The Institutional Determinants of Health Insurance: Moving Away from Labor Market, Marriage, and Family Attachments under the ACA.
The Institutional Determinants of Health Insurance: Moving Away from Labor Market, Marriage, and Family Attachments under the ACA.
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DOI：
10.1177/0003122418811112
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发表时间：
2018-12-01
影响因子：
9.1
通讯作者：
Gutierrez, Carmen M.
中科院分区：
文献类型：
--
作者：
Gutierrez, Carmen M.
世纪以来，美国的福利国家要求工作年龄的成年人通过与雇主、配偶或子女的联系获得社会福利。然而，最近由《患者保护和平价医疗法案》（ACA）推动的美国医疗保健政策的变化为成年人提供了新的途径，使他们能够获得一种与雇主、配偶和子女脱钩的关键形式的社会福利--健康保险。利用国家社会福利制度的这一根本性转变，我使用全国药物使用和健康调查（NSDUH）的数据来探索ACA在2014年活跃之前和之后的健康保险覆盖模式。结果表明，在ACA通过后的前三年，劳动力市场，婚姻和家庭依恋作为覆盖途径的重要性显着下降。通过为成年人提供一条与他们的机构附属关系脱钩的新的覆盖途径，ACA帮助缩小了性别、种族和民族以及教育方面的医疗保险不平等。鉴于健康保险和健康结果之间的密切联系，本研究的结果提出了重要的问题，我们的健康不平等知识的中心机构附件。
For more than a century, the American welfare state required working-age adults to obtain social welfare benefits through their linkages to employers, spouses, or children. Recent changes to U.S. healthcare policy prompted by the Patient Protection and Affordable Care Act (ACA), however, provide adults with new pathways for accessing a key form of social welfare—health insurance—decoupled from employers, spouses, and children. Taking advantage of this fundamental shift in the country’s system of social welfare provision, I use data from the National Survey on Drug Use and Health (NSDUH) to explore patterns of health insurance coverage from before and after the ACA became active in 2014. The results show that the salience of labor market, marriage, and family attachments as pathways to coverage significantly declined in the first three years following passage of the ACA. By providing adults with a new route to coverage decoupled from their institutional attachments, the ACA helped narrow health insurance inequalities across gender, race and ethnicity, and education. Given the strong association between health insurance and health outcomes, the results from this study raise important questions about the centrality of institutional attachments for our knowledge of health inequalities.
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