Introduction
Health insurance is associated with better care in the U.S., but little is known about
the associations of coverage disruptions (i.e., periods without insurance) with care
access, receipt, and affordability.
Methods
Adults aged 18–64 years with current private (n=124,746), public (n=30,932), or no (n=31,802) insurance coverage were identified from the 2011–2018 National Health Interview
Survey. Data were analyzed in 2020. Separate multivariable logistic regressions evaluated
the associations of having coverage disruptions or being uninsured with care access,
receipt, and affordability.
Results
Overall, 5.0% of currently insured adults with private and 10.7% with public insurance
reported a coverage disruption in the previous year, representing nearly 9.1 million
adults in 2018. Among currently uninsured, 24.9% reported coverage loss within the
previous year, representing nearly 8.1 million adults in 2018. Among adults with current
private or current public coverage, disruptions were associated with lower receipt
of all preventive services (AOR=0.42, 95% CI=0.37, 0.46 and AOR=0.48, 95% CI=0.40,
0.58, respectively), with forgoing any needed care because of cost (AOR=4.79, 95%
CI=4.44, 5.17 and AOR=4.28, 95% CI=3.86, 4.75), and with medication nonadherence because
of cost (AOR=3.55, 95% CI=3.13, 4.03 and AOR=4.09, 95% CI=3.43, 4.88) compared with
that among adults with continuous coverage (p<0.05). Longer disruptions among currently insured adults were significantly associated
with worse care access, receipt, and affordability, with dose–response patterns. Currently
uninsured adults, especially those with longer uninsured periods, reported significantly
worse care access, receipt, and affordability than currently insured adults with coverage
disruptions or continuous coverage.
Conclusions
Findings highlight the importance of continuous insurance coverage; disruptions owing
to the COVID-19 pandemic will likely have adverse consequences for care access and
affordability.
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Published online: May 24, 2021
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
