Access to Health Insurance, Health Disparities and Physical Well-Being

Access to Health Insurance, Health Disparities and Physical Well-Being

Health insurance is very much in the news right now.  Late on Monday, January 22, 2018, the United States Senate was able to pass a temporary budget that provided funding to the Children’s Health Insurance Program (CHIP), which provides health insurance to economically disadvantaged children.  During the first year of the presidency of Donald Trump, health insurance coverage under the Affordable Care Act (ACA; i.e., “Obamacare”) was a source of contentious debate in Congress.   The research project that I am undertaking as a fellow in the Center for Health and Nursing Research examines the relationship between health insurance and psychological well-being and stress in American Adults, a relatively understudied topic.  While we do know relatively little about the benefits of health insurance on mental health, empirical research has fairly conclusively demonstrated that health insurance is associated with a number of aspects of physical health and well-being (Baker, Sudano, Albert, Borawski, & Dor 2001; McWilliams, 2009).

Affordable health care is associated with better physical health.  In fact, current and historic data have demonstrated that adults who lack health insurance are at greater risk for death than adults with health insurance (Franks, Clancy & Gold, 1993; Wilper et al., 2009).  This increased risk may be due in part to the fact that individuals without health insurance are less likely to receive routine medical care and preventative care (Hsia et al., 2000; Hadley, 2007; Sudano, et al., 2003; Sudano & Baker, 2003).  Additionally, they are likely to have poorer control of chronic conditions such as Hypertension and Cardiovascular Disease (Havranek et al., 2015; Smolderen et al., 2010), and Diabetes and Kidney Disease (Jurkovitz et al., 2013; Zhang et al., 2008).  Uninsured adults as a population appear to be more likely to receive medical diagnoses when they are more severe and more expensive to treat (Ayanian, Kohler, Abe, & Epstein, 1993; Braveman, Schaaf, Egerter, Bennett, & Schecter, 1994). 

While we do know that individuals with access to affordable health care are physically healthier as a group, this highlights an important area of focus for healthcare administration research—Healthcare Disparities. As we move from January, the month in which we celebrate Martin Luther King Day, and move into African American History month in February, we, as healthcare researchers, need to be cognizant of existing healthcare disparities among socio-demographic minorities (e.g., racial minorities, sexual minorities) in the United States of America (Sudano & Baker, 2006; Williams, 2013).  Historical epidemiological research has found that Hispanic and African American are less likely to have health insurance coverage, and less likely to have regular access to physicians (Hargraves & Hadley, 2003).  There is some evidence that gaps in healthcare disparities have diminished since the implementation of the ACA (Cohen, Martinez, & Zammitti, 2016; Griffith, Evans & Bor, 2017; Okoro, Zhao, Dhingra & Xu, 2015).    It is also hard to tease apart the relationship between minority status, socioeconomic status, and education level as these variables are all highly correlated, and socioeconomic status has been strongly linked to increased mortality and poor health (Braveman, Cubbin, Egerter, Williams, & Pamuk, 2010; Chetty et al., 2016), and multiple forms of minority status may exponentially increase risk for poor health (Zonderman, Mode, Ejiogu, & Evans, 2016).

Thus, we have a complex picture of the relationship between access to healthcare, morbidity and mortality, and socio-demographic characteristics such as race, SES, education and sexual orientation (Adler, Glymour & Fielding, 2016).  As healthcare providers, clinicians, and administrators, and as a collective population, we need to consider paths to balance the disparities, and consider models that can lead to more Americans, regardless of sociodemographic characteristics, are able to receive preventative and primary healthcare..



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