consequences of the lack of health insurance coverage and access to quality health care? Among researchers doing studies in this area, this concern has raised new debates. The general debate over the uninsured has revealed that certain U.S. populations are at greater risk of being uninsured than others. There are certain aspects of this crisis that are particularly disturbing. According to the Census Bureau, the number of people with health insurance increased by 1.2 million between 2000 and 2001, to 240.9 million, but at the same time the number of the uninsured rose by 1.4 million, to 41.2 million, or 14.6% of the total U.S. population (Bergman 2002). Some scholars (Klein 1979) argue, “well-being is a human concern in all societies – in part because humans, like other life forms, are susceptible to illness.”1 Other scholars, particularly those doing research in this area, argue for more government-sponsored programs to provide health insurance for more of the nation’s uninsured. Neutrality is not a viable solution to this perplexing crisis and national urgency should be focused on reducing this fast growing population.

Over the past twenty years, the U.S. population has experienced dramatic changes in its composition. Asians and Pacific Islanders, as a whole, have become the fastest growing of all major ethnic groups (Le 2001). In fact, the combined Asian and Pacific American population has increased 48 percent during the decade of 1990 – 2000 (Bennett 2002). Although the actual numbers of this population may still seem relatively small on a national level, they are one of the fastest growing minority populations in the United States.

In many cases, health statistics for the Asian and Pacific American population is under reported due to their categorization as “Others.” 2 Although the 2000 Census Brief was the first attempt that collected data on “race” into two broad categories, i.e. the “race” alone population and the “race” in combination population, Hispanic Americans and Asians and Pacific Islanders were still overwhelmingly represented in the population of the medically uninsured. Who are the uninsured and why should the lack of insurance concern all Americans? Why should those who have medical insurance be concerned with those who do not? Studies show that the uninsured include young adults mostly in the 18-24 year old category, people with lower levels of education, people of Hispanic, Asian, non-Hispanic White and African American origins, those who work part-time and people born in foreign countries. The problem is there are 42 million uninsured in the U.S. and those figures are increasing. The dilemma is that the uninsured tend to live sicker and die earlier than insured Americans (Landers 2000). There have been hundreds of studies linking the lack of insurance with poor health. Proposals to help the uninsured are being crafted by a wide range of health care advocates and members of Congress as well.3 What is more telling is that studies show one major reason for the lack of health insurance, particularly among working adults, is their inability to afford premiums. Now, the employer-based system works for millions of working Americans but with the likelihood of rising costs of employer-sponsored health care coverage and the certainty that employers will pass more and more of these costs along to workers, problematizes thedilemma for the uninsured debate.

Census statistics show us that between 1994 and 1997 the proportion of uninsured non-elderly Asians and Pacific Islanders increased significantly. Although the Latino population maintains the single largest percentage of uninsured in the U.S at 35 percent, Asians and Pacific Islanders have become the second greatest population lacking health coverage at 24 percent of the total U.S. population (Brown 1999). Reasons for lack of coverage vary, however certain Asians and Pacific Islanders are more likely to be uninsured. Primarily, Southeast Asians, Koreans, Chinese and Filipinos are among the groups most represented by these figures. Given this estimated growth rate, the Asian and Pacific American populations’ numbers of uninsured are expected to increase dramatically.

This paper presents a critical analysis of the impact of the lack of health insurance on illness, suffering and death on the Asian and Pacific Islander populations. It addresses critical concerns on the proportions of the uninsured, their demographic characteristics, cultural identity, disease prevalence, access to care and health outcomes. Findings illustrate the complex processes involved in disparities in insurance coverage that exist for Asians and Pacific Islanders. Time constraints prevented incorporation of ethnographic date, however fieldwork is currently underway.

2. Asian and Pacific American Population Growth

Along with Hispanics, Asians and Pacific Islanders have experienced enormous population growth in the past decade. Currently, there is approximately 12.7 million Asians and Pacific Islanders constituting 4-5 percent of the total US population (Kim 2003). Available evidence indicates they are the fastest growing major ethnic group in California. Each year from 1997 to 2050 more than half of America’s population growth will occur among the nation’s Hispanic and Asian and Pacific American populations (Spencer 1996). Also, the Census Bureau estimates that after 2011, three out of 10 births each year will be to Asian and Pacific Islander families (Spencer 1996). More important, this population group is projected to grow by 76 percent over the next twenty years (Spencer 1996). Clearly, this makes the Asian and Pacific American populations the fastest growing segments of the American population.

Unfortunately, the Asians and Pacific Islanders population is represented in very large numbers among the medically uninsured and are more likely than whites to suffer the consequences of not having job-based health insurance coverage. For example, 64 percent of Asians and Pacific Islanders versus 73 percent of White Americans have job-based coverage. Additionally, Asian and Pacific Islanders are overall 21 percent less likely to be uninsured versus only 14 percent of White Americans (Brown 1998). With the current projections in population growth for Asians and Pacific Islanders, the numbers of the uninsured is expected to increase as well.

As a result, the lack of health insurance among the Asian and Pacific American populations will have an increasing impact on the health status of the U.S. as they continue to grow and diversify. This population will bear a considerable amount of the consequences of the medically uninsured.

3. Socio-demographic Characteristics

While it is important to look at the Asian and Pacific American populations as a whole, it is equally significant to recognize the diversity that exists within their population. There are several sizeable subgroups within that population - the largest being the Chinese, Filipino, Japanese, Asian Indian, Korean, and Vietnamese (Kim 2003). Southeast Asian populations such as the Hmong, Laotians and Cambodians are relatively new immigrants, yet have become a vital and integral part of that population.4 According to the U.S. Census Bureau, approximately 24 percent of the Asians and Pacific Islanders population is of Chinese origin; 20 percent is of Filipino origin; 16 percent is of Asian Indian origin; and 10 percent is of Korean, Vietnamese and Japanese descent (Le 2001). These numbers reflect diversity not only in terms of ethnic groups but also in nationality, culture, socioeconomic status and social class as well. Equally important, these subgroups are growing at different rates giving each region or metropolitan area in which they reside its own particular blend of Asian and Pacific American cultural characteristics.

Although the patterns of geographic distribution vary among the different subgroups of Asians and Pacific Islanders, the western United States has the highest proportions. Thus, the largest proportions currently live in just five states: California, New York, Hawaii, Texas, and Illinois (Le 2001). In fact, over one third of all Asians and Pacific Islanders in the nation live in the state of California. California has had the largest numeric increase of Asians and Pacific Islanders of all states in the U.S. and they represent the third largest ethnic group in Los Angeles county (Kim 2003)