Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–June 2021

Gregory, Elizabeth C W; Osterman, Michelle J K; Valenzuela, Claudia P

doi:10.15620/cdc:110854

Cited by 77 publications

(67 citation statements)

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“…19 Despite these losses, we observed a slight decline in the national uninsurance rate during 2020. Although we cannot identify coverage source in BRFSS, our results also comport with estimates from the National Health Interview Survey, 20 the Current Population Survey, 21 the Survey of Income and Program Participation, 22 and the Health Reform Monitoring Survey, 11 which all suggest that gains in public coverage may have offset losses in private coverage. 8 , 23 Thus, we have good reason to believe uninsurance and lack of health care access was prevented for some individuals because of Medicaid expansion.…”

Section: Discussionmentioning

confidence: 54%

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

et al. 2022

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Background: The intersecting crises of the COVID-19 pandemic, job losses, and concomitant loss of employer-sponsored health insurance may have disproportionately affected health care access within minorized and lower-socioeconomic status communities. Objective: To describe changes in access to care during the COVID-19 pandemic, stratified by race/ethnicity, household income, and state Medicaid expansion status. Research Design: We used interrupted time series and difference-in-differences regression models, controlling for respondent characteristics and preexisting trends. Subjects: Data were extracted for all adults aged 18–64 surveyed in the 2015-2020 Behavioral Risk Factor Surveillance System (N=1,731,699) from all 50 states and the District of Columbia. Measures: Our outcomes included indicators for whether respondents had any health insurance coverage or avoided seeking care because of cost within the prior year. The primary exposure was the onset of the COVID-19 pandemic in the United States in March 2020. Results: The pandemic was associated with a 1.2 percentage point (pp) decline in uninsurance for Medicaid expansion states (95% CI, −1.8, −0.6); these reductions were concentrated among respondents who were Black, multiracial, or low income. The rates of uninsurance were generally stable in nonexpansion states. The rates of avoided care because of cost fell by 3.5 pp in Medicaid expansion states (95% CI, −3.9, −3.1), and by 3.6 pp (95% CI, 4.3–2.9) in nonexpansion states. These declines were concentrated among respondents who were Hispanic, Other Race, or low income. Conclusions: Our findings reinforce the value of Medicaid expansion as one tool to improve access to health insurance and care for marginalized and vulnerable populations.

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Section: Discussionmentioning

confidence: 54%

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

et al. 2022

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“…3 Nearly a third of families in 2011 reported healthcare-related financial burden. 4 Financial burden associated with serious illness impacts Health-Related Quality of Life (HRQoL) and mortality. 5,6 In oncologic literature, cancer treatment-related financial burdens are associated with poorer physical and psychological health, less satisfying relationships, and higher mortality rates.…”

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confidence: 99%

Patients Follow Different Financial Hardship Trajectories in the Year after Injury

et al. 2022

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Objective: To determine if distinct financial trajectories exist and if they are associated with quality-of-life outcomes. Summary of Background Data: Financial hardship after injury measurably impacts Health-Related Quality of Life outcomes. Financial hardship, encompassing material losses, financial worry, and poor coping mechanisms, is associated with lower quality of life and increased psychological distress. However, recovery is dynamic and financial hardship may change over time. Methods: This is a secondary analysis of a cohort of 500 moderate-tosevere nonneurologic injured patients in which financial hardship and Health-related Quality of Life outcomes were measured at 1, 2, 4, and 12 months after injury using survey instruments . Enrollment occurred at an urban, academic, Level 1 trauma center in Memphis, Tennessee during January 2009 to December 2011 and followup completed by December 2012. Results: Four hundred seventy-four patients had sufficient data for Group-Based Trajectory Analysis. Four distinct financial hardship trajectories were identified: Financially Secure patients (8.6%) had consistently low hardship over time; Financially Devastated patients had a high degree of hardship immediately after injury and never recovered (51.6%); Financially Frail patients had increasing hardship over time (33.6%); and Financially Resilient patients started with a high degree of hardship but recovered by year end (6.2%). At 12-months, all trajectories had poor Short Form-36 physical component scores and the Financial Frail and Financially Devastated trajectories had poor mental health scores compared to US population norms. Conclusions and Relevance: The Financially Resilient trajectory demonstrates financial hardship after injury can be overcome. Further research into understanding why and how this occurs is needed.

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“…These findings are of high importance, given that Tennessee ranks in the bottom tier of all US states for several key health indicators 33–35 . Although the number of insured individuals in Tennessee has dropped significantly during the last decade, the high out-of-pocket healthcare costs are of major concern, with implications including mental health 5 …”

Section: Discussionmentioning

confidence: 99%

Association between Financial Barriers to Healthcare Access and Mental Health Outcomes in Tennessee

Ahuja

Cimilluca

Stamey

et al. 2023

Southern Medical Journal

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Objectives: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. Methods:We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables.Results: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001).Conclusions: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.

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Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–June 2021

Abstract: Using National Health Interview Survey data from the first six months of 2021, this Early Release report provides preliminary estimates of the percentages of adults and children living in homes with only wireless telephones.

Cited by 77 publications

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Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

Patients Follow Different Financial Hardship Trajectories in the Year after Injury

Association between Financial Barriers to Healthcare Access and Mental Health Outcomes in Tennessee

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