Florida Public Health Review

Publication Date




From 2014-2018, the US Census Bureau reported that 8.3 percent of Americans had limited English proficiency (LEP), defined as speaking English less than very well. Section 1557 of the Affordable Care Act (ACA) ensures meaningful access to care for individuals with LEP.


This research aims to identify the current relationship between LEP and healthcare access.


Data used in this study were obtained from electronic files from the 2019 Full Year Consolidated File of the Medical Expenditure Panel Survey, or MEPS. Binary logistic regression was used to analyze the relationship between insurance coverage and whether an individual speaks another language at home, was born in the USA, their sex, whether they could afford medical care, their ethnicity, their poverty category, and how well they speak English.


A total of 21,722 participants were included in the analysis. A total of 5,274 participants spoke another language, other than English, at home and were therefore asked to self-report on their LEP, with 27.7 percent reporting LEP. When controlling for all other variables, Hispanic/Latino individuals in the same had 2.7 times higher odds of being uninsured (95% CI 2.342-3.12) compared to non-Hispanic/Latino individuals, p < 0.001. Those not born in the U.S. had 1.45 times higher odds of not being insured (95% CI 1.259-1.667) versus those born in the U.S., p < 0.001. Those who spoke another language at home had 1.59 times higher odds for being uninsured (95% CI 1.344-1.88) than those who only spoke English, p < 0.001.


In the initial years of ACA’s implementation, the racial and ethnic disparities in healthcare access were significantly reduced. Still, however, all of the disparities have not been erased.