The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act – How does lack of insurance affect access to care? – 7451-14 | KFF

How does lack of insurance affect access to care?

Health insurance makes a difference in whether and when people get needed medical care, where they get it, and ultimately how healthy they are. uninsured people are much more likely than those with insurance to postpone medical care or forego care altogether. The consequences can be serious, especially when preventable conditions or chronic diseases go undetected.

Compared to people who have health coverage, people without health insurance are more likely to skip preventive services and report that they do not have a regular source of health care. adults without insurance have times more likely than insured adults to say they have not visited a doctor or other office or clinic about their own health in the past 12 months.1 They are also less likely to receive recommended screening tests, such as checkups of blood pressure. , cholesterol checks, blood sugar tests, pap smears or mammograms (among women), and colon cancer screening.2 Part of the reason for poor access among the uninsured is that half don’t have a regular place to go. go when they are sick or need medical advice, while most insured people do have a regular source of care (figure 8).3

People without insurance are more likely than those with insurance to report problems getting the health care they need. One in five (20%) uninsured adults say they didn’t get the care needed in the past year due to cost compared to 3% of adults with private coverage and 8% of adults with public coverage.4 many uninsured people do not receive the treatments recommended by their health care providers. in 2017, 19% of uninsured adults said they delayed or didn’t get a prescription they needed because of cost, compared to 14% with public coverage and 6% with private coverage.5 with a chronic condition receive plans For similar follow-up care from their doctors, people without health coverage are less likely than those with coverage to get all recommended services.6,7

Because the uninsured are less likely than those with insurance to receive regular outpatient care, they are more likely to experience negative health consequences. because uninsured patients are also less likely to receive necessary follow-up exams than their insured counterparts,8 they are at higher risk of being diagnosed at later stages of disease, including cancer, and have higher mortality rates higher than those with insurance.9,10,11 furthermore, when uninsured people are hospitalized, they receive fewer diagnostic and therapeutic services and also have higher mortality rates than those with insurance.12,13,14,15

Children without insurance also face problems getting needed care. Uninsured children are more likely to lack a regular source of care, delay care, or have unmet medical needs than children with insurance (Figure 9).16 In addition, uninsured children with illnesses and injuries Ordinary children do not receive the same level of care as others and are at higher risk of preventable hospitalizations and misdiagnosis of serious health conditions.17,18 Among children with special health care needs, those without health insurance have poorer access to care than those with insurance.19

Lack of health coverage, even for short periods of time, results in decreased access to care. Research has shown that adults who experience breaks in their health insurance coverage are less likely to have a regular source of care or be up-to-date with blood pressure or cholesterol checks than those with continuous coverage.20 research also indicates that children who are uninsured for part of the year have more access problems than those with coverage for the entire year.21,22 Similarly, adults who are uninsured for the entire year have less access to care than those who have coverage for at least part of the year. year, suggesting that even a short period of coverage can improve access to care.23

research shows that getting health insurance greatly improves access to health care and decreases the adverse effects of not having insurance. a pivotal study of a medicaid expansion in oregon found that Uninsured adults who got Medicaid coverage were more likely to have an outpatient visit or receive a prescription and less likely to have depression or short-term stress than their uninsured counterparts.24 Findings two years after the expansion showed improvements significant differences in access, utilization, and reported health among adults who gained coverage.25 In addition, a large body of research on the impact of Medicaid expansion under the ACA demonstrates that gains in Medicaid coverage positively impact access. to care and utilization of health care services.26 Research also shows that people who obtained Those who remained uninsured in 2014 were much more likely than those who remained uninsured to obtain a regular source of care and receive preventive care services.27

Public hospitals, community clinics and health centers provide a critical health care safety net for the uninsured; however, the safety net does not close the access gap for the uninsured. Safety net providers, including public and community hospitals, community health centers, rural health centers, and local health departments, provide care to many people without health coverage. In addition, almost all other hospitals and some private doctors provide charity care. however, safety net providers have limited resources and service capacity, and not all uninsured people have geographic access to a safety net provider.28,29 the aca has led to significant growth in the number of health centers and their ability to serve through new grant funding and revenue from new patients due to expanded coverage.30 However, this impact has been more limited in states that did not expand Medicaid, where a proportion Far more health center patients remain uninsured than in states that did.31 In addition, health centers in every state report that securing needed specialty care for their uninsured patients is a major challenge.32