SHADAC Expertise

Health Coverage and Access to Care

Health Coverage and Access to Care

Since its inception, SHADAC has been dedicated to conducting research and providing technical assistance in order to examine characteristics of and trends in health insurance coverage and access to care and associations with overall physical, social, and mental health status. Our work on these topics includes technical briefs describing the complexity of measuring health insurance coverage and understanding the strengths and weaknesses of various data sources, e.g., federal and state-specific surveys, towards the goal of improving estimates of health insurance coverage, which is critical to the evaluation of federal and state health reform efforts. We also have conducted research studies of access to care during the coronavirus pandemic, insurance churning in Medicaid, and insurance-based discrimination. We have helped states field their own health insurance surveys or used federal data to help states target their coverage-related efforts as well as produced 50-state analyses of geographic disparities in coverage and key measures of health care access with data from State Health Compare.

Related SHADAC work
Click on any title below to learn more about the project.

Reduced Access to Health Care due to Coronavirus Pandemic - SHADAC COVID-19 Survey
SHADAC conducted a two-part survey designed by our researchers to measure the impacts of the novel coronavirus on health care access and insurance coverage, as well as COVID-related worries and coping responses, for adults in the United States. The SHADAC COVID-19 Survey was fielded in late April 2020 as part of the AmeriSpeak omnibus survey conducted by NORC at the University of Chicago. The first portion of the survey results focused on recording changes in health insurance coverage, delays in seeking medical care, and issues of access to and affordability of care due to the pandemic as reported by adult respondents.

Impacts of the Affordable Care Act's Medicaid Expansion in California
With funding from the California Health Care Foundation, SHADAC conducted an analysis of the impact of the Medicaid expansion on healthcare coverage, access, health status, affordability, and disparities in these outcomes by race/ethnicity for low-income Californians. Researchers on this project used nationally representative survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS) 2011-2019 data years and a difference-in-differences approach that compared California with non-expansion states.

MACPAC Analysis of Insurance Churning
SHADAC conducted a quantitative analysis for MACPAC that explored the magnitude and type of churn among the Medicaid population. Specifically, the study used the Survey of Income and Program Participation Panel (SIPP) to examine the characteristics of those who churned with those who had continuous Medicaid coverage throughout the year and explored possible causes of churn. The study produced descriptive statistics to address many of the research questions and regression analysis to explore life events that potentially cause churn. The study team was able to produce state-level estimates by leveraging the large sample size of the American Community Survey (ACS) to enhance the statistical power of the SIPP by post stratifying the individual weights to match a variety of relevant population estimates in the ACS.

Minnesota Health Access (MNHA) Survey
The Minnesota Health Access (MNHA) Survey, conducted collaboratively between SHADAC and the Minnesota Department of Health (MDH), is a large-scale telephone and mail survey that collects information on the health of Minnesotans and how they access health insurance and health care services. The survey is conducted every two years and results are presented in a follow-up report from MDH.

The Intersection of Structural Risk Factors and Insurance-based Discrimination on Healthcare Access Inequities
Social risk factors independently influence experiences of discrimination and they converge leaving some people even more vulnerable leading to worse access to healthcare. Supported by a grant from the Robert Wood Johnson Foundation (RWJF) and in collaboration with the Minnesota of Department of Health and Minnesota Department of Human Services, researchers conducted an evaluation on the effects of insurance-based discrimination and other social risk factors (e.g., low income, minority status) on disparities in access to healthcare services.

Minnesota’s Uninsured and the Communities in Which They Live
Supported by a grant from the Blue Cross and Blue Shield Foundation of Minnesota and essential guidance from an advisory board of MNsure navigators and policymakers, SHADAC used data from the American Community Survey (ACS) to create a new resource consisting of a profile and an interactive map, which provides rates and counts of the uninsured in Minnesota at the ZIP code level (i.e., Census-defined ZIP code) county, economic development region (EDR), and state. The focus of this resource is to (a) support targeted outreach and enrollment activities of health insurance navigators; and (b) provide information about the uninsured to policymakers as they develop strategies to reach the remaining uninsured in Minnesota and reduce geographic disparities in coverage.

Educational Attainment and Access to Health Care: 50-State Analysis
Using data from the Behavioral Risk Factor Surveillance System (BRFSS), SHADAC examined educational attainment and access to health care, looking at the extent to which adults (25 years and older) with different levels of education skipped needed care due to cost and did not have a personal doctor. These indicators are both available for all states in SHADAC’s State Health Compare.