Objective: The lack of adequate health insurance may result in a downward spiral of the diabetic condition, imposing an increased financial strain on family and the society as a whole. The objective of our study was to assess the insurance type and coverage among diabetic adults from three major ethnic groups.

Design and Setting: We used data of two cross-sectional national surveys to estimate insurance coverage among diabetic adults aged20–64 years, 1988–1994 and 2003–2008.

Results: The prevalence of doctor-diagnosed diabetes has increased by 120%, 178% and135% respectively among non-Hispanic Whites(NHWs), non-Hispanic Blacks (NHBs), and Mexicans & other Hispanics (M&OHs) from1988–94 to 2003–08. However, during the same period, the percentages of diabetic adults covered by health insurance declined for all three groups. In the 2003–08 period, 15%, 19%and 40% of NHWs, NHBs and M&OHs, respectively, had no insurance. Diabetic NHBs and NHWs had an equal likelihood to be covered by government-sponsored programs. However, 70% of NHWs, in contrast to 37% of NHBs, were covered by private programsexclusively. Diabetic M&OHs remained at the lowest likelihood to be covered by government sponsored programs. The diabetic citizen’s probability of being insured was more than tripled compared with the non-citizens (OR53.40, 95%51.42–8.14).

Conclusion: Increasing percentages of diabetic shad no insurance. Diabetic Whites were more likely to be covered by private programs than diabetic Blacks. Hispanics were the group falling through the cracks between private programs due to low income and government programs because of immigration status.