The Affordable Care Act helps to address health disparities by making prevention more affordable and accessible, requiring many health insurance plans to cover recommended prevention and wellness benefits with no cost-sharing (such as a co-payment or deductible).16 The services that many insurers are now required to cover with no cost-sharing include well-child visits, blood pressure and cholesterol screenings, diabetes screening, Pap smears and mammograms for women, and flu shots for both children and adults. An estimated 2.7 million Asian Americans and Pacific Islanders with private insurance currently have access to expanded preventive services with no cost-sharing because of the Affordable Care Act.17
The 867,000 elderly and disabled Asian Americans and Pacific Islanders who receive health coverage from Medicare also have access to an expanded list of preventive services with no cost-sharing under the Affordable Care Act. These benefits include an annual wellness visit with a personalized prevention plan and access to such important screenings and services as diabetes and colorectal cancer screenings, bone mass measurement, mammograms, and hepatitis B and pneumococcal shots.18 Asian American adults are 29 percent less likely than Whites to receive the pneumococcal vaccination.19
Cancer screenings are particularly important for Asian Americans and Pacific Islanders who are less likely to undergo mammograms, Pap smears, and colorectal cancer screening than Whites.20 Cervical cancer incidence rates are particularly high for Laotian Americans, Samoan Americans, Vietnamese Americans, and Cambodian Americans.21 The law also requires insurers to cover HIV screening without cost-sharing for individuals at high risk of infection. This is important for Asian Americans who are less likely to be tested for HIV/AIDS.22 While the rates of adults and adolescents living with a diagnosis of HIV infection has generally declined over the past five years for Whites and Native Hawaiian and Other Pacific Islanders, it has continued to increase for Asian Americans.23
Asian American children are the most likely to have had no health care visits to an office or clinic in the past year.24 Asian American adults are also more likely than their White counterparts to have had no office visits in the past year (24.7 percent for Asian Americans, compared with 19.6 percent for Whites) and tend to report relatively high lengths of time since last contact with a doctor or other health care professional.25
The Affordable Care Act benefits Asian Americans and Pacific Islanders in many other ways, including:
- Improving Chronic Disease Management. Racial and ethnic minorities often receive poorer quality care and face more barriers in seeking care and chronic disease management than White patients. The Affordable Care Act’s Innovation Center explores opportunities to invest in care innovations such as community health teams to improve the management of chronic disease.26 Such investments seek to improve care for Americans suffering from chronic disease such as the estimated 891,000 Asian American adults with diabetes.27 In addition, an estimated 1.4 million people in the United States are living with chronic hepatitis B. More than half are Asian Americans and Pacific Islanders, who have a hepatitis B virus mortality rate seven times greater than Whites.28 Tuberculosis continues to disproportionally affect the Asian American and Pacific Islander population. In 2010, Asian Americans had a prevalence rate of tuberculosis 25 times higher than Whites (22.5 cases per 100,000 population for Asian Americans, compared to 0.9 cases per 100,000 population for Whites). Native Hawaiians and Other Pacific Islanders had a prevalence rate of tuberculosis 23 times higher (20.6 cases compared to 0.9 cases).29
- Increasing Access to Community Health Centers. The Affordable Care Act increases the funding available to the more than 1,100 community health centers in all fifty states, the District of Columbia, and Puerto Rico, and the additional funding will enable them to increase the number of patients they serve.30
- Strengthening Cultural Competency in Health Care. The Affordable Care Act includes initiatives to strengthen cultural competency training among health care providers.31 These initiatives will help providers better understand and respond to the particular experiences and needs of Asian Americans and Pacific Islanders. Improved doctor patient communication is especially important as many Asian Americans and Pacific Islanders believe their doctors do not understand their culture or their values.32 Asian Americans are the most likely to be born outside the United States (66.7 percent compared to 8.3 percent for Whites) and speak English less than “very well” (35.5 percent compared to 6.0 percent for Whites).33
- Addressing Health Disparities. The Affordable Care Act invests in data collection and research focused on disparities in health and health care to help us better understand the causes of disparities and effective programs to eliminate them.34 Leveraging the Affordable Care Act, the U.S. Department of Health and Human Services (HHS) has developed and is implementing the HHS Disparities Action Plan, the Department’s largest commitment to the elimination of health disparities.35 The Affordable Care Act promotes the National Center on Minority Health and Health Disparities at the National Institutes of Health (NIH) to Institute status, enabling it to access increased funding and to plan, coordinate, and evaluate disparity-related research within NIH.36 The law also invests in the Community Transformation Grant program to support States and communities by promoting healthy lifestyles (for example, tobacco-free living), especially among groups experiencing high rates of chronic disease such as Asian Americans and Pacific Islanders. The program aims to improve health, reduce health disparities, and lower health care costs.37
HHS is in the process of upgrading data collection standards to better understand the causes of health disparities and evaluate progress toward eliminating them.38 HHS has adopted new data collection standards for its major surveys that include additional granularity for Asian Americans and Pacific Islanders. These new standards, which add a combined nine additional data collection categories for these two groups, will enhance the ability of HHS to identity and address disparities among Asian American and Pacific Islander subgroups.
- Native Hawaiians and Other Pacific Islanders. Native Hawaiians and OtherPacific Islanders are a small group in absolute numbers and often are not sampled sufficiently in surveys to estimate reliable statistics. When Native Hawaiian and Other Pacific Islander numbers are reported separately, it becomes evident that these Americans suffer from many health disparities. For example, Native Hawaiian and Other Pacific Islanders have the highest rates of all types of circulatory diseases (20.2 percent of Native Hawaiian and Other Pacific Islander adults have a circulatory disease compared to 11.7 percent of White American adults).39 Circulatory diseases include coronary heart disease, hypertension, and stroke. Native Hawaiian and Other Pacific Islanders report the highest rates of difficulty in physical functioning (25.6 percent of Native Hawaiian and Other Pacific Islander adults have any physical difficulty compared to 14.8 percent of all White American adults).40 Native Hawaiian and Other Pacific Islanders also have the highest rates of obesity (43.5 percent of Native Hawaiian and Other Pacific Islander adults are obese compared to 26.8 percent of all White American adults).41 Moreover, Native Hawaiian and Other Pacific Islanders have the highest percentage of adults (37.4 percent) with no office visits in the past year.42 The Affordable Care Act’s provisions will be particularly important for this population.
Because of the Affordable Care Act, all Americans will have access to affordable health care coverage. For Asian Americans and Pacific Islanders, the benefits are especially important. The law’s benefits will help reduce disparities in both health care and health outcomes through expanded insurance coverage and better access to high-quality health care services.
Table 1.Key Benefits of the Affordable Care Act for Asian Americans and Pacific Islanders
Key Benefits of the Affordable Care Act for Asian Americans and Pacific Islanders
|Benefit||Number of Asian Americans and Pacific Islanders Affected||When Effective|
|Expanded Insurance Coverage (ages 19-25)||97000||Plan years beginning on or after September 23, 2010|
|Preventive Health Services (Private Insurance)||2700000||Plan years beginning on or after September 23, 2010|
|Preventive Health Services (Medicare)||867000||January 1, 2011|
|Expanded Eligibility and Insurance Coverage (ages 0-64)||2000000||January 1, 2014|
Two Million Asian Americans Who Would Otherwise Be Uninsured
Will Be Covered or Eligible for Coverage Under the Affordable Care Act
Source: RAND COMPARE microsimulation model.
Note: Estimates shown are for 2016 coverage of individuals ages 0-64 reporting themselves as Asian.
Estimates do not include individuals reporting themselves as Native Hawaiian or Other Pacific Islander;
individuals reporting themselves as Spanish, Hispanic, or Latino; or individuals reporting more than one race.
The 2.5 million included in this figure are Asian Americans who would be uninsured in the the absence of the Affordable Care Act
(the 0.6 million and 2.0 million shown in the figure do not add to 2.5 million because of rounding).
The 2.0 million Asian Americans who are covered or eligible for coverage in 2016 will be covered or eligible for coverage
through the expansion of Medicaid eligibility or subsidized coverage in the Affordable Insurance Exchanges, or will be newly covered by their employers.