Latinos in the United States are less likely to have adequate health insurance than Americans overall, according to a new survey from health research nonprofit The Commonwealth Fund.

The nonprofit found that 46 percent of Latinos in the U.S. of working age have health insurance for the whole year and are not underinsured, according to the survey published Tuesday.

Another 21 percent of working-age Latinos have insurance for the whole year but are underinsured, meaning they have out-of-pocket costs—excluding premiums—equal to 10 percent or more of their household income, according to the survey.

For low-income Latinos in the U.S., that means having out-of-pocket expenses, excluding premiums, that amount to five percent or more of their household income. The term also applies to Latinos with year-round health insurance but with deductibles that amount to five percent or more of their household income.

There are another 18 percent of Latinos in the U.S. who said they had health insurance at the time of the survey but did not at some point during the past 12 months, and 16 percent who reported being uninsured during the time of the survey.

The percentage of working-age Latinos with year-round health insurance and properly insured is 10 points lower than the country’s overall population.

A survey released by the Commonwealth Fund last month found that 56 percent of working-age adults, regardless of race or ethnicity, have health insurance for the whole year and are not underinsured.

Latinos in the U.S. also appear to be slightly less likely to have health insurance but be underinsured compared to the overall population but more likely to report having been without health insurance at some point during the past 12 months.

Out of the overall population, 23 percent of people have health insurance all year long but are underinsured, while 12 percent said they had health insurance at the time of the survey but had not had insurance at some point during the past 12 months.

Another nine percent admitted they did not have health insurance at the time of the survey.

This difference in health insurance coverage, in part, is connected to the industries Latinos in the U.S. overwhelmingly work in, such as agriculture and the service industry, according to Joe Betancourt, president of the Commonwealth Fund.

Jobs in those sectors do not commonly offer employer-based health insurance, which is how most Americans receive their health insurance coverage, Betancourt added. Latinos are also more likely to take on gig work or have multiple jobs, neither of which guarantees they will receive any health insurance, he said.

The disparity could also be explained by the fact that two of the 10 states that have yet to expand Medicaid—Texas and Florida—have enormous Latino populations, according to Betancourt.

The Affordable Care Act allows states to expand their Medicaid coverage to include almost all adults with a family income of 138 percent below the Federal Poverty Level. That means a single person can qualify for health insurance under Medicaid if they make about $20,700 a year, according to KFF.

Since 2014, states have been slowly adopting the new standard by which residents can qualify for Medicaid, but there are 10 states that have yet to adopt this “expansion.”

Most states that have yet to expand Medicaid are located in the South and are led by Republican lawmakers.

Language and cultural barriers could also play a role in why Latinos are less likely to have proper health insurance coverage.

“The health care system and insurance are tough to navigate for anyone, but if you don’t have a lot of experience with health insurance or if you have a language barrier or a cultural barrier…I think that makes it even more challenging,” said Betancourt.

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