1. 1 Lynn A. Blewett, Ph.D. Assistant Professor Tracy L. Johnson, Ph.D. President, Health Policy Solutions Adjunct Faculty, University of Colorado Timothy Beebe, Ph.D. Senior Research Associate Gestur Davidson, Ph.D. Senior Research Associate Kathleen Call, Ph.D. Associate Professor Division of Health Services Research and Policy University of Minnesota, School of Public Health Assessing Health Insurance Coverage of Latinos with Limited English Proficiency (LEP) American Public Health Association Annual Meeting November 18, 2003

2. 2 Research Questions 1. Controlling for other variables, do Latinos with Limited English Proficiency (LEP) have lower rates of health insurance coverage than Latinos with English proficiency? -- Is language a key barrier? 2.Do the rates of health insurance coverage for Latinos with English proficiency approach the coverage rates for non-Latinos? 3.Do trends hold across two different states: Minnesota and Colorado?

3. 3 Definition of LEP Limited English Proficiency “Sometimes called ‘English Language learners’ (ELL), [individuals with limited English proficiency] cannot speak, read, write or understand English well enough to effectively communicate in English. This means that they may have difficulty communicating with health care providers and social service agencies.” Source: Minnesota Medical Association http://www.mnmed.org/pdf/proficiency.PDF http://www.mnmed.org/pdf/proficiency.PDF Operational definition for study: Latinos who requested and answered the health insurance survey questions in Spanish

4. 4 Minnesota and Colorado Uninsured Rates by Race/Ethnicity Race/EthnicityMinnesota Colorado STATEWIDE RATE5.4% uninsured11.7% uninsured NON-LATINO WHITES4.6% uninsured 9.1% uninsured LATINO RATE17.4% uninsured22.4% uninsured Source: Minnesota Health Access Survey (2001); Colorado Household Survey (2001)

5. 5 Descriptive Statistics for Latino’s with LEP Latinos with Limited English Proficiency: - are more likely to have poorer health, - are less likely to be employed, - are more likely to be poor, and - are more likely to be uninsured. As compared with Latinos with English proficiency and with non-Latino whites. Data Sources: Minnesota Health Access Survey (2001); Colorado Household Survey (2001)

6. 6 Minnesota and Colorado Latino Uninsured Rates by LEP Status (Adults19-64 years) Race/EthnicityMinnesota Colorado LATINOS w/ LEP42.2% uninsured 50.9% uninsured LATINOS w/ English Proficiency13.8% uninsured16.3% uninsured Source: Minnesota Health Access Survey (2001); Colorado Household Survey (2001)

7. 7 Isolating the Impact of Language Difficult to isolate the impact of language on access to care –Latinos have lower rates of health insurance coverage which is associated with lower access. It might not be language per se… LEP is correlated with other explanatory variables in relation to health insurance access –Income, employment status, years in the country, access to employer-sponsored coverage –Again confounding with health insurance coverage

8. 8 2001 Minnesota Health Access Survey Colorado Household Survey (2001) RDD telephone survey: English, Spanish. (Hmong: Minnesota) Two stage design: selected random individuals within random households Statewide stratified probability sample: – over-sampling non-metro regions – among populations of color MN Sample size = 27,315 (Adult 19-64 Latino = 535) CO Sample size=10,217 (Adult 19-64 Latino = 1406) Collected point-in-time coverage for all HH members

9. 9 Methods Multivariate Logistic Regression / Method of Recycled Probabilities Populations: (1) Latinos with Limited English Proficiency (2) Latinos with English Proficiency (3)Non-Latino Population (all the rest) Dependent Variable: Health Insurance Coverage = Yes/No Other Explanatory Variables: Age, Gender, Income, MSA, Health Status, Marital Status, Employment Status, More than one job, Education States: Colorado, Minnesota (separate regression models)

10. 10 MINNESOTA Percent Uninsured at Time of Survey (Adults 19-64) Unadjusted (%) Adjusted (%) % Difference LEP42.2018.4156% Non-LEP13.759.3032% Non-Latino6.186.24.01%

11. 11 COLORADO Percent Uninsured at Time of Survey (Adults 19-64) Unadjusted (%) Adjusted (%) % Difference LEP50.825.749% Non-LEP16.312.921% Non-Latino11.913.0-9%

12. 12 MINNESOTA Difference in Uninsured Rates – Adults UnadjustedAdjusted LEP vs. Non-LEP 28.45% (p=.000) 9.11% (p=.036) LEP vs. Non- Latino 36.02% (p=.000) 12.17% (p=.004) Non-LEP vs. Non-Latino 7.56% (p=.001) 3.06% (p=.067)

13. 13 COLORADO Difference in Uninsured Rates – Adults UnadjustedAdjusted LEP vs. Non-LEP 34.6% (p=.000) 12.7% (p=.052) LEP vs. Non- Latino 40.0% (p=.000) 12.8% (p=.046) Non-LEP vs. Non-Latino 4.4% (p=.044).01% (p=.96)

14. 14 Conclusions/Policy Implications Measuring coverage across all Latinos masks underlying disparities, (e.g., LEP vs. non-LEP) Policies and programs need to respond to identified subgroup differences While language is important, much of the effect goes away when you control for other key variables: income, education, employment, etc…. More services and information in Spanish for new arrivals to facilitate access to health insurance coverage Employment and education are equally important to facilitating access to coverage

15. 15 SHADAC Contact Information www.shadac.org 2221 University Avenue, Suite 345 Minneapolis Minnesota 55414 (612) 624-4802 Principal Investigator: Lynn Blewett, Ph.D. (blewe001@umn.edu)blewe001@umn.edu Co-Principal Investigator: Kathleen Call, Ph.D. (callx001@umn.edu)callx001@umn.edu Senior Research Associate: Gestur Davidson, Ph.D. (david004@umn.edu)david004@umn.edu Senior Research Associate: Timothy Beebe, Ph.D. (beebe002@umn.edu)beebe002@umn.edu Consultant: Tracy L. Johnson, Ph.D. (TLJ6805@aol.com)