Diversity & Equality in Health and Care Open Access

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Health Insurance Coverage Gaps in Non-Elderly United States Adults Before and After the Implementation of the Affordable Care Act

Danielle Kilchenstein*, Jim E. Banta, Jisoo Oh and Bin Grohar

National Health Interview Survey Data from Integrated Public Use Microdata Set (2010-2017) were used to examine associations between health insurance coverage gaps and poverty, non-white race, and unmarried status before and after the implementation of the Affordable Care Act (ACA) in 2014. The 140,341 survey respondents represented 138 million adults over eight years annually, with 15.7% reporting inconsistent health coverage from 2010-2013 and 9.9% from 2014-2017. Survey design adjusted multivariable logistic regression indicated modest changes post ACA. There were limited changes for people of color experiencing insurance gaps after 2014, although American Indians/Alaskan Natives were more likely to experience gaps post ACA. Pre and post ACA divorced adults were more likely to have insurance gaps, while adults below 200% FPL and those in the West/Northeast improved compared to the South. Generally, odds of experiencing coverage gaps were higher for marginalized populations and slightly declined after 2014, suggesting the need to prioritize expanded eligibility.

Published Date: 2022-02-03; Received Date: 2022-01-10