HPC Corner: Low Income Minority Barriers To Health Access

By: Dorys Arlene Chavez Melendez, MD; Hardik Valand, BSc, MS-4; Raymond K. Tu, M.D.,  M.S.,  F.A.C.R.


The United States will be a minority majority country in 2050 with non-Hispanic whites making up 46%, Hispanic whites 30% and African-Americans 12% of the population.[1]

According to the US Census Bureau, Hispanics had the highest uninsured rate at 16.1% of all ethnic groups.[2]  Hispanics are employed mainly in food service and construction, jobs which frequently lack employer health insurance benefit. [3],[4] Over half of uninsured Hispanics have incomes below the Affordable Care Act (ACA) expansion limit of 138% of the federal poverty level ($17,236/year) and are often left without affordable coverage or have coverage with unaffordable high deductibles.[5]  Nearly 6 in 10 Hispanic adults have had a difficult time communicating with a health care provider because of a language or cultural barrier, according to the Associated Press-NORC Center for Public Affairs Research.[6]  This suboptimal cultural competency reduces effective communication between patients and providers.  Incomplete and inaccurate health care information, inappropriate emergency visits, and inconsistent follow-up increase cost.

According to the U.S Census bureau, the median income of Hispanic households in 2016 was $47,675 in comparison to $61,394 for non-Hispanic whites. 22.6% of Hispanics in comparison to 10.4 percent of non-Hispanic whites were living at the poverty level. [7] Educational attainment is still low mainly among Hispanics: 1/4 of Hispanic adults have less than a 9th grade education, adding to the challenge of stable employment.[8]

Physicians will treat Hispanics facing higher death rates from cancer, heart disease and homicide in comparison to non-Hispanic whites, according to the CDC. Unaffordable care that Hispanics confront limits early access to health care services.  Barriers such as lack of health insurance, language, and low socioeconomic status delay entry into the health system, subsequently leading to presentation with more advanced conditions. [9] 

Medicaid or other safety net insurance provides access to preventive services covered in the ACA, such as cancer screening, treatment of chronic conditions, health promotion, pregnancy care and women’s health. Resources as GoodRx, an on-line resource,[10] and the 4 Dollar Generic Discount Drug Programs of Walmart and Target have provided access to prescription drugs.[11]

Despite being the intention of the ACA, many are left with unaffordable healthcare. The ACA provided care for those who were once insured but many workers are left with unaffordable deductibles. Access will be a hot election cycle debate along with Medicaid work expansion, waivers, opioid treatment, community based-long term care services, and Medicaid-Buy-In programs.



[1] Incentivizing Physician Diversity in Radiology Mcintosh-Clarke, Damani R. et al. Journal of the American College of Radiology , Volume 16 , Issue 4 , 624 – 630

[2] United States Census Bureau.https://www.census.gov/library/publications/2018/demo/p60-264.html, Published September 12, 2018. Accessed April 2019.

[3] Why Are Latinos the Most Uninsured Racial/Ethnic Group of US Children? A Community-Based Study of Risk Factors for and Consequences of Being an Uninsured Latino Child. https://pediatrics.aappublications.org/content/118/3/e730

[4] How job characteristics, immigrant status, and family structure keep Hispanics uninsured. https://www.commonwealthfund.org/. Published May 2001. Accessed April 2019


[5] Health Coverage by Race and Ethnicity: The Potential Impact of the Affordable Care Act. Kaiser Family Foundation. https://www.kff.org/disparities-policy/issue-brief/health-coverage-by-race-and-ethnicity-the-potential-impact-of-the-affordable-care-act/ Accessed on April 30th, 2019.

[6] Latinos Healthcare communication barriers https://www.apnews.com/cf37bb252b0c414ea2b23afb36899e6b Published July 2018, Accessed 2019.

[7] United States Census Bureau.https://www.census.gov/library/publications/2018/demo/p60-264.html, Published September 12, 2018. Accessed April 2019.

[8] Hispanic Health in the U.S.A https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809877/ Published 2016, Accessed April 2019

[9] https://www.cdc.gov/vitalsigns/hispanic-health/index.html. Published May 2015. Accessed April 2019.

[10] https://www.goodrx.com/ Accessed April 2019.

[11] https://www.walmart.com/cp/$4-prescriptions/1078664 Accessed April 2019


More Information

Dorys Arlene Chavez Melendez, MD

Research Fellow / Division of Cardiology

The George Washington University, Washington, DC

Twitter: @DorysChavez6


Hardik Valand, BSc, MS-4

American University of Integrative Sciences, Tucker, GA

Twitter: @hvaland1


Raymond K. Tu, M.D.,  M.S.,  F.A.C.R.

Progressive Radiology, The George Washington University, United Medical Center

2121 K Street NW Suite 100 Washington DC 20037



Twitter: @RayTu10

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