Brief Many Asian American and Native Hawaiian/Pacific Islander Adults May Face Health Care Access Challenges Related to Limited English Proficiency
Jennifer M. Haley, Stephen Zuckerman, Nikhil Rao, Michael Karpman, Alena Stern
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Growing interest in addressing health equity is fueling efforts to better understand the unique challenges faced by Asian American and Native Hawaiian/Pacific Islander (AANHPI) communities. A lack of language accessibility for AANHPI people who are not proficient in English, in particular, could restrict their access to health insurance and health care, especially for those who may have to navigate complicated systems to enroll in coverage. In this brief, we assess the extent of limited English proficiency (LEP) among AANHPI nonelderly adults and variation in LEP across AANHPI subgroups, using the most recently available data from the American Community Survey. We find the following:

  • In 2019, about 3 in 10 (30.8 percent) Asian American adults and 1 in 8 (12.1 percent) Native Hawaiian/Pacific Islander (NHPI) adults had LEP, compared with 32.9 percent of Hispanic adults, 3.1 percent of Black adults, and 1.4 percent of white adults. An estimated 14.9 percent of Asian American adults lived in a household in which all members ages 14 and older reported having LEP.
  • AANHPI adults with LEP were more likely than those proficient in English to be noncitizens and to have economic disadvantages such as lower incomes, lower levels of education, and higher uninsurance rates.
  • Whereas almost all Hispanic adults with LEP reported speaking Spanish, the languages AANHPI adults with LEP speak were much more varied, making it more challenging to reach all members of this group with targeted language access interventions.
  • Estimated LEP rates varied widely across subgroups of AANHPI adults; for instance, LEP rates were around 12 percent for NHPI adults, whereas more than 40 percent of Chinese, Bangladeshi, Vietnamese, Nepalese, and Burmese adults had LEP.

Overall, AANHPI adults have LEP at rates nearly as high as Hispanic adults. But while Spanish is frequently offered in health system settings and materials (e.g., the federal Marketplace for purchasing health insurance coverage or state Medicaid resources) as a language option for people who do not speak English, the diverse languages spoken by AANHPI adults are rarely available. These findings show the need for greater language accessibility for AANHPI adults with LEP in health care and other settings, especially as some pandemic-related health insurance coverage protections expire and the need for clear communication from state health insurance agencies to enrollees continues to grow.

Research Areas Health and health care Immigration Race and equity Social safety net Education Economic mobility and inequality
Tags Asian American and Pacific Islander communities Economic well-being Health insurance Immigrant communities and racial equity Income and wealth distribution Immigrant communities demographics and trends Medicaid and the Children’s Health Insurance Program  Medicare Inequities in educational achievement Racial and ethnic disparities Racial equity in education Welfare and safety net programs Social determinants of health Language access
Policy Centers Health Policy Center Office of Race and Equity Research
Research Methods Quantitative data analysis