Perception of the Affordable Care Act Among Korean Americans

Background and Purpose: Although economic resources are a reliable predictor for health insurance coverage, Korean Americans are exceptionally likely to be uninsured relative to their economic prosperity. The Affordable Care Act (ACA) improved health insurance coverage among racial/ethnic minorities because of series of policy changes, including Medicaid expansion and the individual mandate rule. Since its passage in 2010, the number of uninsured Korean Americans has declined; however, the uninsurance rates of Korean Americans still remain the highest among Asian Americans. Information is scarce about whether the expanded health insurance coverage actually improved access to care among Korean Americans and what are barriers that this group still encounter even if newly insured. This study aimed to explore the view of self-employed Korean immigrants on the policy changes triggered by the ACA and whether newly obtained health insurance improved their access to care.

Methods: In-depth interviews were conducted with 24 self-employed Korean immigrants living in the Greater Los Angeles area in 2015 (50% females; mean age=51; average monthly income=$5,650). Most of the participants (n=19) did not have health insurance before the individual mandate took into effect in 2014. Currently, only 5 (21%) were still uninsured. Participants were asked about their experiences with and opinions on the health insurance which they obtained due to the ACA. Interviews were analyzed using an inductive thematic content analysis.

Results: Although a few participants shared their excitement with having health insurance, most expressed concerns and shared problems impeding their access to care despite being insured. From the data three themes emerged: affordability, accessibility, and law-abiding. Insurance premiums and out-of-pocket cost were perceived still expensive, particularly when compared to what they paid for health care in South Korea. Commonly, respondents shared ethnic-specific hurdles discouraging seeking care, such as lacking Korean-speaking physicians in their provider networks, excessive waiting time to see such providers, and inability to navigate a maze-like system of care. When respondents were asked why they purchased health insurance, most of them did so to avoid the individual mandate penalty and would stop paying the premium if the individual mandate rule was abolished.

Conclusions and Implications: Expansion of insurance coverage may be insufficient to reduce disparities in access to care experienced by Korean Americans because cultural, perceptual, and system-wide barriers discourage them from keeping health insurance and seeking health services. With the recent abolition of the individual mandate rule, it is imperative to study the extent to which this group stop paying premium of the health insurance plans they purchased to avoid the penalty.