COVID-19-Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States.
COVID-19-Related Insurance Coverage Changes and Disparities in Access to Care Among Low-Income US Adults in 4 Southern States.
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DOI：
10.1001/jamahealthforum.2021.2007
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Sommers BD
中科院分区：
文献类型：
--
作者：
Figueroa JF;Khorrami P;Bhanja A;Orav EJ;Epstein AM;Sommers BD
2019冠状病毒病大流行及其相关的经济衰退如何影响低收入家庭的保险覆盖范围、获得医疗保健的差异和医疗负担能力，这种模式是否因医疗补助扩张状态而异？在这项针对美国成年人的调查研究中，在COVID-19大流行期间，南部4个州（阿肯色州、肯塔基州、路易斯安那州和得克萨斯州）的低收入成年人的无保险率有所上升，但在医疗补助计划扩大的州，黑人和拉丁裔个人的无保险率增幅较为温和。在所有州，由于大流行病而导致的非财务障碍是普遍的。这些发现表明，COVID-19大流行影响了保险覆盖范围和低收入人群获得医疗保健的能力，但似乎医疗补助扩张的存在对黑人和拉丁裔人起到了保护作用。目前尚不清楚COVID-19大流行及其相关的经济衰退如何影响保险覆盖范围以及低收入家庭和有色人种在已经和尚未扩大医疗补助的州中获得医疗保健的差异。确定南部4个州低收入家庭和有色人种的保险覆盖范围变化和获得医疗保健的差异以及医疗补助扩展状态。这项随机数字拨号电话调查研究于2020年10月至12月在4个州（阿肯色州、肯塔基州、路易斯安那州和得克萨斯州）对19至64岁家庭收入低于联邦贫困线138%的美国公民进行。使用差异中差异设计，我们估计了2020年（n = 1804）与2018年至2019年（n = 5710）相比，总体医疗补助扩展状态以及种族和民族的结果变化。我们还探讨了种族和民族对医疗保健和远程医疗使用的障碍。数据分析于二零二一年一月至二零二一年三月进行。2019冠状病毒病大流行和之前的医疗补助扩展状态。主要结果是未保险率和次要结果是财政和非财政障碍，以获得医疗保健。在7514名受访者中（11%应答率; 3889例白色非拉丁裔[51.8%]，1881例非拉丁裔黑人[25.0%]，1156例拉丁裔个体[15.4%]; 4161例女性[55.4%]），5815例（77.4%）来自既往扩展的州，1699例（22.6%）来自德克萨斯州（非扩展州）。与德克萨斯州的受访者相比，扩张州的受访者年龄更大，更有可能是白色，上过大学的可能性更小。德州2020年未参保率上升7.4个百分点（95%CI，2.2-12.6; P = 0.01）和2.5个百分点（95%CI，-1.9至7.0; P = 0.27），医疗补助扩展的差异估计为-4.9%（95%CI，-11.3至1.6; P = 0.14）。在黑人和拉丁裔个体中，医疗补助的扩大与保护未保险率的上升有关（差异中的差异，-9.5%; 95%CI，-19.0至-0.1; P = 0.048）。2020年，所有4个州的获得措施，包括拥有私人医生和定期护理慢性病，都显着恶化，医疗补助扩展状态没有显着差异。在这项对美国成年人的调查中，在COVID-19大流行期间，南部4个州的低收入成年人的无保险率有所增加，但医疗补助计划的扩大表明，黑人和拉丁裔人之间的这种关联有所减少。在所有州，由于大流行病而导致的非财务障碍是普遍的。这项调查研究考察了在COVID-19大流行之前和期间，南部4个州的低收入家庭和有色人种的保险覆盖范围和获得医疗保健的差异以及医疗补助扩展状态的变化。
How did the COVID-19 pandemic and its associated economic recession affect insurance coverage, disparities in access to health care, and affordability of care among low-income families, and did this pattern vary by Medicaid expansion status? In this survey study of US adults, uninsured rates rose among low-income adults in 4 Southern states (Arkansas, Kentucky, Louisiana, and Texas) during the COVID-19 pandemic, but in states with Medicaid expansion, uninsured rate increases were more moderate among Black and Latinx individuals. Nonfinancial barriers to care because of the pandemic were common in all states. These findings suggest that the COVID-19 pandemic affected insurance coverage and the ability of low-income people to access health care, but it appears that the presence of Medicaid expansion was protective for Black and Latinx individuals. 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. 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. 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. COVID-19 pandemic and prior Medicaid expansion status. Primary outcome was the uninsured rate and secondary outcomes were financial and nonfinancial barriers to health care access. 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. 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. This survey study examines 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 before and during the COVID-19 pandemic.
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影响因子：
3.4
作者：
Karaca-Mandic, Pinar;Norton, Edward C.;Dowd, Bryan
通讯作者：
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DOI：
10.1001/jamahealthforum.2020.1278
发表时间：
2020-10-01
期刊：
JAMA health forum
影响因子：
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作者：
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通讯作者：
Sommers, Benjamin D
影响因子：
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