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SHADAC in AJPH: Insurance-Based Discrimination Reports and Access to Care Among Non-Elderly U.S. Adults, 2011-2019December 8, 2022:
This journal article was originally published in the American Journal of Public Health (AJPH).
Authors: Kathleen Thiede Call, PhD, Giovann Alarcon-Espinoza, PhD, MPP, Natalie Schwer Mac Arthur, PhD, MAc, and Rhonda Jones-Webb, DrPH
SHADAC researchers and external co-authors recently published an article in the American Journal of Public Health (AJPH) that examines rates of insurance-based discrimination 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.
Using 2011–2019 data from the biennial Minnesota Health Access Survey, the study found that about 4,000 adults aged 18 to 64 report insurance-based discrimination experiences. Using logistic regressions, the authors examined associations between insurance-based discrimination and (1) sociodemographic factors and (2) indicators of access.
- On average, approximately 10% of nonelderly adults reported insurance-based discrimination, although there was a statistically significant increase from 7.7% in 2015 to 11.0% in 2017.
- Reports of insurance-based discrimination remained remarkably stable within each coverage type between 2011 and 2019:
- Uninsured adults ranged between 24.7% to 28.1%
- Adults with public coverage ranged between 18.4% to 24.0%
- Adults with private coverage ranged between 3.0% to 5.4%
- Compared with adults with private insurance (4% on average), insurance-based discrimination was 5 or 6 times higher for adults with public insurance (21% on average) and about 7 times higher for adults with no insurance (27% on average).
- There was little association between insurance-based discrimination and having a usual source of care. However, insurance-based discrimination persistently interfered with confidence in getting needed care and reports of forgone care.
These findings indicate that 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 healthcare inequities.