Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50–64
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data and Sample
2.2. Measures
2.2.1. Health Insurance (HI) Coverage
2.2.2. Healthcare Access and Use in the Past 12 months
2.2.3. Sociodemographic Factors
2.2.4. Health Status
2.3. Analysis
3. Results
3.1. Health Coverage among the 65+ Age Group and the 50–64 Age Group
3.2. Health Coverage among the 50–64 Age Group from 2013 to 2018
3.3. Sociodemographic and Health Characteristics of those without Health Coverage
3.4. Sociodemographic and Health Correlates of Lack of HI: Multivariable Analysis
3.5. Odds of Past-year Healthcare Access among those without HI Compared to those with HI
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- U.S. Census Bureau. American Fact Finder: Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2018. 2018 Population Estimates. 2019. Available online: https://www2.census.gov/programs-surveys/popest/tables/2010-2018/national/asrh/PEPAGESEX.pdf (accessed on 15 February 2020).
- Ward, B.W.; Black, L.I. State and regional prevalence of diagnosed multiple chronic conditions among adults aged ’ 18 years—United States, 2014. Morb. Mortal. Wkly. Rep. 2016, 65, 735–738. [Google Scholar] [CrossRef] [PubMed]
- Gulley, S.P.; Rasch, E.K.; Chan, L. Ongoing coverage for ongoing care: Access, utilization, and out-of-pocket spending among uninsured working-aged adults with chronic health care needs. Am. J. Public Health 2011, 101, 368–375. [Google Scholar] [CrossRef] [PubMed]
- Shi, L.; Lee, D.C.; Haile, G.P.; Liang, H.; Chung, M.; Sripipatana, A. Access to care and satisfaction among health center patients with chronic conditions. J. Ambul. Care Manag. 2017, 40, 69–76. [Google Scholar] [CrossRef] [PubMed]
- Organisation for Economic Co-operation and Development. Universal Health Coverage and Health Outcomes: Final Report. 2016. Available online: https://www.oecd.org/els/health-systems/Universal-Health-Coverage-and-Health-Outcomes-OECD-G7-Health-Ministerial-2016.pdf (accessed on 15 February 2020).
- Centers for Medicare and Medicaid Services. Original Medicare (Part A and B) Eligibility and Enrollment. 2019. Available online: https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol (accessed on 2 March 2020).
- Garfield, R.; Orgera, K.; Damico, A. The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid. Kaiser Family Foundation Issue Brief. 2020. Available online: http://files.kff.org/attachment/Issue-Brief-The-Coverage-Gap-Uninsured-Poor-Adults-in-States-that-Do-Not-Expand-Medicaid (accessed on 15 February 2020).
- National Center for Health Statistics. Health, United States, 2017. (See Footnote of Table 98. Sources of Payment for Health Care, by Selected Population Characteristics: United States, Selected Years 1987–2014). Hyattsville, MD. 2019. Available online: https://www.cdc.gov/nchs/data/hus/2017/098.pdf (accessed on 2 March 2020).
- Nadash, P.; Miller, E.A.; Jones, D.K.; Gusmano, M.K.; Rosenbaum, S. A series of unfortunate events: Implications of Republican efforts to repeal and replace the Affordable Care Act For older adults. J. Aging Soc. Policy 2018, 30, 259–281. [Google Scholar] [CrossRef] [PubMed]
- Kaiser Family Foundation. Explaining Health Care Reform: Questions about Health Insurance Subsidies. 2020. Available online: https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/ (accessed on 2 March 2020).
- Martinez, M.E.; Ward, B.W. Health care access and utilization among adults aged 18–64, by poverty level: United States, 2013–2015. NCHS Data Brief 2016, 262, 1–8. [Google Scholar]
- Sommers, B.D. Health insurance coverage: What comes after the ACA? Health Aff. 2020, 39, 502–508. [Google Scholar] [CrossRef] [PubMed]
- Garfield, R.; Orgera, K.; Damico, A. The Uninsured and the ACA: A Primer: Key Facts about Health Insurance and the Uninsured Amidst Changes to the Affordable Care Act. Kaiser Family Foundation. 2019. Available online: http://files.kff.org/attachment/The-Uninsured-and-the-ACA-A-Primer-Key-Facts-about-Health-Insurance-and-the-Uninsured-amidst-Changes-to-the-Affordable-Care-Act (accessed on 2 March 2020).
- Tolbert, J.; Orgera, K.; Singer, N.; Damico, A. Key Facts about the Uninsured People. Kaiser Family Foundation Issue Brief. 2019. Available online: http://files.kff.org/attachment/Issue-Brief-Key-Facts-about-the-Uninsured-Population (accessed on 2 March 2020).
- Jones, D.K.; Gusmano, M.K.; Nadash, P.; Miller, E.A. Undermining the ACA through the executive branch and federalism: What the Trump administration’s approach to health reform means for older Americans. J. Aging Soc. Policy 2018, 30, 282–299. [Google Scholar] [CrossRef] [PubMed]
- Semanskee, A.; Claxton, G.; Levitt, L. How Premiums are Changing. Kaiser Family Foundation. 2017. Available online: https://www.kff.org/health-costs/issue-brief/how-premiums-are-changing-in-2018/ (accessed on 1 March 2010).
- National Center for Health Statistics. Health, United States, 2018. Figure 20. Health Insurance Coverage among Adults Aged 18–64, by Type of Coverage and Race and Hispanic Origin: United States, 2007–2018 (Preliminary Data). Hyattsville, MD. 2019. Available online: https://www.cdc.gov/nchs/data/hus/hus18.pdf (accessed on 5 March 2020).
- Buchmueller, T.C.; Levy, H.G. The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care: An examination of how the insurance coverage expansions of the Affordable Care Act have affected disparities related to race and ethnicity. Health Aff. 2020, 39, 395–402. [Google Scholar] [CrossRef] [PubMed]
- Fehr, R.; Cox, C.; Levitt, L. Data Note: Changes in Enrollment in the Individual Health Insurance Market through Early 2019. Kaiser Family Foundation. 2019. Available online: https://www.kff.org/private-insurance/issue-brief/data-note-changes-in-enrollment-in-the-individual-health-insurance-market-through-early-2019/ (accessed on 5 March 2020).
- Li, R.; Barker, L.E.; Shrestha, S.; Zhang, P.; Duru, O.K.; Pearson-Clarke, T.; Gregg, E.W. Changes over time in high out-of-pocket health care burden in U.S. adults with diabetes, 2001–2011. Diabetes Care 2014, 37, 1629–1635. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Valtorta, N.K.; Hanratty, B. Socioeconomic variation in the financial consequences of ill health for older people with chronic diseases: A systematic review. Maturitas 2013, 74, 313–333. [Google Scholar] [CrossRef] [PubMed]
- Zhou, R.A.; Baicker, K.; Taubman, S.; Finkelstein, A.N. The uninsured do not use emergency department more—They use other care less. Health Aff. 2017, 36, 2112–2122. [Google Scholar] [CrossRef] [PubMed]
- National Center for Health Statistics. 2018 National Health Interview Survey (NHIS) Public Use Data Release: Survey Description. Centers for Disease Control and Prevention U.S. Department of Health and Human Services. 2019. Available online: https://www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm (accessed on 26 November 2019).
- National Center for Health Statistics. National Health Interview Survey Health Insurance Information Glossary. 2018. Available online: https://www.cdc.gov/nchs/nhis/health_insurance/hi_glossary.htm (accessed on 2 February 2020).
- Allison, P. When can you Safely Ignore Multicollinearity? 2012. Available online: https://statisticalhorizons.com/multicollinearity (accessed on 5 February 2020).
- Miller, S.; Altekruse, S.; Johnson, N.; Wherry, L.R. Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data. National Bureau of Economic Research, Working Paper 26081. 2019. Available online: http://www.nber.org/papers/w26081 (accessed on 7 March 2020).
- Ghosh, A.; Simon, K.; Sommers, B.D. The effect of health insurance on prescription drug use among low-income adults: Evidence from recent Medicaid expansions. J. Health Econ. 2019, 63, 64–80. [Google Scholar] [CrossRef] [PubMed]
- Khullar, D.; Song, Z.; Chokshi, D.A. Safety-net Health Systems at Risk: Who Bears the Burden of Uncompensated Care? Health Affairs Blog Health Equity. 2018. Available online: https://www.healthaffairs.org/do/10.1377/hblog20180503.138516/full/ (accessed on 7 March 2020).
- Spencer, D.; Richardson, S.K.; McCormick, M.K. Inpatient hospital utilization among the uninsured near elderly: Data and policy implications for West Virginia. Health Serv. Res. 2007, 42, 2442–2457. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rosenbaum, S.; Wilensky, G. Closing the Medicaid coverage gap: Options for Reform. Health Aff. 2020, 39, 514–518. [Google Scholar] [CrossRef] [PubMed]
- Glied, S.A.; Rollins, A.A.; Lin, S. Did the ACA lower Americans’ financial barriers to health care? Health Aff. 2020, 39, 379–386. [Google Scholar] [CrossRef] [PubMed]
- Centers for Medicare and Medicaid Services. Medicare’s End-stage Renal Disease Program. Available online: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/List-of-Past-Articles-Items/CMS1191649 (accessed on 7 March 2020).
50–64 | 65+ | |
---|---|---|
N | 49,025 | 48,284 |
No HI | 9.93 (9.53–10.34) | 0.65 (0.56–0.75) |
Private HI | 69.19 (68.51–69.86) | 45.77 (44.84–46.70) |
VA/military HI | 4.17 (3.90–4.45) | 8.05 (7.67–8.45) |
Medicare without Medicaid | 6.61 (6.31–6.93) | 81.94 (81.37–82.50) |
Medicare and Medicaid | 2.18 (2.03–2.35) | 6.06 (5.69–6.45) |
Medicaid without Medicare | 6.21 (5.88–6.57) | 1.18 (1.05–1.34) |
Had no usual place for sickness/injury care in past 12 months | 8.14 (8.07–8.77) | 3.28 (3.08–3.49) |
Worried about paying for healthcare | 47.23 (46.64–48.01) | 29.13 (28.52–29.74) |
Healthcare delayed or not received due to cost in past 12 months | 12.35 (11.97–12.73) | 4.52 (4.29–4.76) |
Saw any healthcare professional in past 12 months | 86.37 (85.93–86.79) | 93.60 (93.32–93.87) |
Healthcare Delay or Nonuse due to Cost in Past 12 Months | No HI | Private HI | VA/Military HI | Medicare | Medicare + Medicaid | Medicaid | |
---|---|---|---|---|---|---|---|
Combined N (% of all in 50–64 age group), 2013–2018 | 7408 (12.35) | 5373 (9.93) | 31,392 (69.19) | 2209 (4.17) | 3567 (6.61) | 1506 (2.18) | 3563 (6.21) |
2013 | 14.09 | 14.48 | 67.62 | 4.19 | 6.67 | 2.03 | 4.45 |
2014 | 12.32 | 11.18 | 68.68 | 4.35 | 6.27 | 2.19 | 5.56 |
2015 | 11.09 | 8.13 | 70.65 | 4.47 | 6.82 | 2.26 | 6.12 |
2016 | 11.54 | 7.67 | 70.33 | 4.16 | 6.40 | 2.30 | 7.21 |
2017 | 11.78 | 8.83 | 69.96 | 3.55 | 6.90 | 2.34 | 7.15 |
2018 | 13.30 | 9.41 | 70.49 | 4.28 | 6.63 | 1.97 | 6.74 |
P value, changes, 2013–2018 | <0.001 | <0.001 | 0.013 | 0.271 | 0.778 | 0.710 | <0.001 |
No HI | Private HI | VA/Military HI | Medicare | Medicare + Medicaid | Medicaid | |
---|---|---|---|---|---|---|
N (% of all 50–64 years old) | 5373 (9.93) | 31,392 (69.19) | 2209 (4.17) | 3567 (6.61) | 1506 (2.18) | 3563 (6.21) |
Age, M (SE) | 56.22 (0.08) | 56.75 (0.03) | 57.62 (0.12) | 58.59 (0.10) | 57.19 (0.14) | 56.61 (0.10) |
% Female | 48.56 | 52.32 | 36.31 | 48.61ǂ | 56.45 | 57.35 |
Race (%) | ||||||
Non-Hispanic White | 53.87 | 75.74 | 68.60 | 68.85 | 54.47 | 46.44 |
Non-Hispanic Black | 13.85 | 9.39 | 16.72 | 15.67 | 23.15 | 21.78 |
Hispanic | 24.61 | 8.66 | 7.54 | 10.16 | 14.44 | 20.60 |
Asian | 4.27 | 4.92 | 3.98 | 2.69 | 2.04 | 7.5 |
All other | 3.41 | 1.28 | 3.17 | 2.63 | 5.91 | 3.69 |
% Not married | 45.65 | 23.94 | 30.39 | 45.94 | 72.55 | 56.55 |
% Without college degree | 84.78 | 60.08 | 33.37 | 86.19ǂ | 94.35 | 90.40 |
Income (%) | ||||||
<200% of poverty | 43.29 | 17.11 | 25.11 | 47.19 | 66.42 | 63.16 |
200–399% of poverty | 25.62 | 23.28 | 26.31 | 25.44 | 15.83 | 18.13 |
400+% of poverty | 21.21 | 51.04 | 40.23 | 19.85 | 9.84 | 11.06 |
Missing | 9.88 | 8.57 | 8.36 | 7.52 | 7.91 | 7.65 |
% Worked in the past year | 68.28 | 82.91 | 56.03 | 10.27 | 7.83 | 35.50 |
No. of chronic medical conditions, M (SE) | 1.12 (0.02) | 1.22 (0.01) | 1.85 (0.04) | 2.63 (0.04) | 3.07 (0.06) | 2.16 (0.04) |
% With any functional limitation | 45.55 | 37.71 | 56.32 | 88.32 | 92.26 | 69.74 |
Healthcare access in past 12 months (%) | ||||||
Had no usual place for sickness/injury care | 37.47 | 5.11 | 3.75 | 3.84 | 2.92 | 6.43 |
Worried about paying for healthcare | 78.96 | 42.50 | 27.06 | 57.98 | 40.19 | 48.29 |
Healthcare delayed or not received due to cost in past 12 months | 40.18 | 7.47 | 5.56 | 22.08 | 11.17 | 14.0 |
Saw/talked with | ||||||
Any healthcare professional | 59.67 | 88.84 | 91.92 | 94.89 | 95.22 | 89.80 |
General practitioner | 45.54 | 77.54 | 83.22 | 86.20 | 85.94 | 80.02 |
Medical specialist | 12.70 | 33.19 | 40.73 | 54.54 | 53.80 | 37.15 |
Dentist | 33.15 | 75.18 | 65.17 | 46.98 | 39.19 | 42.96 |
Eye doctor | 20.44 | 49.42 | 50.69 | 44.41 | 46.56 | 37.89 |
Used cost-saving strategy for prescription drugs | 34.07 | 18.92 | 11.61 | 39.09 | 25.87 | 22.92 |
No. of emergency department visits | ||||||
0 | 82.0 | 84.96 | 73.31 | 61.84 | 50.66 | 62.89 |
1 | 10.62 | 9.97 | 14.60 | 18.35 | 19.23 | 16.95 |
2–3 | 4.33 | 2.89 | 8.01 | 12.34 | 17.15 | 11.98 |
4+ | 1.64 | 0.92 | 3.01 | 6.37 | 11.69 | 6.20 |
Missing | 1.41 | 1.26 | 1.06 | 1.10 | 1.27 | 1.98 |
Overnight hospital stay | 6.05 | 7.03ǂ | 11.05 | 21.78 | 28.34 | 17.97 |
No HI vs. Any HI AOR (95% CI) | |
---|---|
Age | 0.98 (0.97–0.99) *** |
Female vs. male | 0.82 (0.76–0.88) *** |
Race/ethnicity: Vs. Non-Hispanic White | |
Non-Hispanic Black | 1.18 (1.05–1.33) *** |
Hispanic | 2.34 (2.09–2.93) *** |
Asian | 1.15 (0.94–1.41) |
Other | 2.18 (1.75–2.71) *** |
Not married vs. married | 1.74 (1.60–1.90) *** |
No college degree vs. college degree | 2.29 (2.06–2.55) *** |
Income: Vs. 400+% of poverty | |
Up to 200% of poverty | 2.67 (2.38–2.99) *** |
200–399% of poverty | 1.82 (1.63–2.04) *** |
Missing | 2.05 (1.77–2.37) *** |
Did not work vs. worked full- or part-time | 1.05 (0.95–1.16) |
No. of chronic medical conditions | 0.75 (0.73–0.78) ** |
Any functional limitation vs. none | 1.11 (1.02–1.22) * |
N = 49,025; Model statistics: Design df = 907; F (14, 894) = 96.39, p < 0.001 |
No HI vs. | |||||
---|---|---|---|---|---|
Private HI | VA/Military HI | Medicare w/o Medicaid | Medicare + Medicaid | Medicaid w/o Medicare | |
AOR (95% CI) | AOR (95% CI) | AOR (95% CI) | AOR (95% CI) | AOR (95% CI) | |
Medical care delay/nonuse due to cost | 7.27 (6.52–8.10) | 15.48 (12.20–19.65) | 4.65 (3.88–5.58) | 14.87 (11.14–19.85) | 7.20 (6.05–8.57) |
Saw any healthcare professional | 0.23 (0.20–0.25) | 0.18 (0.14–0.22) | 0.15 (0.12–0.18) | 0.16 (0.11–0.22) | 0.23 (0.19–0.28) |
Saw general practitioner | 0.28 (0.25–0.30) | 0.23 (0.19–0.27) | 0.23 (0.20–0.28) | 0.26 (0.20–0.34) | 0.27 (0.23–0.32) |
Saw medical specialist | 0.32 (0.28–0.36) | 0.29 (0.24–0.35) | 0.24 (0.20–0.29) | 0.27 (0.21–0.35) | 0.34 (0.29–0.41) |
Saw dentist | 0.25 (0.23–0.27) | 0.28 (0.24–0.33) | 0.41 (0.35–0.49) | 0.44 (0.35-0.55) | 0.52 (0.45–0.60) |
Saw eye doctor | 0.34 (0.31–0.37) | 0.30 (0.26–0.35) | 0.38 (0.32–0.44) | 0.30 (0.24–0.38) | 0.47 (0.40–0.54) |
Visited Emergency Department | 1.02(0.92–1.15) ǂ | 0.74 (0.62–0.89) | 0.68 (0.57–0.81) | 0.63 (0.50–0.80) | 0.62 (0.54–0.72) |
Hospitalized | 0.69 (0.57–0.82) | 0.78 (0.60–1.01) ǂ | 0.51 (0.39–0.65) | 0.57 (0.43–0.76) | 0.54 (0.43–0.69) |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Choi, N.G.; DiNitto, D.M.; Choi, B.Y. Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50–64. Int. J. Environ. Res. Public Health 2020, 17, 2711. https://doi.org/10.3390/ijerph17082711
Choi NG, DiNitto DM, Choi BY. Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50–64. International Journal of Environmental Research and Public Health. 2020; 17(8):2711. https://doi.org/10.3390/ijerph17082711
Chicago/Turabian StyleChoi, Namkee G., Diana M. DiNitto, and Bryan Y. Choi. 2020. "Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50–64" International Journal of Environmental Research and Public Health 17, no. 8: 2711. https://doi.org/10.3390/ijerph17082711