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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.
Figueroa, Jose F; Khorrami, Peggah; Bhanja, Aditi; Orav, E John; Epstein, Arnold M; Sommers, Benjamin D.
  • Figueroa JF; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Khorrami P; Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts.
  • Bhanja A; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Orav EJ; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Epstein AM; Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts.
  • Sommers BD; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Health Forum ; 2(8): e212007, 2021 08.
Article in English | MEDLINE | ID: covidwho-1453490
ABSTRACT
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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Protection and Affordable Care Act / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: JAMA Health Forum Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Protection and Affordable Care Act / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: JAMA Health Forum Year: 2021 Document Type: Article