Falling Through the Cracks: Lack of Health Insurance Among Elderly Foreign- and Native-Born Blacks

Little research examines lack of health insurance among elderly Black immigrants in the US. We use data from the 2008 American Community Survey to describe variation in insurance coverage and conduct multivariate logistic regression analyses of uninsurance. Among elderly Blacks, 1.7% of the US-born were uninsured, compared to 8.4% of the Latin American and Caribbean-born, 23.2% of the African-born, and 9.3% of those born in other regions. In multivariate models, relative to the US-born, the odds of being uninsured were significantly higher among each immigrant group. Among immigrants, the odds of being uninsured were 3.80 times higher among African-born than Latin American and Caribbean-born immigrants net of demographic and socioeconomic controls. This difference was explained by the inclusion of either year of immigration or length of residence. Relative to Latin America and Caribbean-born immigrants, the odds of being uninsured were significantly higher among immigrants from "other" regions only in the model that included the immigration-related variables. This suppression effect was evident when either length of residence or citizenship was controlled. Recently-arrived, elderly Black immigrants fall through the cracks of insurance coverage. Results are discussed in relation to public and private safety net options.