Research

In a New York Times article published in the summer of 2023, author Reed Abelson discusses the issues many Americans face when seeking medical care. For many people, even with health insurance, paying for medical bills can be difficult for various reasons. This can lead to those people often delaying getting medical care due to the costs they face when pursuing medical treatment. In a survey that was conducted by the nonprofit KFF, around 40 percent of people reported that they delayed getting care or went without in the last year because of the cost. Also, people delay care due to the complexity of the system, so it is important to educate people on how it works to prevent people from avoiding medical care. Insurance can be very confusing for everyone, no matter what form of health coverage you have. This is harmful to many people's health and their finances because the longer they wait to see a doctor, the worse their condition gets, and this could cost them more money. The survey showed that people in fair or poor health were two times as likely to not be able to pay their medical bills in comparison to those who were healthier. Additionally, Black adults were more likely to indicate difficulties paying compared to White adults. Overall, due to the confusion and expense that healthcare and coverage pose, people often delay getting care, which causes more harm than good, especially for people in poorer health. This also holds true for young adults who believe health insurance is not worth the expense. Young adults in their 20s statistically have the greatest rates of being uninsured as there is a false belief they are healthy and will not need it; however, having health insurance actually prevents them from being faced with unexpected medical issues that will only worsen if they do not have insurance and delay visiting a physician.

Before the implementation of the ACA in 2010, nonelderly minority groups were more likely to be uninsured than their white counterparts. The Kaiser Family Foundation (KFF) examined the data and found that these rates directly correlated to the more limited access to affordable health coverage options. Although most families had at least one full-time worker, the ongoing disparities in employment and income made it more difficult for some individuals to get coverage from an employer or afford private insurance. Medicaid helped fill some gaps, resulting in a decrease in the percentage of uninsured people overall, but medical eligibility was often limited to those with very low incomes. Not everyone who needed the help got the help if they made too much money to qualify but not enough to pay for private insurance. Over the years, coverage has slowly expanded, helping to decrease the rate of uninsured people in America, and the percentage of uninsured individuals reached an all-time low as a result of the Covid 19 pandemic. Graphical representations within the source provide great visualizations of these trends. The disparities still remain for many minority groups, such as Hispanic and African Americans, who are uninsured at higher rates than their white counterparts. Coverage disparities have actually widened over time for these groups, making them less likely to have insurance than White people; however, states that have expanded their Medicaid have lower rates of people who are uninsured. States that have not expanded have larger differences in coverage rates between Hispanic and Black people, while those that have expanded have maintained the gap or even lessened it. The Expansion of Medicaid has been shown to reduce racial or ethnic gaps in health coverage as well as lessen disparities in health outcomes for Black and Hispanic individuals. Overall, having health insurance makes a key difference in people getting medical care and, ultimately, how healthy they are.

This paper, published in 2014 by Liying Jia and others, compares two studies done in the U.S. to examine how different strategies of health insurance expansion compare to each other in effectiveness. Specifically, in order to help uninsured children gain insurance, the two studies were compared to find an effective method for educating and helping families obtain health insurance. One study was conducted with the aim of helping Latin American children who were uninsured gain access to health insurance. Parents of these children were given information about health insurance, were helped to apply, and appeared when wrong decisions were made. The other study was conducted by handing insurance applications to families with children in the E.D. of a hospital. The results of both of these studies were compared to families that were not provided with additional support or information to identify effective ways to help expand health insurance coverage. The results of the studies demonstrated that families who were offered help through the first study were more likely to enroll their children in health insurance programs quickly and to continue insuring them. In the second study, families who simply handed applications at the E.D. were only slightly more likely to enroll their children in health insurance. Overall, health insurance can improve access to healthcare for those who are insured. It can also decrease the financial burdens of seeking out healthcare. While health insurance is helpful, people often find it confusing, so they do not enroll their children; however, those who were given support in the process of obtaining insurance were much more likely to give their children insurance. Groups that need the most support are those in low-income groups and are vulnerable to financial distress. Although there are some good systems in place for providing health insurance to children, such as CHIP, the systems are confusing for many. Researchers concluded that if people were educated and guided through the process, they would be more likely to help get their children insured.

This research paper written by James B Kirby and Toshiko Kaneda looks at life expectancy discrepancies as well as uninsured rates and percent of life uninsured. Researchers found a link between the discrepancies in having health insurance and life expectancy. Not only did data show that without health insurance, life expectancy decreased on average, but there was also a disparity among racial backgrounds in this data. Findings showed that there is a disparity between black and white life expectancy and uninsured rate. There are negative consequences to being uninsured for both issues related to health and financial well-being. Research has established that people without health insurance have poor access to medical care. Additionally, individuals without health insurance are much more likely not to obtain preventative care and routine care for chronic conditions. Even conditions that physicians see as serious and require medical attention are less likely to be taken care of for those who are uninsured. Individuals who do get their conditions treated are charged more by healthcare providers if they do not have insurance because insurers negotiate prices on the patient's behalf. This amplifies the financial disadvantage of being uninsured, and the article shows that because of this, over 29 million Americans are in financial debt due to medical bills.

When comparing non-Hispanic blacks to non-Hispanic Whites, they are twice as likely to be uninsured, and Hispanics are three times as likely to be uninsured. This may partially have to do with the disproportionate decline in employer-sponsored health insurance coverage these groups have seen. These racial and ethnic minorities are more likely to have to rely on public health programs for their insurance coverage. Additionally, the researchers found that they are more likely to have a higher risk of serious illness at any age compared to people in the White population, which, in turn, lowers life expectancy as well. A lot of this has to do with the result of socioeconomic factors and the fact that these minorities are more likely to have poor-paying jobs that frequently offer no health benefits. Considering all this, there is a link between higher morbidity rates in these populations associated with being uninsured. Experiencing an unexpected illness could cause major financial stress, and this cycle of being unable to afford insurance and care due to debt becomes a major problem, as this paper was written prior to the implementation. Regarding the ACA, it is important to note that the data analyzed here has changed a bit since this study. Demonstrating the changes in the ways people can obtain insurance now has improved these issues discussed and has aided in lessening the gap between those who can obtain insurance due to socioeconomic disadvantages.

In this article, Aiden Lee and others at the Office of Health policy with ASPE present data and discuss the downward trends of the nation's uninsured rate. Between 2021 and 2022, the uninsured rate declined significantly, reaching an all-time low for the U.S. at a rate of 8% for residents of all ages. About 5.2 million people have gotten health coverage since 2020 as a direct result of the implementation of the American Rescue Plan, which provided expansion, made enrollment in Medicaid easier, and was expanded in many states. While uninsured rates for children aged 0-17 had increased in 2019 and 2020, they finally fell from 6.4% to 3.7% in 2022. The changes in these uninsurance rates had the greatest decrease in Americans who fall below the poverty level. The data collected showed that states that expanded Medicaid recently had larger impacts on the uninsured rate for low-income adults than those states that did not expand. Overall, the significant gains in health insurance coverage from 2021-2022 have been very widespread. The government's policies to support health insurance expansion from 2020-2022 have helped majorly decrease the uninsured rates. These gains have built upon those that happened after the implementation of the ACA in 2014. Research has shown that since the ACA was introduced, health outcomes have improved, people have better access to care, and financial security has improved for families.

This article from the U.S. News and World Report discusses a case in Texas regarding issues of whether or not all Americans have access to free coverage for many basic preventative medical care services and medications. Author Paul Shafer talks about the impacts the court rulings could have on people if access to preventive services, at little to no cost, were revoked. Currently, the  ACA requires insurers to offer full coverage of preventive services. While the ACA does not work perfectly, clauses such as the requirement for all insurers to provide these preventative services have made a big difference in reducing the costs of services such as wellness visits, mammograms, and more. There are times when patients can be left frustrated by unexpected bills even with the ACA in place, but this does not mean improvements have not been made by helping lower the costs overall. The ACA helps Americans not only with public insurance benefits from this free preventative care but also with private health insurance benefits from at least one free service per year. An example of a preventative service Shafer utilizes is access to a preventative medication for HIV known as PrEP. He states, "Raising the cost barrier again for PrEP, for example, would disproportionately harm younger patients, people of color, and those with lower incomes''. With this policy in jeopardy, we would be taking a step backward in prevention and health equity in the U.S. Overall, this article discusses how the court's ruling on cases regarding access to low-cost or free health care could negatively impact people in many ways. While numerous improvements have been made over the years thanks to the ACA, putting the policies under scrutiny may cause much more harm than good. Preventative care helps so many people keep medical costs low by being monitored and treated regularly before their condition turns into something that could cost them thousands of dollars.

Heeju Sohn from UCLA researched and reported on the great variations in health insurance coverage between racial and ethnic groups in the United States. As a whole, people of Hispanic and African American origin had consistently lower insurance coverage rates. At all ages, this trend was persistent, with Hispanic populations having the greatest divides in coverage rates. In particular, uninsured rates among all populations skyrocketed after the age of 18, leaving many young adults without insurance from every demographic; however, the uninsured rate of the Hispanic population was much higher than all others, with the Non-Hispanic White population having the lowest rates of being uninsured. The data collected by Sohn demonstrated that socioeconomic characteristics and other factors often correlate with a loss of insurance after the age of 18. This is often because while children from disadvantaged backgrounds have access to some form of health care thanks to the ACA, that coverage goes away after they become adults. Losing coverage does not mean they can go under their parent's insurance because their parents also do not have coverage or good health benefits from their jobs. Similarly, these factors can make it take longer for people in these groups to gain insurance after they have lost it. A discussion of health insurance variations by age is a key point brought up in this research. Less than 10% of all children under 18 years old are uninsured, but once they reach 18-24, the rate goes up to 20% and peaks between the ages of 25-30. Once children age out of the state programs, they often do not get insurance again until later in life when they get stable jobs with good pay. Graphical representations of these findings are good for visualizing the gap between health insurance coverage among different populations and age groups. The disparity Hispanic and African American groups demonstrate when compared with non-Hispanic whites is very clear in Figure 1. Overall, once these groups reach age 65 and become eligible for Medicaid, the uninsured rates once again drop. This shows that public health insurance options offer greater coverage for all populations, especially those who struggle the most to obtain coverage. Social and economic factors impact the uninsured rates among minority groups, causing health insurance instability and issues with health care delivery. This higher insurance instability may directly relate to disparities in healthcare delivery and inequalities in health outcomes.

This short video provides a brief background of what health insurance is and how people can get it from different sources. It works to explain some complicated aspects of healthcare in a way that can make it more manageable for people new to the concept. The costs involved with health care are a main point discussed as this is a major factor in health insurance for many people. A comparison between the different distribution of cost between public and private health insurance companies is emphasized, making it clear how much individuals need to pay in different situations. For example, people with Medicaid or Medicare (public insurance) pay very little as the government is able to cover most of the costs since they can negotiate with healthcare providers on a large scale. On the other hand, private insurance requires individuals and/or their employers to pay for the services and often costs more than public insurance due to the company being smaller and having less influence. Overall, the Affordable Care Act has allowed people who do not have jobs or do not make very much money to have access to health insurance at a reduced price. Also, the video explains how having insurance is important because it provides security for those emergency situations when it is hard to be prepared for. Paying for insurance over time allows most people to manage the cost of their medical care easier than if they had to pay on their own. Health insurance also allows people to have low-cost or free health visits that ultimately decrease the need for emergency medical care quite as often as people's health is generally improved by annual visits. Comparisons between the health insurance systems in the U.S. and other countries are made to emphasize what makes the U.S. so complicated for many people seeking care. While public health insurers in other countries can negotiate costs on a larger scale with hospitals and doctors more efficiently, in the U.S., all private insurers have to make negotiations separately. Private insurance providers do not have as much pull with the smaller populations they cover, and that is why there are more expensive and varying costs with doctors who are out of network versus in-network. Public insurers can cover more since everyone is under the same plan, but private insurers cannot reach as far if everyone has different providers.