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Four in Ten Adults with Disabilities Experienced Unfair Treatment in Health Care Settings, at Work, or When Applying for Public Benefits in 2022

October 11, 2023

In this brief, we used December 2022 data from a nationally representative survey of adults ages 18 to 64 to examine rates at which adults with and without disabilities reported they were treated or judged unfairly in the past year in three settings: at doctors' offices, clinics, or hospitals; at work; and when applying for public benefits. We also examined the impact of such treatment on their well-being.Despite important federal antidiscrimination protections, people with disabilities experience unfair treatment in health care settings, workplaces, and when applying for public benefits. Understanding and addressing these experiences is necessary to ensure that people with disabilities have equitable access to health care, employment opportunities, and economic support essential for meeting basic needs.

Closing the Coverage Gaps: Reducing Health Insurance Disparities in Massachusetts

April 27, 2023

Massachusetts has been exemplary in developing health insurance coverage policies to cover its residents. By 2019, the state's uninsurance rate was 3.0 percent, the lowest rate in the nation, representing about 204,000 uninsured residents. While the state's overall uninsured rate at a given point in time is low, more than twice as many people - 503,000, or 7.3 percent of the population - experienced a gap in coverage over the previous twelve months. And importantly, not all groups benefit equally. People who are Black or Hispanic, or who have lower incomes, experience significantly higher rates of uninsurance than the state population overall. As a result, these groups are more likely to face access barriers and financial insecurity associated with being uninsured.The purpose of this report is to begin charting a course toward closing the coverage gaps in Massachusetts, with a particular focus on creating a more racially and ethnically equitable system of coverage. The report and accompanying infographics describe the people in Massachusetts without health insurance and the barriers to coverage they face, including affordability, administrative complexity, and immigration, language, and cultural barriers. It then proposes a menu of policy options that address the specific circumstances in Massachusetts. The proposed options are meant to inform a statewide conversation about the best approaches to closing the remaining coverage gaps in Massachusetts and removing structural barriers that result in racial and ethnic disparities in health insurance coverage.

Mixed-Status Immigrant Families Disproportionately Experienced Material Hardships in 2021

February 6, 2023

Mixed-status immigrant families, where one or more members are undocumented and all other members are either US citizens or have lawful immigration status, are in a difficult predicament. Undocumented family members often have limited economic opportunities because they lack work authorization, are restricted from accessing federal safety net programs, and are under constant threat of immigration enforcement. Immigrant families may fear enrolling their children in safety net programs, even when children may be eligible, because of immigration-related concerns. Yet, limited data on the undocumented population in the US has made it difficult to assess the level of material hardships mixed-status families experience.We examine data from the Urban Institute's December 2021 Well-Being and Basic Needs Survey, a nationally representative survey of adults ages 18 to 64, to assess material hardships in the previous year among adults in mixed-status families, adults in families with permanent residents, adults in families with naturalized citizens, and adults in all-US-born families.Our findings show the following:Adults in mixed-status families were more likely than adults in families with other immigration statuses and adults in all-US-born families to report material hardships. Nearly half of adults in mixed-status families reported food insecurity, a share much higher than that for adults in other families.Adults in mixed-status families were much more likely than those in other families to have a child in the family and to have low family incomes.Our findings support previous research on how immigration policies designed to limit access to employment and safety net supports for undocumented individuals can affect other members of their family. If a goal of policymakers is to reduce hardships among low-income families and improve equitable access to safety net programs and economic opportunity, then the unique circumstances of mixed-status families, which can include members eligible for these programs, must be considered.

Being an Immigrant with Disabilities: Characteristics of a population facing multiple structural challenges

April 25, 2022

Immigrants with disabilities face multiple structural challenges, including discrimination, socioeconomic disadvantage, and barriers to safety net access. However, limited research discusses the prevalence of disability among nonelderly adult immigrants and the characteristics of this population. Drawing on five-year estimates from the 2015 to 2019 American Community Survey, this brief provides a snapshot of select characteristics of nonelderly immigrants with disabilities ages 18 to 64. Overall, 5.6 percent of nonelderly immigrants have a disability. Disaggregation by race and ethnicity shows us that this prevalence is highest among nonelderly Black Latinx immigrants at 10.2 percent and lowest for non-Latinx Asian immigrants at 4.2 percent. Other key findings are as follows:Roughly 1 in 3 (35.3 percent) immigrants with disabilities has limited English proficiency.About 3 in 10 (30.7 percent) immigrants with disabilities are from Mexico.Nearly half (49.3 percent) of nonelderly immigrants with disabilities report having low family incomes (under 200 percent of the family federal poverty level).About four in 10 (41.4 percent) immigrants with disabilities are employed. Three in 10 (30.0 percent) immigrants with disabilities are working in service occupations, such as janitors and building cleaners, housekeeping cleaners, and personal care aides.One in 8 (12.7 percent) immigrants with disabilities reported receiving Supplemental Security Income in the 12 months before the survey.Three in 10 (30.3 percent) noncitizens report being uninsured at the time of the survey, while 1 in 10 (9.5 percent) naturalized citizens report being uninsured.The results presented in this brief can inform efforts to improve the well-being of immigrants with disabilities through strategies such as increased access to government public services, improvements in job access and quality, and development of community models to promote disability inclusion.

Racial, Ethnic, and Language Concordance between Patients and Their Usual Health Care Providers

March 23, 2022

Patients of color are less likely than White patients to report being the same race as their healthcare providers. The disparity could have negative implications for patient-provider relationships and patient health outcomes.

Three in 10 Adults in California Immigrant Families with Low Incomes Avoided Safety Net Programs in 2020

July 29, 2021

Many immigrant families have avoided safety net and pandemic relief programs in recent years over concerns that their participation would have adverse immigration consequences. These chilling effects on program participation occurred in the context of a restrictive immigration policy environment under the Trump administration, including the expansion of the "public charge" rule. Though the Biden administration has reverted to prior guidance on the public charge rule and reversed many other immigration policy changes, chilling effects may continue to deter adults in immigrant families from seeking safety net supports for which they or their children are eligible.This study draws on Well-Being and Basic Needs Survey data collected in December 2020 and interviews conducted with adults in immigrant families and people who work at organizations that connect immigrant families to health, nutrition, and other support programs in California. The interviews were conducted between March and May 2021, in the early months of the Biden administration, offering unique insights as policy priorities were shifting.

COVID-19 Vaccine Attitudes Among Nonelderly Adults Who Reported Being Unlikely to Get Vaccinated

June 21, 2021

With the US supply of COVID-19 vaccines having increased in recent months and demand starting to level off, most states were at or near having more vaccines available than people who want them as of May 2021. Current efforts to expand vaccine access, such as increasing vaccine supply to community health centers and facilitating access through mobile or pop-up vaccination clinics, will be key to ensuring equitable vaccine availability for communities of color and other communities at high risk of exposure to the coronavirus and death from COVID-19 (Artiga, Corallo, and Pham 2020; Corallo, Artiga, and Tolbert 2021; Dubay et al. 2020; Ndugga, Artiga, and Pham 2021). These efforts will also help the US advance toward herd immunity, meaning between 70 and 85 percent of the population is vaccinated against COVID-19. However, doing so requires sustained focus on vaccine confidence, defined as people's trust in recommended vaccines, the providers who administer vaccines, and the vaccine development process. Confidence in the COVID-19 vaccines has improved since they were first rolled out in December 2020, but about 13 percent of adults in the US still said they would definitely not get a COVID-19 vaccine as of May 2021. Another 12 percent were waiting to see how the vaccines affect people before deciding whether to get vaccinated.