Blog & News
Analyzing Forgone Care by Coverage Type: New on State Health CompareJune 29, 2023:
For most Americans, having health insurance is an important first step to being able to access and afford health care when it is needed.
As shown in recent data published on SHADAC’s State Health Compare, adults with health insurance coverage were at least 79% less likely to report having forgone (gone without) medical care when they needed it because of cost than adults without health insurance coverage. Whereas 63 percent of adults without health coverage reported forgone care, no more than 14 percent of those with coverage reported forgone care. This statistic illustrates the ability of health insurance coverage to protect against unexpected health care costs.
However, these data indicate that health insurance coverage’s ability to protect against unexpected health care costs varies by state and by type of health insurance coverage. The chart below shows the percent of adults (age 18+) who could not get medical care when needed due to cost by state and source of health insurance coverage. In the U.S., adults with some types of coverage such as Medicare (5 percent) or employer/military coverage (6 percent) were less likely to have gone without care because of cost compared with other types of coverage, such as individual coverage (10 percent) or Medicaid/CHIP coverage (14 percent).
It is important to note that the size of these differences in the protective power of health insurance coverage varied substantially by state. For example, where 11 percent of Georgia adults with employer coverage went without care, just 3 percent of employer-covered adults in the District of Columbia went without care. And similar state differences existed for other types of coverage:
- For adults with Medicare coverage, 9 percent of Louisianans had forgone care versus 3 percent of Vermonters.
- For adults with individual coverage, 16 percent of Nevadans had forgone care versus 3 percent of Vermonters.
- For adults with Medicaid/CHIP coverage, 25 percent of Oklahomans had forgone care versus 7 percent of South Dakotans.
- For adults with no health insurance coverage, 77 percent of Nevadans had forgone care versus 44 percent of South Dakotans.
These state differences highlight the inconsistency in the quality of health insurance coverage across the U.S., often related to differences in states’ markets for private health insurance coverage (e.g., individual coverage or employer coverage), differences in state Medicaid and CHIP programs, and differences in health care costs across the states.
Differences by coverage type call attention to variation in the ability of different types of health insurance coverage to protect covered adults from the risks of expensive or unexpected health care needs. However, these differences also highlight disparities in the underlying economic and health vulnerabilities of adults covered by different types of coverage.
Accessing BRFSS Coverage Data on State Health Compare
The data presented here come from SHADAC analysis of the 2021 Behavioral Risk Factor Surveillance System (BRFSS), a survey conducted in partnership between states and the Centers for Disease Control, and are available on SHADAC’s State Health Compare web tool.
Data on detailed health insurance coverage types were collected among all participating states in the BRFSS for the first time in 2021. These new data have allowed State Health Compare to include breakdowns by detailed coverage type for all eight BRFSS measures that feature 2021 data and are the first source of information about these important measures of access and affordability of care, outcomes, and health behaviors for adults with specific types of coverage (e.g., Medicaid/CHIP).
BRFSS measures to explore further:
|- Adults Who Forgo Needed Medical Care|
|- Adult Binge Drinking|
|- Adult Smoking|
|- Adult E-Cigarette Use|
|- Chronic Disease Prevalence|
|- Activities Limited due to Health Difficulty|
|- Adult Unhealthy Days|
|- Adults with No Personal Doctor|
Notes: All differences described in this analysis are statistically significant at the 95% confidence level. Estimates are representative of the civilian non-institutionalized population 18 years and over and are based on SHADAC analysis of the 2021 Behavioral Risk Factor Surveillance System public use files. Florida data are not available in 2021 because the state was unable to collect sufficient data, and 2021 national data do not include Florida. Other state-level data were not available due to suppression where the number of sample cases was too small.