Getting Back on Track: A Detailed Look at Health Coverage Trends for Latino Children Appendix

In This Report:

Appendix A. How the Census Bureau Collects Questions about Race and Ethnicity on the American Community Survey and Compiles Hispanic/Latino Data

The American Community Survey (ACS), fielded by the U.S. Census Bureau, collects questionnaires from approximately 3.5 million households every year and extrapolates estimates from these responses.35 The ACS provides the most reliable annual estimates of health insurance coverage for geographic areas of over 65,000 individuals. The data is used by various agencies at multiple levels of government to plan outreach and enrollment efforts.36 However, post-survey quality checks and measures of accuracy conducted by the Census Bureau indicate that the Latino population is consistently under-sampled in the ACS.37 Exacerbating this challenge, young children ages 0-4, especially young Latino children, have historically been undercounted in ACS and Census Bureau data.38

The Census Bureau follows guidelines set by the Office of Management and Budget (OMB) that define race and ethnicity as two separate facets of a person’s identity.39 The ACS definition of Hispanic/Latino is:


“Hispanics or Latinos who identify with the terms ‘Hispanic,’ ‘Latino,’ or ‘Spanish’ are those who classify themselves in one or more of the specific Hispanic, Latino, or Spanish categories listed on the questionnaire (‘Mexican,’ ‘Puerto Rican,’ or ‘Cuban’) as well as those who indicate that they are ‘another Hispanic, Latino, or Spanish origin.’ People who do not identify with any of the specific origins listed on the questionnaire but indicate that they are ‘another Hispanic, Latino, or Spanish origin” are those who identify as Argentinian, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, or other Spanish cultures or origins […] Origin can be viewed as the heritage, nationality group, lineage, or country of birth of the person or the person’s parents or ancestors before their arrival in the United States. People who identify their origin as Hispanic, Latino, or Spanish may be of any race.”


When tallying responses, the Census Bureau constructs the “Hispanic/Latino” category by adding together all those who indicate that they were of Mexican, Puerto Rican, Cuban, or another Hispanic/Latino origin, regardless of race (see Data Note). While the Census Bureau does not specifically list Brazilian as an option for Latino ethnicity, if a Brazilian individual self-identifies as Hispanic/Latino and indicates “another Hispanic, Latino, or Spanish origin” on their survey, they are counted as Latino. A very small share of individuals who indicate that they are of Brazilian descent also indicate that they are Hispanic/Latino on the Census.40

Data Note: Concerns about the ACS Definition of Hispanic/Latino
Separating ethnic and racial identity is not a universally accepted standard for collecting demographic data.41 Asked to choose a race, but not identifying as white, a large share of Latino survey respondents select “Some other race” or skip the race question altogether.42 The Census Bureau itself has conducted research showing that combining the questions on race and Hispanic/Latino question into a single “race/ethnicity” question would reduce item nonresponse rates and yield more accurate results.43 In a 2017 report to OMB, the Census Bureau concluded that, “By combining the race and Hispanic origin questions into one question on race/ethnicity, the research has shown that Hispanics can better find themselves among the race and ethnicity categories.”44

Appendix B. National Latino Child Uninsured Rate by Detailed Ethnicity, 2016-2019

Appendix C. Latino Child Uninsured Rate by State, 2016-2019

Appendix D. Number of Uninsured Latino Children by State, 2016-2019

Appendix E. Comparing the Rate of Uninsured Latino Children to Uninsured Non-Latino Children

Back to Report


35 “American Community Survey Information Guide” (Washington D.C.: United States Census Bureau, December 2017), available at
36 United States Census Bureau, “Why We Ask Questions About… Health Insurance Coverage,” available at
37 United States Census Bureau, 2019 American Community Survey, Table B98013, “Total Population Coverage Rate by Weighting Race and Hispanic or Latino Groups,” available at
38 Jensen, E., “Investigating the 2010 Undercount of Young Children—Examining Coverage in Demographic Surveys,” (Washington D.C.: United States Census Bureau, January 2019), available at
39 United States Census Bureau, “American Community Survey: Why We Ask Questions About… Race,” available at
40 Hugo Lopez, M. Manuel Krogstad, J., and Passel, J., “Who is Hispanic?” (Washington D.C.: Pew Research Center, September 2020), available at
41 González, J. and Santos, R., “Separating Race from Ethnicity in Surveys Risks an Inaccurate Picture of the Latinx Community,” Urban Wire Blog, The Urban Institute (October 15, 2019), available at
42 “Research to Improve Data on Race and Ethnicity,” (Washington D.C.: United States Census Bureau, March 2017), available at
43 Ibid.
44 Mathews, K. et al., “2015 National Content Test Race and Ethnicity Analysis Report: A New Design for the 21st Century,” (Washington D.C.: United States Census Bureau, February 2017), available at