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COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States

IMPORTANCE: It is unclear how the COVID-19 pandemic and its associated economic downturn have affected insurance coverage and disparities in access to health care among low-income families and people of color in states that have and have not expanded Medicaid. OBJECTIVE: To determine changes in insu...

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Autores principales: Figueroa, Jose F., Khorrami, Peggah, Bhanja, Aditi, Orav, E. John, Epstein, Arnold M., Sommers, Benjamin D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796874/
https://www.ncbi.nlm.nih.gov/pubmed/35977190
http://dx.doi.org/10.1001/jamahealthforum.2021.2007
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author Figueroa, Jose F.
Khorrami, Peggah
Bhanja, Aditi
Orav, E. John
Epstein, Arnold M.
Sommers, Benjamin D.
author_facet Figueroa, Jose F.
Khorrami, Peggah
Bhanja, Aditi
Orav, E. John
Epstein, Arnold M.
Sommers, Benjamin D.
author_sort Figueroa, Jose F.
collection PubMed
description IMPORTANCE: It is unclear how the COVID-19 pandemic and its associated economic downturn have affected insurance coverage and disparities in access to health care among low-income families and people of color in states that have and have not expanded Medicaid. OBJECTIVE: To determine changes in insurance coverage and disparities in access to health care among low-income families and people of color across 4 Southern states and by Medicaid expansion status. DESIGN, SETTING, AND PARTICIPANTS: This random-digit dialing telephone survey study of US citizens ages 19 to 64 years with a family income less than 138% of the federal poverty line in in 4 states (Arkansas, Kentucky, Louisiana, and Texas) was conducted from October to December 2020. Using a difference-in-differences design, we estimated changes in outcomes by Medicaid expansion status overall and by race and ethnicity in 2020 (n = 1804) compared with 2018 to 2019 (n = 5710). We also explored barriers to health care and use of telehealth by race and ethnicity. Data analysis was conducted from January 2021 to March 2021. EXPOSURES: COVID-19 pandemic and prior Medicaid expansion status. MAIN OUTCOMES AND MEASURES: Primary outcome was the uninsured rate and secondary outcomes were financial and nonfinancial barriers to health care access. RESULTS: Of 7514 respondents (11% response rate; 3889 White non-Latinx [51.8%], 1881 Black non-Latinx [25.0%], and 1156 Latinx individuals [15.4%]; 4161 women [55.4%]), 5815 (77.4%) were in the states with previous expansion and 1699 (22.6%) were in Texas (nonexpansion state). Respondents in the expansion states were older, more likely White, and less likely to have attended college compared with respondents in Texas. Uninsurance rate in 2020 rose by 7.4 percentage points in Texas (95% CI, 2.2-12.6; P = .01) and 2.5 percentage points in expansion states (95% CI, −1.9 to 7.0; P = .27), with a difference-in-differences estimate for Medicaid expansion of −4.9% (95% CI, −11.3 to 1.6; P = .14). Among Black and Latinx individuals, Medicaid expansion was associated with protection against a rise in the uninsured rate (difference-in-differences, −9.5%; 95% CI, −19.0 to −0.1; P = .048). Measures of access, including having a personal physician and regular care for chronic conditions, worsened significantly in 2020 in all 4 states, with no significant difference by Medicaid expansion status. CONCLUSIONS AND RELEVANCE: In this survey of US adults, uninsured rates increased among low-income adults in 4 Southern states during the COVID-19 pandemic, but Medicaid expansion states, that association was diminished among Black and Latinx individuals. Nonfinancial barriers to care because of the pandemic were common in all states.
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spelling pubmed-87968742022-02-07 COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States Figueroa, Jose F. Khorrami, Peggah Bhanja, Aditi Orav, E. John Epstein, Arnold M. Sommers, Benjamin D. JAMA Health Forum Original Investigation IMPORTANCE: It is unclear how the COVID-19 pandemic and its associated economic downturn have affected insurance coverage and disparities in access to health care among low-income families and people of color in states that have and have not expanded Medicaid. OBJECTIVE: To determine changes in insurance coverage and disparities in access to health care among low-income families and people of color across 4 Southern states and by Medicaid expansion status. DESIGN, SETTING, AND PARTICIPANTS: This random-digit dialing telephone survey study of US citizens ages 19 to 64 years with a family income less than 138% of the federal poverty line in in 4 states (Arkansas, Kentucky, Louisiana, and Texas) was conducted from October to December 2020. Using a difference-in-differences design, we estimated changes in outcomes by Medicaid expansion status overall and by race and ethnicity in 2020 (n = 1804) compared with 2018 to 2019 (n = 5710). We also explored barriers to health care and use of telehealth by race and ethnicity. Data analysis was conducted from January 2021 to March 2021. EXPOSURES: COVID-19 pandemic and prior Medicaid expansion status. MAIN OUTCOMES AND MEASURES: Primary outcome was the uninsured rate and secondary outcomes were financial and nonfinancial barriers to health care access. RESULTS: Of 7514 respondents (11% response rate; 3889 White non-Latinx [51.8%], 1881 Black non-Latinx [25.0%], and 1156 Latinx individuals [15.4%]; 4161 women [55.4%]), 5815 (77.4%) were in the states with previous expansion and 1699 (22.6%) were in Texas (nonexpansion state). Respondents in the expansion states were older, more likely White, and less likely to have attended college compared with respondents in Texas. Uninsurance rate in 2020 rose by 7.4 percentage points in Texas (95% CI, 2.2-12.6; P = .01) and 2.5 percentage points in expansion states (95% CI, −1.9 to 7.0; P = .27), with a difference-in-differences estimate for Medicaid expansion of −4.9% (95% CI, −11.3 to 1.6; P = .14). Among Black and Latinx individuals, Medicaid expansion was associated with protection against a rise in the uninsured rate (difference-in-differences, −9.5%; 95% CI, −19.0 to −0.1; P = .048). Measures of access, including having a personal physician and regular care for chronic conditions, worsened significantly in 2020 in all 4 states, with no significant difference by Medicaid expansion status. CONCLUSIONS AND RELEVANCE: In this survey of US adults, uninsured rates increased among low-income adults in 4 Southern states during the COVID-19 pandemic, but Medicaid expansion states, that association was diminished among Black and Latinx individuals. Nonfinancial barriers to care because of the pandemic were common in all states. American Medical Association 2021-08-13 /pmc/articles/PMC8796874/ /pubmed/35977190 http://dx.doi.org/10.1001/jamahealthforum.2021.2007 Text en Copyright 2021 Figueroa JF et al. JAMA Health Forum. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Figueroa, Jose F.
Khorrami, Peggah
Bhanja, Aditi
Orav, E. John
Epstein, Arnold M.
Sommers, Benjamin D.
COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States
title COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States
title_full COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States
title_fullStr COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States
title_full_unstemmed COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States
title_short COVID-19–Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States
title_sort covid-19–related insurance coverage changes and disparities in access to care among low-income us adults in 4 southern states
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796874/
https://www.ncbi.nlm.nih.gov/pubmed/35977190
http://dx.doi.org/10.1001/jamahealthforum.2021.2007
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