Dataset Information

Changes in Insurance Coverage and Access to Care for Young Adults in 2017.

ABSTRACT:

Purpose

Previous work has demonstrated the Affordable Care Act (ACA) increased young adults' health care access during its first years. However, it is unclear if these trends continued through 2017; recent policies enacted by the Trump administration may have decreased the ACA's effectiveness. Our purpose was to determine changes in young adults' health care access during the transition from Obama to Trump administrations.

Methods

Data on noninstitutionalized U.S. young adults (18-24 years) was obtained from the Behavioral Risk Factor Surveillance System 2011-2017 (N = 173,848). We used interrupted time series and difference-in-differences analysis to quantify changes in self-reported insurance coverage, access to a primary care physician, and unmet care because of cost from 2013 to 2017.

Results

Young adults' health care access continued to improve through 2016; for instance, the percentage of respondents experiencing uninsurance declined by 8.7 points from 2013 to 2016 (95% confidence interval [CI] -9.4 to -8.0). However, these trends began to reverse and from 2016 to 2017, the percentage of young adults who experienced uninsurance increased by 1.4 points (95% CI .6-2.1), not having a personal doctor increased by 1.1 points (95% CI .2-2.0), and unmet care because of cost increased by 1.0 points (95% CI .3-1.7). The 2017 declines in access were concentrated in states which did not expand Medicaid and in households earning above 138% of federal poverty level.

Conclusions

Health care access declined for young adults in 2017, after several years of improvements. These changes correspond with recent policy actions, which may have weakened the ACA's reforms.

SUBMITTER: Griffith KN

PROVIDER: S-EPMC8211364 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ImportanceIt is unclear how the COVID-19 pandemic and its associated economic downturn have affected insurance coverage and disparities in access to health care among low-income families and people of color in states that have and have not expanded Medicaid.ObjectiveTo determine changes in insurance coverage and disparities in access to health care among low-income families and people of color across 4 Southern states and by Medicaid expansion status.Design setting and participantsThis random-digit dialing telephone survey study of US citizens ages 19 to 64 years with a family income less than 138% of the federal poverty line in in 4 states (Arkansas, Kentucky, Louisiana, and Texas) was conducted from October to December 2020. Using a difference-in-differences design, we estimated changes in outcomes by Medicaid expansion status overall and by race and ethnicity in 2020 (n = 1804) compared with 2018 to 2019 (n = 5710). We also explored barriers to health care and use of telehealth by race and ethnicity. Data analysis was conducted from January 2021 to March 2021.ExposuresCOVID-19 pandemic and prior Medicaid expansion status.Main outcomes and measuresPrimary outcome was the uninsured rate and secondary outcomes were financial and nonfinancial barriers to health care access.ResultsOf 7514 respondents (11% response rate; 3889 White non-Latinx [51.8%], 1881 Black non-Latinx [25.0%], and 1156 Latinx individuals [15.4%]; 4161 women [55.4%]), 5815 (77.4%) were in the states with previous expansion and 1699 (22.6%) were in Texas (nonexpansion state). Respondents in the expansion states were older, more likely White, and less likely to have attended college compared with respondents in Texas. Uninsurance rate in 2020 rose by 7.4 percentage points in Texas (95% CI, 2.2-12.6; P = .01) and 2.5 percentage points in expansion states (95% CI, -1.9 to 7.0; P = .27), with a difference-in-differences estimate for Medicaid expansion of -4.9% (95% CI, -11.3 to 1.6; P = .14). Among Black and Latinx individuals, Medicaid expansion was associated with protection against a rise in the uninsured rate (difference-in-differences, -9.5%; 95% CI, -19.0 to -0.1; P = .048). Measures of access, including having a personal physician and regular care for chronic conditions, worsened significantly in 2020 in all 4 states, with no significant difference by Medicaid expansion status.Conclusions and relevanceIn this survey of US adults, uninsured rates increased among low-income adults in 4 Southern states during the COVID-19 pandemic, but Medicaid expansion states, that association was diminished among Black and Latinx individuals. Nonfinancial barriers to care because of the pandemic were common in all states.

Project description:ImportanceAn increasing diversity of children's health coverage options under the US Patient Protection and Affordable Care Act, together with uncertainty regarding reauthorization of the Children's Health Insurance Program (CHIP) beyond 2017, merits renewed attention on the quality of these options for children.ObjectiveTo compare health care access, quality, and cost outcomes by insurance type (Medicaid, CHIP, private, and uninsured) for children in households with low to moderate incomes.Design, setting, and participantsA repeated cross-sectional analysis was conducted using data from the 2003, 2007, and 2011-2012 US National Surveys of Children's Health, comprising 80,655 children 17 years or younger, weighted to 67 million children nationally, with household incomes between 100% and 300% of the federal poverty level. Multivariable logistic regression models compared caregiver-reported outcomes across insurance types. Analysis was conducted between July 14, 2014, and May 6, 2015.ExposuresInsurance type was ascertained using a caregiver-reported measure of insurance status and each household's poverty status (percentage of the federal poverty level).Main outcomes and measuresCaregiver-reported outcomes related to access to primary and specialty care, unmet needs, out-of-pocket costs, care coordination, and satisfaction with care.ResultsAmong the 80,655 children, 51,123 (57.3%) had private insurance, 11,853 (13.6%) had Medicaid, 9554 (18.4%) had CHIP, and 8125 (10.8%) were uninsured. In a multivariable logistic regression model (with results reported as adjusted probabilities [95% CIs]), children insured by Medicaid and CHIP were significantly more likely to receive a preventive medical (Medicaid, 88% [86%-89%]; P < .01; CHIP, 88% [87%-89%]; P < .01) and dental (Medicaid, 80% [78%-81%]; P < .01; CHIP, 77% [76%-79%]; P < .01) visits than were privately insured children (medical, 83% [82%-84%]; dental, 73% [72%-74%]). Children with all insurance types experienced challenges in access to specialty care, with caregivers of children insured by CHIP reporting the highest rates of difficulty accessing specialty care (28% [24%-32%]), problems obtaining a referral (23% [18%-29%]), and frustration obtaining health care services (26% [23%-28%]). These challenges were also magnified for privately insured children with special health care needs, whose caregivers reported significantly greater problems accessing specialty care (29% [26%-33%]) and frustration obtaining health care services (36% [32%-41%]) than did caregivers of children insured by Medicaid, and a lower likelihood of insurance always meeting the child's needs (63% [60%-67%]) than children insured by Medicaid or CHIP. Caregivers of privately insured children were also significantly more likely to experience out-of-pocket costs (77% [75%-78%]) than were caregivers of children insured by Medicaid (26% [23%-28%]; P < .01) or CHIP (38% [35%-40%]; P < .01).Conclusions and relevanceThis examination of caregiver experiences across insurance types revealed important differences that can help guide future policymaking regarding coverage for families with low to moderate incomes.