Insurance-Based Discrimination Reports and Access to Care Among Nonelderly US Adults, 2011-2019

To report insurance-based discrimination rates for nonelderly adults with private, public, or no insurance between 2011 and 2019, a period marked by passage and implementation of the Affordable Care Act (ACA) and threats to it. We used 2011-2019 data from the biennial Minnesota Health Access Survey....

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Bibliographic Details
Published in:American journal of public health (1971) 2023-02, Vol.113 (2), p.213-223
Main Authors: Call, Kathleen Thiede, Alarcon-Espinoza, Giovann, Arthur, Natalie Schwer Mac, Jones-Webb, Rhonda
Format: Article
Language:English
Subjects:
Adult
Adults
Discrimination
Health care access
Health Care Facilities/Services
Health care industry
Health care policy
Health disparities
Health insurance
Health Policy
Health Reform
Health Services Accessibility
Humans
Insurance
Insurance Coverage
Insurance, Health
Medicaid
Medicare
Minnesota
Patient Protection & Affordable Care Act 2010-US
Patient Protection and Affordable Care Act
Prevention
Primary care
Public health
Research & Analysis
Sociodemographics
Uninsured people
United States
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Summary:To report insurance-based discrimination rates for nonelderly adults with private, public, or no insurance between 2011 and 2019, a period marked by passage and implementation of the Affordable Care Act (ACA) and threats to it. We used 2011-2019 data from the biennial Minnesota Health Access Survey. Each year, about 4000 adults aged 18 to 64 years report experiences with insurance-based discrimination. Using logistic regressions, we examined associations between insurance-based discrimination and (1) sociodemographic factors and (2) indicators of access. Insurance-based discrimination was stable over time and consistently related to insurance type: approximately 4% for adults with private insurance compared with adults with public insurance (21%) and no insurance (27%). Insurance-based discrimination persistently interfered with confidence in getting needed care and forgoing care. Policy changes from 2011 to 2019 affected access to health insurance, but high rates of insurance-based discrimination among adults with public insurance or no insurance were impervious to such changes. Stable rates of insurance-based discrimination during a time of increased access to health insurance via the ACA suggest deeper structural roots of health care inequities. We recommend several policy and system solutions. ( 2023;113(2):213-223. https://doi.org/10.2105/AJPH.2022.307126).
ISSN:0090-0036
1541-0048
1541-0048
DOI:10.2105/AJPH.2022.307126