Economics Division, Babson College, 231 Forest Street, Babson Park, MA, 02457-0310, USA.
BMC Health Serv Res. 2020 Apr 21;20(1):334. doi: 10.1186/s12913-020-05226-1.
There is a rich literature on insurance coverage and its impacts on health care. Many recent studies have examined the impacts of the Affordable Care Act (ACA) and found that it had positive effects on health insurance coverage and health care usage. Most of the literature, however, has focused on insurance coverage at a single point in time, while research on insurance instability is underrepresented, even though it could significantly impact health outcomes. The aim of this study is to examine changes and implications of insurance instability among nonelderly adults from 2006 to 2016, covering the Great Recession and post-ACA periods.
Using 2006-to-2016 Medical Expenditure Panel Survey data, we identify seven insurance patterns and analyze them by race/ethnicity, age, geography, income, and medical conditions. We then use multivariable linear models to analyze the relationship between insurance instability and health care status, access, and utilization. Logistic, Poisson and nonlinear models test the robustness of our results.
The post-ACA period 2015-2016 saw the lowest ever-uninsured rate (25.68% or 67.91 million). The largest decrease in insurance instability was among adults aged 19-25, low-income families, Hispanics, the western population, and the healthy population. Like the always-uninsured, those with other insurance gaps experienced a lack of access to care and decreased preventive care and other services.
Despite the post-ACA instability reduction, over 25% of the U.S. population continued to have insurance gaps over a two-year period. Disparities continued to exist between income groups, race/ethnicities, and regions. Repealing ACA could exacerbate insurance instability and disparities between different groups, which in turn could lead to adverse health outcomes.
关于保险覆盖范围及其对医疗保健影响的文献十分丰富。许多近期研究都考察了《平价医疗法案》（ACA）的影响，发现其对医疗保险覆盖范围和医疗保健利用产生了积极影响。然而，大多数文献都集中在单一时间点的保险覆盖范围上，尽管保险不稳定可能会对健康结果产生重大影响，但对其的研究却相对较少。本研究旨在考察 2006 年至 2016 年间非老年成年人保险不稳定的变化及其影响，涵盖大衰退和 ACA 之后的时期。
我们利用 2006 年至 2016 年的《医疗支出调查》数据，确定了七种保险模式，并按种族/族裔、年龄、地理位置、收入和医疗条件对其进行分析。然后，我们使用多变量线性模型分析保险不稳定与医疗保健状况、获得和利用之间的关系。逻辑、泊松和非线性模型检验了我们结果的稳健性。
ACA 之后的时期（2015-2016 年），未参保率达到历史最低水平（25.68%，或 6791 万人）。保险不稳定程度最大的降幅出现在 19-25 岁、低收入家庭、西班牙裔、西部地区和健康人群中。与始终未参保者一样，其他保险缺口人群也存在享受医疗服务机会不足以及预防性保健和其他服务减少的情况。
尽管 ACA 之后保险不稳定状况有所缓解，但在两年期间，仍有超过 25%的美国人存在保险缺口。收入群体、种族/族裔和地区之间的差异仍然存在。废除 ACA 可能会加剧保险不稳定和不同群体之间的差异，进而导致不良的健康结果。
