Consistent health insurance coverage critical to preventive health care

Research finds the Affordable Care Act will be more successful if gaps in insurance coverage are prevented


RESEARCH TRIANGLE PARK, N.C. — As would be expected, consistent health insurance coverage is critical to receiving appropriate preventive health care.  A new report by researchers at RTI International found that the Affordable Care Act will have a greater impact if gaps in insurance coverage are prevented.  

The report, Insurance Coverage and Preventive Care among Adults, published by RTI Press, examined the effect of inconsistent insurance coverage on health care and health outcomes of individuals who lacked continuous coverage. 

“Lack of health insurance has been linked with a wide range of serious health-related consequences,” said Lisa M. Lines, Ph.D., health services researcher at RTI International and lead author of the report. “Patients with intermittent coverage are often excluded from studies about the effect of being uninsured. Our research found that gaps in insurance coverage of any length can cause barriers to receiving preventive care.”

The study assessed how individuals with and without continuous insurance coverage—whether public or private—differ in receiving preventive care by examining a nationally representative sample of nearly 9,000 adults in the United States who are most likely to be affected by the Affordable Care Act and Medicaid expansions. Researchers used survey data from the Medical Expenditure Panel Survey, which includes information about the cost and use of health care and health insurance coverage. 

The study found that gaps in insurance coverage increased the risk of not receiving preventive health care services, such as flu shots and mammograms, more than factors of race, ethnicity, education, perceived health status, employment status or residence. However, the effect of inconsistent coverage was less than the effects of continuous lack of insurance, age, gender, English proficiency or income. 

Inconsistent insurance coverage is a modifiable risk factor that can be changed more easily than many other factors to improve health outcomes, according to the study. 

The Affordable Care Act is designed to provide affordable health insurance to all U.S. citizens; however, the researchers predict that many individuals will continue to experience inconsistent insurance coverage because of paperwork requirements, changing eligibility and inability to pay. New regulations also allow gaps in coverage without a tax penalty for up to three months. 

In Massachusetts, evidence suggest that insurance coverage is difficult to maintain because of communication problems and recertification requirements associated with Massachusetts’s health insurance exchange, known as Commonwealth Care, a legislation similar to the Affordable Care Act. 

“The Affordable Care Act may partially, but not completely, solve the problems associated with access to care for previously uninsured individuals,” Lines said. “Although access to new benefits, such as no-cost preventive services, has the potential to yield enormous gains in addressing disparities and reducing chronic illness, just enrolling people will not be enough because maintaining coverage is also important.”

Continuous health insurance coverage is associated with fewer emergency department visits, greater use of physician services and preventative care, higher self-reported health status, and lower mortality rates from injury and disease.