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Holes in the Safety Net: Trends in Uninsurance Rates for Individuals with Functional Impairment or Chronic Illness

Frakt AB, Pizer SD, Iezzoni L. Holes in the Safety Net: Trends in Uninsurance Rates for Individuals with Functional Impairment or Chronic Illness. Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 29; Chicago, IL.

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Research Objective The percentage of nonelderly adult U.S. residents without health insurance has increased steadily for more than two decades. Yet, the risk of being uninsured is not evenly distributed throughout the population. The objective of this study is to examine how the risk of being uninsured depends on health, disability, potential eligibility for Medicaid, and geographic region. Study Design This is a descriptive study of the working-age (ages 25-61) population using person-level data from the household and medical provider components of the Medical Expenditure Panel Survey (MEPS), pooled across years 2000-2005. To these data we merged a variable that reflects the generosity of the Medicaid program available in each respondent's region. Population Studied This study focuses on the civilian, non-institutionalized US population between the ages of 25 and 61. Principal Findings Among working-age adult U.S. residents, the risk of being uninsured increased from 2000 to 2005 and varied widely across subpopulations defined by income, health status, and geography. Over all regions and years, uninsurance rates were particularly high for low-income workers reporting potentially serious health conditions (32%) or disabilities (24%). Rates for low-income workers were highest in the South (42% for persons with health conditions; 39% for persons with disabilities) and West (27% health conditions; 21% disability). Conclusions Uninsurance rates approach alarming levels among low-income persons living in the South, even for individuals with disabilities or potentially serious health conditions. State-level differences in Medicaid eligibility rules may contribute to these high uninsurance rates. Implications for Policy, Delivery or Practice The uninsured individuals identified by this study face substantial health risks because of their lack of insurance. Persons without health insurance who have significant health conditions have shorter life spans than do insured individuals. Uninsured working-age adults with potentially serious conditions are much less likely to have seen a physician within the previous year than are insured persons, and they are also much more likely to report unmet medical needs during the past year. Providing health insurance can improve health, changing downward trajectories of functional declines.

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