Health Insurance Coverage before and after the Affordable Care Act in the USA †
Abstract
:1. Introduction
2. Literature Review
2.1. Effect of the ACA on Health Insurance Rate
2.2. Impact of Age
2.3. Impact of Race and Ethnicity
2.4. Impact of Nativity
2.5. Impact of Poverty and Medicaid Expansion
2.6. Gaps in the Literature
3. Hypotheses
4. Data and Methods
4.1. Data and Samples
4.2. Variables and Measurements
4.3. Limitations of Data
4.4. Methods of Analysis
5. Results
5.1. Descriptive Analysis
5.2. Bivariate Analysis
5.3. Logistic Regression Analysis
6. Discussion and Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | |
Has insurance | 0.822 | 0.38 | 0.813 | 0.39 | 0.823 | 0.38 | 0.827 | 0.38 | 0.83 | 0.38 | 0.866 | 0.34 | 0.894 | 0.31 |
Male | 0.48 | 0.50 | 0.48 | 0.50 | 0.48 | 0.50 | 0.48 | 0.50 | 0.48 | 0.50 | 0.48 | 0.50 | 0.48 | 0.50 |
Age | 46.12 | 17.69 | 46.24 | 17.76 | 46.38 | 17.85 | 46.66 | 17.88 | 46.79 | 17.94 | 47.01 | 18.00 | 47.15 | 18.05 |
Race | ||||||||||||||
White | 0.81 | 0.39 | 0.81 | 0.39 | 0.81 | 0.40 | 0.80 | 0.40 | 0.80 | 0.40 | 0.80 | 0.40 | 0.792. | 0.41 |
Black | 0.12 | 0.33 | 0.12 | 0.33 | 0.12 | 0.33 | 0.12 | 0.32 | 0.12 | 0.33 | 0.12 | 0.33 | 0.12 | 0.33 |
Asian | 0.05 | 0.21 | 0.05 | 0.22 | 0.05 | 0.22 | 0.05 | 0.23 | 0.06 | 0.23 | 0.06 | 0.23 | 0.06 | 0.24 |
Other | 0.02 | 0.13 | 0.01 | 0.12 | 0.02 | 0.13 | 0.02 | 0.13 | 0.02 | 0.13 | 0.02 | 0.13 | 0.02 | 0.14 |
Hispanic | 0.14 | 0.34 | 0.14 | 0.35 | 0.14 | 0.35 | 0.15 | 0.36 | 0.15 | 0.36 | 0.15 | 0.36 | 0.16 | 0.36 |
Currently married | 0.56 | 0.50 | 0.55 | 0.50 | 0.55 | 0.50 | 0.55 | 0.50 | 0.54 | 0.50 | 0.54 | 0.50 | 0.55 | 0.50 |
Foreign-born | 0.17 | 0.37 | 0.17 | 0.38 | 0.17 | 0.38 | 0.18 | 0.38 | 0.18 | 0.38 | 0.18 | 0.39 | 0.19 | 0.39 |
U.S. citizen | 0.92 | 0.28 | 0.92 | 0.28 | 0.92 | 0.27 | 0.92 | 0.28 | 0.92 | 0.28 | 0.92 | 0.28 | 0.92 | 0.28 |
Region | ||||||||||||||
Northeast | 0.18 | 0.38 | 0.18 | 0.38 | 0.18 | 0.38 | 0.18 | 0.39 | 0.18 | 0.38 | 0.18 | 0.38 | 0.18 | 0.38 |
Midwest | 0.23 | 0.42 | 0.23 | 0.42 | 0.23 | 0.42 | 0.22 | 0.42 | 0.22 | 0.42 | 0.22 | 0.49 | 0.22 | 0.41 |
South | 0.36 | 0.48 | 0.36 | 0.48 | 0.36 | 0.48 | 0.37 | 0.48 | 0.37 | 0.48 | 0.37 | 0.48 | 0.37 | 0.48 |
West | 0.23 | 0.42 | 0.23 | 0.42 | 0.23 | 0.42 | 0.23 | 0.42 | 0.23 | 0.42 | 0.23 | 0.42 | 0.23 | 0.42 |
Education | 12.29 | 2.43 | 12.87 | 2.44 | 12.91 | 2.45 | 12.95 | 2.40 | 12.98 | 2.42 | 13.01 | 2.42 | 13.08 | 2.40 |
Family income | ||||||||||||||
$0–$49,999 | 0.47 | 0.50 | 0.48 | 0.50 | 0.48 | 0.50 | 0.47 | 0.50 | 0.46 | 0.50 | 0.45 | 0.50 | 0.42 | 0.49 |
$50,000–$99,999 | 0.31 | 0.46 | 0.30 | 0.46 | 0.30 | 0.46 | 0.31 | 0.46 | 0.31 | 0.46 | 0.29 | 0.46 | 0.30 | 0.46 |
$100,000 and over | 0.22 | 0.42 | 0.21 | 0.41 | 0.22 | 0.41 | 0.23 | 0.42 | 0.24 | 0.43 | 0.26 | 0.43 | 0.28 | 0.45 |
Below poverty line | 0.12 | 0.33 | 0.13 | 0.34 | 0.14 | 0.35 | 0.14 | 0.35 | 0.14 | 0.34 | 0.13 | 0.34 | 0.12 | 0.32 |
N | 64,047 | 65,332 | 74,337 | 79,339 | 77,066 | 82,986 | 77,182 |
2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Variable | % | % Base | % | % Base | % | % Base | % | % Base | % | % Base | % | % Base | % | % Base |
Gender | ||||||||||||||
Female | 84.7 | 33,736 | 84.1 | 34,410 | 84.5 | 39,186 | 84.9 | 41,941 | 85.0 | 40,672 | 88.4 | 43,686 | 91.1 | 40,586 |
Male | 79.5 | 30,311 | 78.3 | 30,922 | 79.9 | 35,151 | 80.4 | 37,398 | 81.0 | 36,394 | 84.7 | 39,300 | 87.6 | 36,596 |
Age | ||||||||||||||
27–99 | 84.7 | 53,589 | 83.9 | 54,533 | 84.1 | 62,258 | 84.3 | 66,833 | 84.8 | 65,203 | 87.8 | 70,504 | 90.4 | 65,879 |
18–26 | 69.5 | 10,458 | 68.4 | 10,799 | 73.2 | 12,079 | 74.2 | 12,506 | 74.2 | 11,863 | 80.5 | 12,482 | 84.2 | 11,303 |
Race | ||||||||||||||
White | 83.1 | 48,370 | 82.5 | 48,650 | 83.2 | 55,849 | 83.5 | 59,746 | 84.0 | 58,179 | 87.1 | 63,613 | 89.8 | 58,845 |
Black | 78.0 | 9473 | 76.0 | 10,039 | 77.8 | 10,827 | 79.0 | 11,300 | 78.2 | 10,978 | 84.3 | 10,957 | 87.3 | 10,165 |
Asian | 82.7 | 4481 | 81.7 | 5021 | 82.6 | 5516 | 82.7 | 5718 | 85.0 | 5432 | 88.5 | 5688 | 92.2 | 5395 |
Other | 69.9 | 1723 | 66.9 | 1622 | 72.6 | 2145 | 74.6 | 2575 | 74.2 | 2477 | 79.0 | 2728 | 83.1 | 2777 |
Hispanic | ||||||||||||||
No | 85.7 | 49,958 | 84.8 | 50,680 | 85.7 | 58,723 | 86.3 | 63,654 | 86.8 | 61,581 | 89.8 | 66,939 | 92.2 | 61,974 |
Yes | 60.0 | 14,089 | 60.1 | 14,652 | 61.2 | 15,614 | 61.9 | 15,685 | 62.1 | 15,485 | 68.7 | 16,047 | 74.4 | 15,208 |
Currently married | ||||||||||||||
No | 76.0 | 20,801 | 74.8 | 29,400 | 76.4 | 33,754 | 77.1 | 36,227 | 77.9 | 35,416 | 82.4 | 37,711 | 86.1 | 34,917 |
Yes | 87.2 | 29,897 | 86.6 | 35,705 | 87.2 | 40,318 | 87.4 | 42,864 | 87.5 | 41,414 | 90.2 | 45,020 | 92.2 | 42,047 |
Foreign-born | ||||||||||||||
No | 85.4 | 48,941 | 84.5 | 49,112 | 85.4 | 57,155 | 85.9 | 62,045 | 86.3 | 60,221 | 89.5 | 65,427 | 91.8 | 60,750 |
Yes | 66.1 | 14,920 | 66.3 | 16,043 | 67.3 | 16,982 | 67.7 | 17,091 | 68.5 | 16,653 | 73.9 | 17,361 | 79.0 | 16,298 |
U.S. citizen | ||||||||||||||
No | 49.3 | 7775 | 48.3 | 8281 | 51.4 | 8546 | 50.0 | 8530 | 51.0 | 8197 | 57.6 | 8521 | 64.0 | 7736 |
Yes | 85.2 | 55,976 | 84.4 | 56,755 | 85.1 | 65,432 | 85.7 | 70,499 | 86.1 | 68,578 | 89.4 | 74,155 | 91.8 | 69,232 |
Region | ||||||||||||||
Northeast | 88.2 | 10,646 | 87.5 | 10,541 | 87.8 | 11,909 | 88.2 | 13,426 | 88.7 | 12,766 | 91.0 | 13,801 | 93.3 | 12,964 |
North Central/Midwest | 85.2 | 13,183 | 85.2 | 13,293 | 86.0 | 15,292 | 86.2 | 15,589 | 86.8 | 14,910 | 89.5 | 16,703 | 91.8 | 15,193 |
South | 78.8 | 23,519 | 77.6 | 23,863 | 78.9 | 26,765 | 79.4 | 28,384 | 79.8 | 28,085 | 83.1 | 28,710 | 85.9 | 26,630 |
West | 79.8 | 16,699 | 78.5 | 17,635 | 79.7 | 20,371 | 80.1 | 21,940 | 80.5 | 21,305 | 86.2 | 23,772 | 89.8 | 22,395 |
Education | ||||||||||||||
No high school | 67.0 | 11,258 | 66.0 | 11,498 | 68.6 | 12,568 | 67.7 | 12,880 | 68.1 | 12,223 | 73.7 | 12,566 | 76.9 | 11,238 |
High school/GED | 78.7 | 17,772 | 77.5 | 17,991 | 77.7 | 20,130 | 78.5 | 21,631 | 79.3 | 20,793 | 82.6 | 22,397 | 86.3 | 20,355 |
Some college | 82.7 | 12,284 | 81.2 | 12,280 | 82.5 | 14,125 | 83.3 | 15,386 | 83.0 | 14,654 | 87.1 | 15,690 | 90.3 | 14,653 |
College degree+ | 91.1 | 21,590 | 90.7 | 22,512 | 91.0 | 26,311 | 91.1 | 28,379 | 91.0 | 28,383 | 93.7 | 31,243 | 95.0 | 30,007 |
Family income | ||||||||||||||
$0–$49 k | 71.8 | 28,338 | 70.4 | 30,084 | 71.7 | 34,340 | 71.7 | 35,869 | 72.2 | 34,211 | 77.3 | 33,540 | 82.4 | 29,341 |
$50 k–$99 k | 87.4 | 17,468 | 87.3 | 17,306 | 88.2 | 19,819 | 88.1 | 21,616 | 88.1 | 20,926 | 91.0 | 20,884 | 91.3 | 19,883 |
$100 k+ | 94.8 | 11,784 | 95.3 | 11,446 | 95.7 | 13,222 | 95.9 | 14,536 | 95.9 | 14,684 | 96.8 | 16,715 | 97.4 | 16,519 |
Poverty status | ||||||||||||||
Above poverty line | 85.2 | 48,004 | 84.4 | 48,077 | 85.4 | 55,020 | 86.0 | 58,815 | 86.2 | 57,535 | 89.0 | 64,672 | 91.0 | 61,613 |
Below poverty line | 62.3 | 7896 | 62.2 | 8886 | 64.3 | 10,355 | 63.9 | 11,133 | 65.0 | 10,501 | 70.7 | 11,189 | 77.3 | 9387 |
Predictor | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 |
---|---|---|---|---|---|---|---|
Male | 0.656 *** | 0.637 *** | 0.681 *** | 0.660 *** | 0.699 *** | 0.669 *** | 0.651 *** |
(0.000) | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | (0.001) | |
Age 26 or below | 0.561 *** | 0.5730 *** | 0.723 *** | 0.774 *** | 0.704 *** | 0.755 *** | 0.731 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Race (ref. = White) | |||||||
Black | 0.857 *** | 0.802 *** | 0.842 *** | 0.905 *** | 0.777 *** | 0.949 *** | 0.840 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Asian | 1.033 *** | 1.099 ** | 1.121 *** | 1.102 *** | 1.166 *** | 1.289 *** | 1.414 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Other | 0.704 *** | 0.773 ** | 0.743 *** | 0.903 *** | 0.879 *** | 0.980 *** | 0.847 *** |
(0.001) | (0.002) | (0.001) | (0.001) | (0.001) | (0.002) | (0.002) | |
Hispanic | 0.533 *** | 0.562 *** | 0.539 *** | 0.546*** | 0.502 *** | 0.524 *** | 0.510 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Currently, married | 1.582 *** | 1.592 *** | 1.583 *** | 1.538 *** | 1.467 *** | 1.545 *** | 1.538 *** |
(0.000) | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | |
Foreign Born | 0.890 *** | 0.967 *** | 0.844 *** | 0.988 *** | 0.944 *** | 0.976 *** | 0.996 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Not U.S. Citizen | 0.320 *** | 0.293 *** | 0.362 *** | 0.288 *** | 0.305 *** | 0.261 *** | 0.245 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Region (ref. = South) | |||||||
Northeast | 1.965 *** | 1.871 *** | 1.848 *** | 1.873 *** | 1.887 *** | 1.973 *** | 2.081 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Midwest | 1.310 *** | 1.385 *** | 1.437 *** | 1.407 *** | 1.364 *** | 1.496 *** | 1.472 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
West | 1.210 *** | 1.190 *** | 1.221 *** | 1.180 *** | 1.165 *** | 1.545 *** | 1.729 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Education | 1.056 *** | 1.057 *** | 1.055 *** | 1.058 *** | 1.047 *** | 1.064 *** | 1.076 *** |
(0.000) | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | |
Family Income | 1.418 *** | 1.475 *** | 1.510 *** | 1.500 *** | 1.488 *** | 1.392 *** | 1.281 *** |
(0.000) | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | (0.000) | |
In Poverty | 0.858 *** | 0.918 *** | 0.959 *** | 0.879 *** | 0.890*** | 0.824 *** | 0.850*** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.001) | |
Constant | 0.423 *** | 0.375 *** | 0.441 *** | 0.356 *** | 0.465 *** | 0.496 *** | 0.651 *** |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | (0.002) | (0.002) | |
−2 log likelihood | 146,190,974 | 150,231,556 | 149,013,535 | 147,812,723 | 147,348,508 | 129,054,233 | 113,606,141 |
Model χ2 | 28,779,090 | 30,515,412 | 28,306,600 | 29,551,108 | 28,982,864 | 24,985,712 | 20,098,466 |
df | 15 | 15 | 15 | 15 | 15 | 15 | 15 |
Pseudo R2 | 0.233 | 0.241 | 0.227 | 0.235 | 0.231 | 0.219 | 0.196 |
N | 64,047 | 65,332 | 74,337 | 79,339 | 77,066 | 82,986 | 77,182 |
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Patrick, J.; Yang, P.Q. Health Insurance Coverage before and after the Affordable Care Act in the USA. Sci 2021, 3, 25. https://doi.org/10.3390/sci3020025
Patrick J, Yang PQ. Health Insurance Coverage before and after the Affordable Care Act in the USA. Sci. 2021; 3(2):25. https://doi.org/10.3390/sci3020025
Chicago/Turabian StylePatrick, Jesse, and Philip Q. Yang. 2021. "Health Insurance Coverage before and after the Affordable Care Act in the USA" Sci 3, no. 2: 25. https://doi.org/10.3390/sci3020025