• James B Kirby, Leticia M Nogueira, Jingxuan Zhao, K Robin Yabroff, and Stacey A Fedewa.
• From the The Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, Maryland. Electronic address: james.kirby@ahrq.hhs.gov.
• Am J Prev Med. 2023 Mar 1; 64 (3): 405413405-413.

IntroductionAlthough the association between health insurance coverage and access to care is well documented, it is unclear whether the deleterious effects of being uninsured are strictly contemporaneous or whether previous disruptions in coverage have persistent effects. This study addresses this issue using nationally representative data covering 2011-2019 to estimate the extent to which disruptions in health insurance coverage continued to be associated with poor access even after coverage was regained.MethodsAnalysis was conducted in 2022. Using a nationally representative cohort of insured adults aged 18-64 years (N=39,904) and multivariable logistic regression models, the authors estimated the association between past disruptions in coverage (occurring at least 1 year before) and the risks of lacking a usual source of care provider and having unmet medical need.ResultsAmong insured nonelderly adults, the risk of being without a usual source of care provider was between 18% (risk ratio=1.18; 95% CI=1.00, 1.38) and 75% higher (risk ratio=1.75; 95% CI=1.56, 1.93) than for those with continuous coverage; the risk of having unmet medical needs was between 41% (risk ratio=1.41; 95% CI=1.00, 1.83) and 66% (risk ratio=1.66; 95% CI=1.26, 2.06) higher. Longer insurance disruptions were associated with a higher risk of lacking a usual source of care provider.ConclusionsPrevious disruptions in health insurance coverage continued to be negatively associated with access to care for more than a year after coverage was regained. Improving access to care in the U.S. may require investing in policies and programs that help to strengthen coverage continuity among individuals with insurance coverage rather than focusing exclusively on helping uninsured individuals to gain coverage.Published by Elsevier Inc.

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