9.1 million adults with health insurance in 2018 reported disruptions in coverage

Recent data show that about 9.1 million adults who had health insurance in 2018 reported disruptions in coverage the previous year.

Adults who had disruptions in private or public insurance coverage received fewer preventive health services and more often reported forgoing needed care and medications due to cost vs. those with continuous coverage, according to researchers.

“Decades of research have demonstrated that in the United States, having health insurance coverage is strongly associated with better access to a usual source of health care, receipt of recommended preventive services, treatment of acute and chronic conditions, and survival,” K. Robin Yabroff, PhD, MBA, the scientific vice president of health services research at the American Cancer Society, told Healio Primary Care. “However, less research has addressed the associations between coverage disruptions (ie, periods without insurance) with care access and affordability.”

Yabroff and colleagues used the 2011 to 2018 National Health Interview Survey to assess whether coverage disruptions or being uninsured affected care access, receipt and affordability among adults aged younger than 65 years. Among the study population, 124,746 had private health insurance, 30,932 had public health insurance and 31,802 were uninsured.

In 2018, 5% of adults with private insurance and 10.7% of adults with public insurance reported a coverage disruption in the previous year, representing an estimated 6.8 million and 2.3 million adults, respectively. Insurance coverage disruptions were associated with receiving fewer preventive services for both private (adjusted OR = 0.42; 95% CI, 0.37-0.46) and public (aOR = 0.48; 95% CI, 0.4-0.58) insurance vs. those with continuous coverage. Costs during periods of coverage disruption were also associated with forgoing needed care for patients with private (aOR = 4.79; 95% CI, 4.44-5.17) and public (aOR = 4.28; 95% CI, 3.86-4.75) insurance and medication nonadherence (private: aOR = 3.55; 95% CI, 3.13-4.03; public: aOR = 4.09; 95% CI, 3.43-4.88) vs. those with continuous coverage.

According to the researchers, longer periods of disruption “were significantly associated with worse care access, receipt and affordability, with doseresponse patterns.”

Although the study period assessed health insurance coverage disruptions in 2018, the researchers noted that the findings have implications for the COVID-19 pandemic. Rising unemployment rates during the early months of the pandemic were later reduced, in part due to “recovery,” but some of this recovery occurred in “sectors less likely to offer insurance coverage to their employees, such as retail and hospitality.” They added that the lasting health effects of infection among the 14.5 million U.S. citizens who had a COVID-19 diagnosis by December 2020 “may adversely affect the ability to work.”

“The COVID-19 pandemic led to widespread unemployment and potential loss of employer-based health insurance coverage, the most common type of coverage for adults aged 18 to 64 years in the United States,” Yabroff said.

The next steps in the research are “to evaluate the impact of the COVID-19 pandemic on health insurance coverage, disruptions in coverage and access to care, as these data become available” and to “evaluate the relationships between the COVID-19 pandemic and health insurance coverage disruptions and stage of cancer diagnosis, receipt of cancer care and related health outcomes,” Yabroff said.