A decade of health care access declines for adults holds implications for changes in the Affordable Care Act

Health Affairs

Volumn 31, Issue 5, 2012, Pages 899-908

  Kenney, Genevieve M ^a   McMorrow, Stacey ^a   Zuckerman, Stephen ^a   Goin, Dana E ^a  

^a URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; AMBULATORY CARE; ARTICLE; CHILD; CONSULTATION; CONSUMER; DENTAL PROCEDURE; EMERGENCY WARD; HEALTH CARE ACCESS; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH INSURANCE; HEALTH SURVEY; HUMAN; LAW; MEDICAID; MEDICAL CARE; MEDICARE; PRIVATE HEALTH INSURANCE; UNITED STATES;

ADULT; HEALTH SERVICES ACCESSIBILITY; HUMANS; MIDDLE AGED; PATIENT PROTECTION AND AFFORDABLE CARE ACT; SUPREME COURT DECISIONS; UNITED STATES; YOUNG ADULT;

EID: 84862490309     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2012.0159     Document Type: Article

References (28)

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12. People with military health coverage are classified as having employersponsored insurance. People reporting other state-sponsored health plans are classified as having Medicaid/CHIP. People reporting coverage only through the Indian Health Service or with only a single service plan are classified as uninsured. See the Appendix for estimates for those with partial-year coverage. To access the Appendix, click on the Appendix link in the box to the right of the article online.
13. We used the multiply imputed income measures from the National Health Interview Survey data for individuals and families to calculate income of health insurance units (that is, individuals, couples, or groups of people who are eligible for family coverage) and the Department of Health and Human Services poverty guidelines to calculate health insurance unit income relative to poverty
14. People who reported the emergency department as their usual source of care were not included as having a usual source of care. "Office visits" excluded visits to hospital emergency departments, overnight hospitalizations, home visits, dental visits, and telephone calls. "Dental visits" were not identified for children under age two. "Emergency department visits" included both visits that did and did not result in a hospital admission.
15. The indicator of unmet dental health need was not available for children under age two
16. The measure of unmet mental health and eye care need was not available for children under age two; thus, the composite indicator is limited to those age two and older
17. All multivariate models included the following controls: age, sex, race, citizenship, region of habitation, educational status of health insurance unit, marital status, parental status, employment status, income, functional status, and self-reported health status
18. In addition, we found significant increases in unmet needs for each of the underlying measures that make up our composite measure: medical care, prescription drugs, mental health care, and eyeglasses (Appendix Table 1; see Note 12)
19. Appendix Table 1 (see Note 12) shows annual estimates between 2000 and 2010 and summary changes between 2000 and 2010 for each variable included in the models that were estimated to derive regression-adjusted differences in access to care and service use. Consistent with prior research, insurance status, age, sex, health and functional status, educational attainment, and income were associated with the access and service use measures that were examined (full regression results are available on request from the authors).
20. The large declines in access that remain after controlling for changes in the income distribution indicate that the recent recession cannot fully explain the trends in access over time. There were a number of potentially important changes in the demographic, socioeconomic, and health characteristics of adults during the past decade that could affect their use of health services and reported access to care. In addition to increases in uninsurance and Medicaid coverage and decreases in private insurance, the underlying data indicate that there was a downward shift in the income distribution of adults; a decrease in the proportion who were white, non-Hispanic, and an increase in the proportion who were Hispanic or other race; an increase in the proportion ages 55-64; a decline in the share who were married; an increase in the share with at least a college education and declines in the share with a high school degree/GED or less; a decrease in the share working full time; and a pattern of declining health status, as indicated by the increasing share in fair or poor health, the share with functional limitations, and the share with mental health problems.
21. Blavin F, Holahan J, Kenney G, Chen V. A decade of coverage losses: implications for the Affordable Care Act. Washington (DC): Urban Institute; 2012 Feb.
22. To access the Appendix, click on the Appendix link in the box to the right of the article online
23. The declines in access for the uninsured were significantly larger than those for the privately insured on seven of the eight measures considered (with the exception being delays in care for noncost reasons) and significantly larger than the declines for the publicly insured on four of the eight measures (with the exceptions being changes in office visits, dental visits, unmet dental need, and non-cost-related delays)
24. Institute of Medicine. America's uninsured crisis: consequences for health and health care. Washington (DC): National Academies Press; 2009.
25. Access for the uninsured was significantly worse than that for the privately insured on seven of eight measures in 2010 (with the exception being delays in care for noncost reasons, for which there was no significant difference). Access for the uninsured was significantly worse than that for the publicly insured on six of eight measures in 2010 (with the exceptions being delays in care for noncost reasons and emergency department visits).
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