Health reform under the patient protection and Affordable Care Act: characteristics of exchange-based health insurance enrollees

Abstract

The Affordable Care Act (ACA) reformed and expanded healthcare coverage with an exchangebased health insurance program. While millions of Americans have benefited from enrollment in ACA marketplace insurance plans, many individuals are likely to be affected by potential future policy changes. Since few studies on the features of marketplace enrollees exist, we adopted a retrospective, cross-sectional study design using 2016 National Health Interview data to identify sociodemographic and health characteristics of enrollees, comparing them to those without insurance. Chi-square tests and logistic regression examined factors associated with enrollees. Adults with multiple chronic diseases (AOR = 1.90, 95% CI = 1.44, 2.50), a history of smoking (AOR = 2.44, 95% CI = 1.82, 3.26), females, married, age 50-64 years, higher educational attainment, and retirees (AOR = 1.86, 95% CI = 1.06, 3.27) were more likely to be enrollees. Since enrollees are largely higher risk individuals with greater healthcare needs, policies that modify the ACA should take these factors into account to reduce potential adverse impacts on enrollees.

Health Insurance Affordability Concerns and Health Care Avoidance Among US Adults Approaching Retirement

“…In addition, because health insurance may be associated not only with health but also with capacity to work, 20,21 such health insurance concerns may be associated with whether adults aged 50 to 64 years feel flexibility to change jobs or retire, both directly and indirectly. 25 and that this proportion grew between 2013 and 2015. 1 In addition to concerns about affordability of health insurance, 14.1% of adults aged 50 to 64 years reported keeping a job specifically to have employer-sponsored health insurance, a phenomenon known as "job lock," whereas 11.4% reported delaying or considering delaying retirement to maintain employer-sponsored health insurance.…”

“…Likewise, adults aged 50 to 64 years may worry about transitions between employer-sponsored insurance plans, or from employer-sponsored insurance to Medicaid or Marketplace plans. In fact, prior studies of adults in their 50s and 60s have found that they are more likely to be enrolled in Marketplace plans compared with younger adults, 25 and that this proportion grew between 2013 and 2015. 1 In addition to concerns about affordability of health insurance, 14.1% of adults aged 50 to 64 years reported keeping a job specifically to have employer-sponsored health insurance, a phenomenon known as "job lock," whereas 11.4% reported delaying or considering delaying retirement to maintain employer-sponsored health insurance.…”

“…Likewise, adults aged 50 to 64 years may worry about transitions between employer-sponsored insurance plans, or from employer-sponsored insurance to Medicaid or Marketplace plans. In fact, prior studies of adults in their 50s and 60s have found that they are more likely to be enrolled in Marketplace plans compared with younger adults, and that this proportion grew between 2013 and 2015…”

Evaluation of Nursing Students' Perceptions of the Phenomenon of Smoking Behavior

“…Through a deeper understanding of nursing students' perceptions of smoking behavior, it is hoped that it can produce significant implications in efforts to prevent and treat smoking behavior in society [16], [17]. The implications of this research can include the development of health education programs that are more effective and relevant to actual needs in the field [18].…”