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The standard categories used by USA governmental forms that ask for a voluntary disclosure of race or ethnicity include the following: Black or African American, White or Caucasian, American Indian or Alaska Native, and Asian American and Pacific Islander. However, on the forms used for the Affordable Care Act (ACA) Marketplace, the Asian American category is subdivided into Vietnamese, Japanese, Korean, and so forth (with "Other Asian" as a catch-all), while the other categories remain unchanged, save for the separation of Native Hawaiians from the category "American Indian and Alaska Native" and the inclusion of categories for Samoa and Guam.

Dividing the categories provides more granular information about which healthcare Americans of various groups have, so that would be one obvious reason to separate them. After all, there may be sizeable differences between types of health insurance and outcomes between Chinese Americans (average household income of 85,424 in 2019) and Myanmarese Americans (45,903). However, this would seem to apply to the groups that are not distinguished as well: presumably, healthcare outcomes might differ between Americans who are Apache (average income 28,745 in 2014) or Chicksaw (average income 49,963) or those of Bolivian descent (72,699) vs Guatemalan (49,584).

As such, what is the reasoning behind the race and ethnicity categories used on the ACA marketplace?

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These categories correspond to the census-defined categories. Understand also that race and ethnicity are distinct, including on the census..

These are, themselves, the products of various regulatory requirements and as such are not the fruit of any single theoretical framework; instead they are the emergent product of several such frameworks being applied at various points throughout history since the Civil Rights Act.

The term "Asian-American" is particularly problematic because Asia itself is geographically titanic. The distinctions are drawn there to cover that fact. The only other group that covers even close to the same degree of geography and cultural divergence is African Americans - most of whom have had their cultural origins obfuscated beyond recovery due to the practices of the slave trade that brought them here. This logic, as you note, could be applied elsewhere but this only happens if/when someone creates a program that makes such a designation.

For the bulk of new programs, the Affordable Care Act included, whatever categories already exist and have data gathered for them are included as part of the data gathered by that new program. To that end, it's arguable that the single unifying rationale is "These categories already exist, so we'll just use them."

A commenter observed that the Asian-American category appears to aggregate the subdetails, but when it comes to the Census, that data is in fact collected.

See This Census Metadata Document, page 6C-7, where it defines the "PRDASIAN" field.

-1 = NIU 1 = Asian Indian 2 = Chinese 3 = Filipino 4 = Japanese 5 = Korean 6 = Vietnamese 7 = Other Asian

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  • This answer says that those categories are the same as the census categories, but the question is actually about why the categories used by the ACA marketplace are distinct from the census categories. Notice that the census categories group all Asian Americans under one umbrella, whereas the ACA Marketplace separates out several groups, as well as separating Native Hawaiians from Pacific Islanders in general and creating separate categories for Guam and Samoa.
    – Obie 2.0
    Dec 15 '21 at 20:14
  • @Obie2.0 Except the census does collect this data. One sec. Dec 15 '21 at 20:19
  • Well, that certainly explains the categories.
    – Obie 2.0
    Dec 15 '21 at 20:24
  • Mind you, to find those categories you have to: go looking for datasheets hinged on Asian-Americans, download one, then clickthrough a link to the metadata spec doc. They're VERY well buried, but they're in there. Dec 15 '21 at 20:26

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