Access to Health Insurance and Health Care for Hispanic Children in the United States

• DOI: 10.1177/00027162211050007
• Author: Krista M. Perreira,Jonathan Oberlander,Chenoa D. Allen
• Date: 01 July 2021
• Published date: 01 July 2021
• Subject Matter: Health

ANNALS, AAPSS, 696, July 2021 223

DOI: 10.1177/00027162211050007

Access to

Health

Insurance and

Health Care for

Hispanic

Children in the

United States

By

KRISTA M. PERREIRA,

CHENOA D. ALLEN,

and

JONATHAN OBERLANDER

1050007ANN THE ANNALS OF THE AMERICAN ACADEMYACCESS TO HEALTH INSURANCE AND HEALTH CARE

research-article2021

Health insurance gives families access to medical ser-

vices and protects them against the costs of illness and

medical treatment. Insured children are more likely

than their uninsured peers to use medical services, pre-

ventive health services, have a usual source of care, and

have fewer unmet medical needs. In this article, we

review trends in health insurance coverage for Hispanic

children and the factors that influence their coverage.

We then discuss health care utilization among Hispanic

children and barriers to health care utilization. We con-

clude with a discussion of strategies to improve Hispanic

children’s health care access in the age of COVID-19.

Keywords: Hispanic/Latino; children; health insur-

ance; utilization; health care access

Children who are covered by health insurance

are more likely than their uninsured peers to

use medical services and preventive health ser-

vices, have a usual source of care, and have fewer

unmet medical needs (Paradise 2014). Insurance

has positive impacts on childhood health, which

Krista M. Perreira is a professor of social medicine at

the University of North Carolina School of Medicine at

Chapel Hill. Her scholarship combines qualitative and

quantitative methodologies to study Hispanic/Latino

health, immigration, and the consequences of structural

inequalities and public policies affecting Hispanic/

Latino and immigrant populations.

Chenoa D. Allen is an assistant professor of health sci-

ences at the University of Missouri and a research

affiliate at the University of Wisconsin Center for

Demography of Health and Aging. Her current work

studies the effects of state and local immigrant policies

on Hispanic children’s health.

Jonathan Oberlander is a professor and chair of social

medicine in the School of Medicine and a professor of

health policy & management, Gillings School of Global

Public Health, at the University of North Carolina at

Chapel Hill. He is author of The Political Life of

Medicare (University of Chicago Press 2003) and

coeditor of The Social Medicine Reader.

Correspondence: perreira@email.unc.edu

224 THE ANNALS OF THE AMERICAN ACADEMY

in turn has lasting effects on adult educational attainment, employment, and future

earnings from work (Guzman, Chen, and Thomson 2020; Case, Fertig, and Paxson

2005).

The United States is the only rich democracy in the world that has a large pro-

portion of its population without health insurance. About 30 million persons in the

United States, including more than 4 million children, were uninsured in 2019.

The absence of universal health care means that widespread disparities in health

insurance exist in the United States. Insurance coverage varies by income, employ-

ment, state of residence, race/ethnicity, citizenship, immigration status, and age.

Hispanic children have long had high uninsured rates. In 2000, 26.1 percent

of Hispanic children were uninsured, compared to 8.2 percent of non-Hispanic

(NH) white and 15.6 percent of NH Black children (Larson etal. 2016). There

has been substantial progress in reducing uninsured rates among Hispanic chil-

dren over the past two decades, due largely to expanded enrollment in public

insurance programs and the impact of the Affordable Care Act (ACA). But dis-

parities persist, and progress in insuring Hispanic children has reversed since

2017. Moreover, the COVID-19 pandemic has laid bare weaknesses and inequi-

ties in U.S. health insurance and medical care delivery that disproportionately

impact Hispanic families.

Higher uninsured rates mean that Hispanic children use fewer medical ser-

vices than NH white or NH Black children and are more likely to have unmet

medical needs (Larson etal. 2016). Yet lack of insurance coverage is not the only

barrier to Hispanic children’s use of medical services. Their access to medical

services is also hindered by employment policies limiting parental access to ben-

efits such as sick leave, inadequate public transportation services in their com-

munities, a lack of culturally and linguistically appropriate care, and climates of

fear and mistrust. This article summarizes the evidence on Hispanic children’s

access to health insurance and use of health care. We conclude by discussing

strategies that could improve their access to health care in the context of the

COVID-19 pandemic and Biden administration.

Health Insurance Coverage

Americans obtain health insurance from both private sources via employment,

direct purchase, or ACA-organized purchasing pools and public programs such as

Medicaid, the Children’s Health Insurance Program (CHIP), and Medicare

(which covers persons 65 and older as well as younger persons with permanent

disabilities who qualify for Social Security Disability Insurance). Most Americans

under age 65 obtain coverage through employer-sponsored insurance (ESI),

NOTE: This research was supported by the Carolina Population Center (CPC) and its

National Institutes of Health (NIH)/National Institute of Child Health and Human

Development (NICHD) Grant Award Number P2C HD50924 as well as the Inclusive Science

Program of the North Carolina Translational and Clinical Sciences (NCTraCS) Institute

through Grant Award Number IL1TR002489 (Perreira).