Our recent report on coverage rates for Latino children and parents highlights geographic disparities in access to affordable health insurance. For example, while nearly 4 million Latino parents and 2 million Latino kids were uninsured in 2019, both groups were much more likely to have insurance coverage in California, which has expanded Medicaid, than in Florida or Texas, neither of which have adopted the expansion.
A study from Health Affairs’ most recent issue on borders and immigrant health examines other geographic disparities in coverage and access among Latinos, comparing the health landscape in counties with newer immigrant communities to those with more established communities.
The University of California-Santa Barbara and the University of Texas at Austin researchers used decennial Census data to classify over 3,000 U.S. counties into “new” or “established” Latino destinations or “other” counties based on the concentration and growth rate of the Latino population between 1990 and 2010 (the Latino population included new immigrants, immigrants who moved to a given county from somewhere else in the U.S., and U.S.-born Latinos). Newer destinations tended to be counties in the Midwest and South in states like Nebraska, Iowa, North Carolina, and Georgia, while established destinations were largely in border states like California, Arizona, New Mexico, and Texas. The authors then compiled data on topics like health care supply, Medicaid expansion, federal immigration enforcement, and partisan vote share to examine five key aspects of the county’s health care landscape: health care shortages, general health care supply, safety-net health care supply, health care access environment, and population health.
What it finds:
- New destination counties:
- were less likely to be designated a primary care, mental health, or dental care shortage area, or to have a shortage in all three areas than established destinations
- had more pediatricians per 10,000 people, but fewer hospitals per 100,000 people than established destinations
- had fewer federal health centers, community health centers, and rural health clinics per 100,000 people than established destinations
- had lower uninsured rates for both children and adults than established destinations
- Established destination counties:
- were more likely to have health care shortages — while the authors estimated that almost a quarter of established counties had a primary, mental health, and dental shortage, only about 7 percent of new destinations did
- had higher adult and child uninsured rates compared to new destinations
- were less likely to be in a Medicaid expansion state than other kinds of counties
- had more hospitals with translators per 100,000 people than other kinds of counties
- Some findings depended on socioeconomics:
- Some general health care supply measures, like the number of hospital beds per 1,000 people and the number of psychologists per 10,000 people, were about equal between different types of counties, and others, like the number of doctors and dentists per 10,000 people, were more related to factors like a county’s poverty rate or the share of adults without a high school diploma.
- New destinations were more often ranked in the top half of their state on health factors, like health behaviors and physical environment, and health outcomes, like length and quality of life. However, when the authors factored in socioeconomic characteristics, there were no differences between new and established destinations.
Why it matters:
- The authors argue that these results show distinct barriers to health care access in both new and established Latino destinations — although new destinations were less likely to have health care shortages, they also had fewer safety-net resources, and established destinations suffered from shortages and high adult and child uninsured rates.
- About 70 percent of the Latino population lived in established destination counties as of 2010. Histories of discrimination and disinvestment in health systems likely contribute to the disparities between these and other counties, but as Kelly Whitener recently wrote, states have a number of options to correct course and expand health care access.