Insurance coverage and preventive care among adults
The Affordable Care Act (ACA) is intended to provide health insurance to all US citizens, but many people will likely continue to have gaps in their insurance coverage after reform. For this study, we used longitudinal survey data from Panel 11 (2006–2007) of the Medical Expenditure Panel Survey to examine the effect of gaps in insurance coverage on adults’ receipt of preventive screening. We categorized individuals (n = 8,985) between the ages of 18 and 64 at baseline as continuously insured (private only or any public), intermittently insured, or continuously uninsured. Outcome measures were routine checkup, blood pressure check, cholesterol check, flu shot, sigmoidoscopy or colonoscopy, mammogram, Pap smear, and an overall composite measure. Logistic regression models controlled for age, sex, race, limited English proficiency, education, urbanicity, census region, income, perceived health, and employment status. Crude rates of receiving preventive services were generally highest for those with public insurance and lowest for the continuously uninsured. In adjusted analyses, having intermittent coverage increased the odds of receiving no preventive services to 1.64 compared with continuous private insurance. Continuously lacking insurance increased the odds of receiving no preventive services to 4.41 compared with continuous private coverage. The effect of intermittent coverage was larger than the effect of race/ethnicity, education, where individuals lived, perceived health status, or employment status. Lack of continuous health insurance is a critical barrier to receiving appropriate health care services. Implementation of the ACA will be less successful if gaps in coverage are not prevented.