The impact of COVID-19 on healthcare coverage and access in racial and ethnic minority populations in the United States

Submitted: 12 July 2023
Accepted: 22 November 2023
Published: 27 December 2023
Abstract Views: 1869
PDF: 546
HTML: 50
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


This study described spatiotemporal changes in health insurance coverage, healthcare access, and reasons for non-insurance among racial/ethnic minority populations in the United States during the COVID-19 pandemic using four national survey datasets. Getis-Ord Gi* statistic and scan statistics were used to analyze geospatial clusters of health insurance coverage by race/ethnicity. Logistic regression was used to estimate odds of reporting inability to access healthcare across two pandemic time periods by race/ethnicity. Racial/ethnic differences in insurance were observed from 2010 through 2019, with the lowest rates being among Hispanic/Latino, African American, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander populations. Pre-pandemic insurance coverage rates were geographically clustered. The percentage of adults citing change in employment status as the reason for non-insurance increased by about 7% after the start of the pandemic, with a small decrease observed among African American adults. Almost half of adults reported reduced healthcare access in June 2020, with 38.7% attributing reduced access to the pandemic; however, by May 2021, the percent of respondents reporting reduced access for any reason and due to the pandemic fell to 26.9% and 12.7%, respectively. In general, racial/ethnic disparities in health insurance coverage and healthcare access worsened during the pandemic. Although coverage and access improved over time, pre-COVID disparities persisted with African American and Hispanic/Latino populations being the most affected by insurance loss and reduced healthcare access. Cost, unemployment, and eligibility drove non-insurance before and during the pandemic.



PlumX Metrics


Download data is not yet available.


Abedi V, Olulana O, Avula V, Chaudhary D, Khan A, Shima, S, Li J, and Zand R. Racial, economic, and health inequality and COVID-19 infection in the United States. J Racial Ethnic Health Disp 2021;8:732-42. DOI:
Admon LK, Wikelman TNA, Zivin K, Terplan M, Mhyre JM, and Dalton VK. Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012–2015. Obst Gynecol 2018;132:1158-66. DOI:
Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, and Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet 2017;389:1453-63. DOI:
Bramlett MD, Dahlhamer JM, Bose J. Weighting Procedures and Bias Assessment for the 2020 National Health Interview Survey. Published September 2021. Accessed June 13, 2023. Available from:
Buchmueller TC, Levy HG. The ACA’s Impact on Racial and Ethnic Disparities in Health Insurance Coverage and Access to Care. Health Affairs 2020; 93:395-402. DOI:
Bundorf MK, Gupta S, Kim C. Trends in US Health Insurance Coverage During the COVID-19 Pandemic. JAMA Health Forum 2021;29:e212487. DOI:
Chinchih C, Frey CB, Presidente G. Culture and contagion: Individualism and compliance with COVID-19 policy. J Economic Behav Organ 2021;190:191-200. DOI:
Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D, Fazlul I. The three-year impact of the Affordable Care Act on disparities in insurance coverage. Health Serv Res 2019;54:307–16. DOI:
Courtemanche CH, Marton J, Ukert B, Yelowitz A, Zapata D. Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States. J Policy AnalysisManag 2017;361:178–210. DOI:
Dalsania AK, Fastiggi MJ, Kahlam A, Shah R, Patel K, Shiau S, Rokicki S, DallaPiazza M. The relationship between social determinants of health and racial disparities in COVID-19 mortality. J Racial Ethnic Health Disp 2022;9:288-95. DOI:
Devakumar D, Selvarajah S, Shannon G, Muraya K, Lasoye S, Corona S, Paradies Y, Abubakar I, Achiume ET. Racism, the public health crisis we can no longer ignore. Lancet 2020;39510242:e112-e113. DOI:
Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health 2015;129:611-20. DOI:
Fay RE, Train GF Aspects of survey and model-based poscensal estimation of income and poverty characteristics for states and counties. Proceedings of the Section of Government Statistics, American Statistical Association, Washington, D.C.; 1995.
Garfield R, Orgera K. The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid. Kaiser Family Foundation. Published 2021. Accessed July 5, 2022. Available from:
Gómez CA, Kleinman DV, Pronk N, Wrenn Gordon GL, Ochiai E, Blakey C, Johnson A, Brewer KH. Practice Full Report: Addressing Health Equity and Social Determinants of Health Through Healthy People 2030. J Public Health Manag Pract 2021;27:S249. DOI:
Hardeman RR, Murphy KA, Karbeah J, Kozhimannil KB. Naming institutionalized racism in the public health literature: a systematic literature review. Public Health Rep 2018;133:240-9. DOI:
Hardeman RR. Examining racism in health services research: a disciplinary self‐critique. Health Serv Res 2020;55: 777. DOI:
Holtgrave DR, Barranco MA, Tesoriero JM, Blog DS, Rosenberg ES. Assessing racial and ethnic disparities using a COVID-19 outcomes continuum for New York State. Ann Epidemio 2020;48: 9-14. DOI:
Kaiser Family Foundation. Status of State Medicaid Decision: Interactive Map. Published 2022. Accessed November 2, 2022. Available from:
Khorrami P, Sommers BD. 2021. Changes in US Medicaid Enrollment During the COVID-19 Pandemic. JAMA Netw Open 2021;45:e219463. DOI:
Lau KHV, Anand P, Ramirez A, Phicil S. Disparities in Telehealth use During the COVID-19 Pandemic. J Immigrant Minority Health 2022;24:1590–1593. DOI:
Lee A, Ruhter J, Bosworth A, Peters C, De Lew N, Sommers BD. Changes in Health Insurance Coverage, 2019-2021: Geographic and Demographic Patterns in the Uninsured Rate. U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation Issue Brief. 2023. Accessed June 13, 2023. Available from:
Li M, Shi X, Li X, Ma W, He J, Liu T, 2019. Sensitivity of disease cluster detection to spatial scales: an analysis with the spatial scan statistic method. Int J Geograph Informat Sci 2019;33:2125-2152. DOI:
Luo J, Tong L, Crotty BH, Somai M, Taylor B, Osinski K, George B. Telemedicine Adoption during the COVID-19 Pandemic: Gaps and Inequalities. Appl Clin Inform 2021;12:836-844. DOI:
Ma A, Sanchez A, Ma M. Racial disparities in health care utilization, the affordable care act and racial concordance preference. Int J Health Econ Manag 2022;22:91-110. DOI:
National Center for Health Statistics. National Health Interview Survey Sample Adult Longitudinal Public-Use File. 2020. Available from:
National Center for Health Statistics. Reduced Access to Care: RANDS During COVID-19 Technical Notes. Published 2021. Accessed June 13, 2023. Available from:
National Center for Health Statistics. Research and Development Survey During COVID-19 Experimental Estimates. 2020. Available from:
Okonkwo NE, Aguwa UT, Jang M, Barré IA, Page KR, Sullivan PS, Beyrer C, Baral S. COVID-19 and the US response: accelerating health inequities. BMJ Evid Based Med 2021;26:176-9. DOI:
Ord JK, Getis A Local spatial autocorrelation statistics: distributional issues and an application. Geographical Analysis 1995;27:286-306. DOI:
Patrick J & Yang PQ. Health Insurance Coverage before and after the Affordable Care Act in the USA. Sci 2021;3:25. DOI:
Paul R, Arif A, Pokhrel K, Ghosh S. The association of social determinants of health with COVID‐19 mortality in rural and urban counties. J Rural Health 2021;37:278-86. DOI:
Peterson P, Toribio N, Farber J, Hornick D. Nonresponse Bias Report for the 2020 Household Pulse Survey. Published March 24, 2021. Accessed June 13, 2023. Available from:
Quiñones AR, Botoseneanu A, Markwardt S, Nagel CL, Newsom JT, Dorr DA, Allore HG. Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PloS One 2019;14:e0218462. DOI:
Ramirez AV, Ojeaga V.E., Hensler B, Honrubia V. Telemedicine in Minority and Socioeconomically Disadvantaged Communities Amidst COVID-19 Pandemic. Otolaryngology—Head and Neck Surgery 2020;1641:91-92. DOI:
Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis 2021;72:703-6. DOI:
U.S. Census Bureau. 2010–2019 American Community Survey 1-Year Estimates Detailed Tables C27001, C27001A, C27001B, C27001C, C27001D, C27001E, C27001F, C27001G, C27001H, and C27001I: Health Insurance Coverage Status by Sex by Age. 2020. Available from:
U.S. Census Bureau. American Community Survey Sample Size. Published 2009-2023. Accessed June 13, 2023. Available from:
U.S. Census Bureau. Household Pulse Survey Data Tables: Phases 1, 2, 3, 3.1, 3.2, and 3.3. 2022. Available from:
Van Rossum G, Drake FL Python 3 Reference Manual. Scotts Valley, California: CreateSpace; 2009.
Walker K, Herman M tidycensus: Load US Census boundary and attribute data as ‘tidyverse’ and ‘sf’-ready data frames. 2022. R package version 1.1.2.

How to Cite

Freelander, L., Rickless, D. S., Anderson, C., Curriero, F., Rockhill, S., Mirsajedin, A., Colón, C. J., Lusane, J., Vigo-Valentín, A., & Wong, D. (2023). The impact of COVID-19 on healthcare coverage and access in racial and ethnic minority populations in the United States. Geospatial Health, 18(2).

List of Cited By :

Crossref logo