Native Hawaiian and Pacific Island people under the age of 65 are less likely to have health insurance than white people, and NHPI women are less likely to have access to prenatal care.
The coverage gaps grow wider for NHPI residents who live on the U.S. mainland, reflecting in part ±á²¹·É²¹¾±Ê»¾±Ê»s broader social safety net.
The disparities increase significantly within Native Hawaiian and Pacific Islander ethnicities — for example, 1 in 4 Marshallese under 65 is currently not covered by any health insurance, according to an analysis by the nonprofit KFF.
That’s more than three times the rate of white people without health insurance and twice the rate for the population who identify their ethnicity as NHPI alone.
There are approximately 1.5 million people in the U.S. who identify as Native Hawaiian or Pacific Islander either in combination with another race, or alone. About half of NHPI people live in ±á²¹·É²¹¾±Ê»¾± or California.
NHPI Coverage Varies Depending On Location
The expansion of Medicaid coverage under the Affordable Care Act in certain states has made geography a key determinant for health coverage, including for the NHPI population.
±á²¹·É²¹¾±Ê»¾±'s eligibility levels for Medicaid coverage, and mandated employer-provided health coverage for those working at least 20 hours per week means that the rate of uninsured NHPI on-island is half the rate of those living off-island.
But NHPI people living in southern states on the U.S. mainland — even in those that have taken advantage of ObamacareÊ»s expanded Medicaid eligibility — are four times more likely to be uninsured than those living in ±á²¹·É²¹¾±Ê»¾±.
The coverage disparities for the NHPI community are heightened by their mainland migration journey.
A third of the nation's Marshallese community – about 15,000 people – now live in northwest Arkansas, drawn by employment opportunities in the food processing industry since the 1980s.
Arkansas has expanded Medicaid eligibility but with one notable omission. It's now the only state that has not extended coverage for mothers beyond 60 days after giving birth.
That's a major contributor to the state's , according to Arkansas Advocates for Children and Families.
The overall outlook for NHPI infants in the U.S. is that they die at almost twice the rate of white infants, and pregnancy-related mortality rates for NHPI people are five times higher than the rate for white people.
Different Experiences Of Care
By sifting data from multiple sources, KFF researchers also found the NHPI population experiences barriers to effective care when they do receive it.
KFF said, "NHPI adults face persistent disparities in health and health care, which, in part, reflect specific challenges such as geographic isolation, limited access to linguistically accessible and culturally competent care, and social and economic inequities."
In a convened by KFF between June and August 2024, NHPI people said their barriers to health care included lack of interpreters for family members, perceived discrimination related to their NHPI identity and appearance, and difficulty finding mental health care providers who understand their cultural background.
A 27-year-old NHPI woman from Oahu interviewed by KFF said, "One of my relatives was going through this health checkup and she doesn’t really know a lot of things. So when she was telling the story of how this incident happened to her, my mom kind of got mad and was like 'Where was your interpreter?' And then she told us that her interpreter didn’t show up."
Experiences like that continue to translate into markedly different health outcomes for NHPI people, KFF found.
NHPI people are twice as likely to die from diabetes than white people despite having similar rates of diabetes and, are less likely to receive mental health treatment.
Is there some good news? Yes.
NHPI people have a lower rate of overall cancer mortality than the white population.
Data Sources: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, U.S. Census Bureau, U.S. Department of the Interior.
Civil Beat’s community health coverage is supported by the , and .
