Hispanics have the lowest health insurance rates of any racial or ethnic group, but rates vary significantly across the United States. The unprecedented growth of the Hispanic population since 1990 in rural areas with previously small or nonexistent Hispanic populations raises questions about disparities in access to health insurance coverage. Identifying spatial disparities in Hispanic health insurance rates can illuminate the specific contexts within which Hispanics are least likely to have health care access and inform policy approaches for increasing coverage in different spatial contexts.

Using county-level data from the 2009–13 American Community Survey, Monnat finds that early new destinations (i.e., those that experienced rapid Hispanic population growth during the 1990s) have the lowest Hispanic adult health insurance coverage rates, with little variation by metropolitan status. Conversely, among the most recent new destinations that experienced significant Hispanic population growth during the first decade of the 2000s, metropolitan counties have Hispanic health insurance rates that are similar to established destinations, but rural counties have Hispanic health insurance rates that are significantly lower than those in established destinations. Findings demonstrate that the new destination disadvantage is driven entirely by higher concentrations of immigrant noncitizen Hispanics in these counties, but labor market conditions were salient drivers of the spatially uneven distribution of foreign-born noncitizen Hispanics to new destinations, particularly in rural areas.