UMMS Affiliation

Department of Population and Quantitative Health Sciences; Graduate School of Biomedical Sciences

Publication Date


Document Type



Health Economics | Health Policy | Health Services Administration | Health Services Research | Insurance | Race and Ethnicity


Purpose: Limited English proficiency adversely impacts people's ability to access health services. This study examines the association between English language proficiency and insurance access and use of a usual care provider after the implementation of the Affordable Care Act (ACA).

Methods: Using cross-sectional data from the 2016 Medical Panel Expenditures Survey, we identified 24,099 adults (weighted n=240,035,048) and categorized them by self-reported English-language proficiency. We classified participants according to responses to: "How well do you speak English? Would you say... Very well; well; Not well; Not at all?" (having limited English proficiency: not well; not at all, English proficient: well; very well; and English only: not applicable) and "What language do you speak at home? Would you say... English, Spanish, Other." Using these two recoded variables, we created a variable with five categories: (1) Spanish speaking, with limited English proficiency, (2) other language speaking, with limited English proficiency, (3) Spanish speaking, English proficient, (4) other language speaking, English proficient, and (5) English only. Health insurance and usual care provider were determined by self-report.

Results: Among those < 65 years, the percent covered by public insurance (Spanish: 21%, Other languages: 28%, English only 14%), who were uninsured (Spanish: 46%, Other languages: 17%, English only: 8%), and who lacked a usual care provider (Spanish: 45%, Other languages: 35%, English only: 26%) differed by English language proficiency. Among those > /=65 years, fewer people with limited English proficiency relative to English only were dually covered by Medicare and private insurance (Spanish: 12%, Other languages: 15%, English only: 59%), and a higher percent lacked a usual care provider (Spanish: 15%, Other languages: 11%, English only: 7%). Differences persisted with adjustment for covariates.

Conclusion: Post the ACA, persons with limited English proficiency remain at a risk of being uninsured relative to those who only speak English.


English proficiency, Latino, access, insurance

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Copyright Andriana M. Foiles Sifuentes et al., 2020; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

DOI of Published Version



Foiles Sifuentes AM, Robledo Cornejo M, Li NC, Castaneda-Avila MA, Tjia J, Lapane KL. The Role of Limited English Proficiency and Access to Health Insurance and Health Care in the Affordable Care Act Era. Health Equity. 2020 Dec 11;4(1):509-517. doi: 10.1089/heq.2020.0057. PMID: 33376934; PMCID: PMC7757700. Link to article on publisher's site

Journal/Book/Conference Title

Health equity

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.