Executive Summary

The National Council of Asian Pacific Islander Physicians (NCAPIP) represents Asian American, Native Hawaiian, and Pacific Islander physicians committed to the advancement of the health and well-being of their patients and communities. NCAPIP believes in shaping health care in America to meet this shared American goal of optimal health for all.

Physicians must take a leadership role in assuring that every American receives the highest quality health care, provided by health care systems and supported by health care policies that value each and every individual and their unique backgrounds. Health care should be provided in an equitable manner, without discrimination based on type of health insurance, income, gender, age, race, ethnicity, national origin, language, religion, disability, sexual orientation, gender identity, geographic location, or immigration status.

NCAPIP recognizes the important policy gains implemented by the Affordable Care Act (ACA) and supports additional national, state, local, and health care industry-driven policy reforms that will address the disparities AANHPI populations face, and which would improve the health care systems in the U.S. for all. To achieve optimal health for all, federal, state, local, and health care industry policies, standards, and practices must address:
  1. affordable access to care that is not only affordable health insurance coverage, but also overcoming cultural and linguistic barriers to care;
  2. improved quality of care, a must for all Americans, with consideration given to the socioeconomic conditions, diversity of needs, and health disparities experienced by AANHPIs;
  3. reduced costs and payment reform with continued innovation, and intentional shift of resources to prevention and wellness, primary care, and home- and community based care; and
  4. health workforce development and leadership.


Asian Americans are the fastest growing racial or ethnic population in the U.S.. Aggregated data and a persistent lack of granular data collection, coupled with incomplete analyses and reporting have masked important differences and disparities among Asian Americans, Native Hawaiians and Pacific Islanders (AANHPIs) and prevented the identification of specific medical and public health needs among subgroups, i.e., disparities in hepatitis B and tuberculosis, alarming and largely unrecognized, increased incidence of diabetes, cardiovascular disease, cancer, and mental health conditions.
A disproportionate number of AANHPIs live in poverty and lack access to affordable health insurance coverage. When disaggregated, data showed Vietnamese and Cambodian Americans having higher poverty rates than Latinos or African Americans and Korean Americans having one of the highest percentages of uninsured among all racial and ethnic groups.

With the implementation of the ACA, the number of uninsured AANHPIs decreased in half (15.1% to 7.5% for Asian Americans, and 14.5% to 7.8% for Native Hawaiians and Pacific Islanders). Also, in state such as California, Washington, New York, and Hawaii, 33% of Native Hawaiians and Pacific Islanders and 17% of Asian Americans are covered by Medicaid through the Medicaid expansion, while 32% of Asian American children rely on Medicaid and the Children’s Health Insurance Program (CHIP) for coverage, and 45% of Asian Americans aged 65 and older benefiting Medicare as their primary health insurance coverage.

However, even with the expanded coverage under ACA, AANHPIs continue to face barriers in obtaining access to quality health care. A myriad of reasons contribute to this, including unaffordable health coverage, particularly for employees and owners of small businesses, disqualifications due to immigration status for those newly arrived or undocumented, lack of culturally and linguistically appropriate health care services, and a paucity of access to preventive services. As a result, there is often poor health status and increasing disparities in clinical outcomes and care among many AANHPI populations.

Finally, throughout the AANHPI communities, the number of primary care physicians who serve these linguistically and culturally isolated and marginalized patients is diminishing and this will only exacerbate the already existing health disparities. Also, while AANHPI physicians have important roles in American medicine, holding vital positions in academia, research, hospitals and health systems, health plans, community health centers, and health departments, their absence in major leadership roles in medicine and public health is almost as conspicuous.

NCAPIP Positions

AFFORDABLE ACCESS TO CARE: NCAPIP will continue to work to:
  1. Expand access to affordable health insurance coverage that include essential health benefits to cover all Americans, including newly arrived and undocumented immigrants; oppose policies that create unnecessary barriers to access, including penalties for breaks in coverage, work requirements, and more frequent reporting and eligibility determination requirements.
  2. Support policies that make health insurance more affordable, including tax credits to offset health insurance premiums, cost-sharing reductions for co-payments and deductibles, and funding to stabilize health insurance marketplaces; and support policies that protect patients from financial burdens that discourage health care utilization, screening, and treatment.
  3. Support policies that expand access and increase affordability of health insurance for all AANHPI populations, including those who live in high cost of living or rural areas, or are small business owners; support funding for culturally and linguistically appropriate and tailored community outreach and enrollment assistance through navigators and brokers.
  4. Ensure that individuals with limited English proficiency (LEP) and individuals with lower health literacy are provided equal access and needed assistance to use enrollment processes, including internet-based portals, to apply for Medicaid and health insurance coverage through health insurance exchanges.
  5. Support full funding for the implementation of comparable expansions of health insurance coverage and Medicaid in the U.S.-associated Pacific Island jurisdictions.
  6. Support state initiatives that expand beyond federal legislation to achieve universal health coverage and more comprehensive health benefits for all.
  7. Safeguard disproportionate share (DSH) payments to existing DSH institutions, many of which provide vital health care services to underserved AANHPI populations.
  8. Include community-based physician practices (providers who have patient panels with at least 30% of their patients on Medicaid), as “essential community providers” in the provider networks of qualified health plans offering health insurance coverage through health insurance exchanges.

IMPROVED QUALITY OF CARE: NCAPIP will continue to work to:
  1. Ensure that all federally-supported medical research and health surveys, include studies that are of relevance and statistical significance for disaggregated AANHPI populations; highlight the need to collect, use, and report disaggregated and granular data for diverse AANHPI populations in all health care performance and quality improvement measures and activities.
  2. Promote and support the development of health information technologies, exchanges, and networks that enable physicians serving AANHPI populations to utilize data to identify and address the clinical needs of their patients.
  3. Support improved integration and coordination of medical, behavioral, oral, and other health care services.
  4. Integrate requirements for culturally and linguistically appropriate services in all quality improvement and practice transformation standards, initiatives, and activities.
  5. Include the identification and reduction of disparities as an integral element in all quality improvement and payment reform initiatives; define disparities populations as including racial and ethnic minorities, individuals with disabilities, sexual and gender minorities, individuals living in rural areas, individuals with limited English proficiency, individuals with primary languages in addition to English, individuals with lower health literacy, individuals living in Health Professions Shortage Areas, individuals living in Medically Underserved Areas, and individuals with social and behavioral risks as defined by the National Academies of Sciences, Engineering, and Medicine.
  6. Use risk adjustment based on patient social and behavioral risk factors, and appropriate incentives, in quality improvement activities and programs for community providers, such as solo and small group physician practices, who care for AANHPI populations who face socioeconomic, language, and cultural barriers to care.
  7. Continue to support continuing education and technical assistance to AANHPI physicians to support quality improvement, practice transformation, and value-based care; support independent practice associations, medical groups, local medical societies, and minority physician associations as technical assistance providers.
  8. Ensure that the experiences of AANHPI and all patients, families, and caregivers are documented and included as an essential measure of health care quality, using translated and culturally appropriate measures, surveys, and other data collection methods; actively promote the inclusion of AANHPI populations in patient-centered outcomes research and use of patient-reported outcomes measures, and ensure that the unique characteristics of AANHPI populations are incorporated in findings and recommendations.

REDUCED COSTS AND VALUE-BASED CARE: Reducing total health care costs is an essential element in reform of U.S. health systems that now account for one-sixth of the Gross Domestic Product. High- cost technological advancements in health care, increased needs of an aging population, as well as high administrative costs, waste, duplication, and “defensive” medicine, all contribute to the continuing increases in costs. Continued innovation, as well as an intentional shift of resources to prevention and wellness, primary care, and home- and community based care, will be required to “bend the cost curve” of rising health care costs. Health care payments will increasingly shift from fees-for-service to value-based payments based on quality outcomes and cost reductions. Health care systems also need to make strategic investments to address the social and cultural determinants of health. NCAPIP will continue to work to:
  1. Provide sustainable support for primary care practices in underserved AANHPI communities, who are essential community providers and part of the health care safety net for medically underserved populations.
  2. Promote programs that focus on the development and recruitment of primary care providers who are trained to meet the diverse linguistic and cultural needs of the AANHPI populations.
  3. Develop and implement programs that invest in prevention and wellness promotion that incorporate the cultural and linguistic needs of diverse AANHPI populations, and use participation in the program as the basis for incentives rather than outcome measures.
  4. Support programs that include community-based organizations in providing chronic care management and transitional care services after hospital discharges and other transitions of care that reduce avoidable readmissions and optimize home- and community-based care.
  5. Promote partnerships between health care providers and systems with community-based social and other services that will address the social and cultural determinants of health.
  6. Include the perspectives of AANHPI physicians and physician groups, especially solo and small group physician practices in the implementation of the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA).
  7. Support the participation and inclusion of AANHPI physicians and physician groups in the development and implementation of new models for care delivery and demonstration projects from the Center for Medicare & Medicaid Innovation; these new models of care should include reimbursements and payments for culturally and linguistically appropriate patient-centered care, and incentives for the reduction of disparities and for advancing health equity.

HEALTH WORKFORCE DEVELOPMENT AND LEADERSHIP: Asian American physicians comprise a significant segment of the medical profession, holding positions in academia, research, public health, and patient care. There also are a significant proportion of nurses, pharmacists, and allied health professionals who are AANHPIs. However, there are some AANHPI populations, especially Southeast Asians, Native Hawaiians, and Pacific Islanders, who remain underrepresented in the health professions. Moreover, AANHPI health professionals are not well represented in leadership and executive positions that can impact health care policies. NCAPIP will continue to work to:
  1. Support the advancement of AANHPI physicians in leadership roles that will lead America to a 21st century health care system which is accessible, affordable, and equitable for all; support AANHPI physician leadership in policy and advocacy, academic medicine, hospitals and health systems, health plans, physician organizations, community health centers, health departments, and in health care teams.
  2. Ensure that specific AANHPI populations, especially Southeast Asians, Native Hawaiians, and Pacific Islanders, and AANHPIs who face linguistic and cultural barriers to care, are included in definitions of “underserved” populations.
  3. Support recognition of specific AANHPI populations, especially Southeast Asians, Native Hawaiians, and Pacific Islanders, as “underrepresented” in medicine and other health professions, and ensure that programs that support the health professions educational and career pipelines and pathways include these underrepresented AANHPI populations.
  4. Support the educational and professional dreams and aspirations of immigrant youth with Deferred Action for Childhood Arrivals status; create safe spaces in hospitals, clinics, and other sites of health care delivery that welcome all immigrants and refugees.

NCAPIP believes that the future of health care should build on the strengths of our current health care systems, but also squarely confront the deficiencies that result in millions of uninsured Americans, unequal treatment, and deteriorating health status among our next generation. While AANHPIs comprise a unique part of America, we embrace shared values of equity, family, and community, and the shared dream that all Americans can achieve their highest potential for health and well-being.

Updated December 2017