Health Insurance Coverage Rates Research Articles

Sexual Orientation Differences in Complementary Health Approaches Among Young Adults in the United States

PurposeLesbian, gay, and bisexual (LGB) young adults experience a wide range of health disparities, compared to heterosexuals. However, LGBs also experience many barriers to conventional health care, including social stigma, lack of LGB-specific knowledge among providers, and lower rates of health insurance coverage, which may limit utilization of conventional health services. Complementary health approaches (CHA) may represent an alternative to conventional care, but very little is currently known about CHA use in this population. We examined whether and how LGB young adults differed from heterosexual young adults in use of CHA. MethodsData were from Wave III of the National Longitudinal Study of Adolescent to Adult Health (2001–2002). Fifteen types of CHA were considered. Descriptive and bivariate statistics were computed using design-based F tests, and logistic regression was used. Analyses were weighted and gender stratified. ResultsAlmost 46% of gay/bisexual men used CHA in the past 12 months versus 26% of heterosexual men (p ≤ .001) and 50% of lesbian/bisexual women versus 30% of heterosexual women (p ≤ .001). LGBs also differed significantly on demographics, access to conventional care, and health behaviors. Multivariate results showed higher odds of CHA among LGBs relative to heterosexuals (adjusted odds ratio = 2.37 for men; adjusted odds ratio = 1.98 for women; both p ≤ .001). ConclusionsThis is the first study to systematically demonstrate sexual orientation differences in CHA in a nationally representative sample of young adults. Public health wellness initiatives for sexual minorities should include evidence-based CHA in addition to conventional health services.

The New Destination Disadvantage: Disparities in Hispanic Health Insurance Coverage Rates in Metropolitan and Nonmetropolitan New and Established Destinations.

Hispanics have the lowest health insurance rates of any racial/ethnic group, but rates vary significantly across the U.S. The unprecedented growth of the Hispanic population since 1990 in rural areas with previously small or non-existent Hispanic populations raises questions about disparities in access to health insurance coverage. Identifying spatial disparities in Hispanic health insurance rates can illuminate the specific contexts within which Hispanics are least likely to have health care access and inform policy approaches for increasing coverage in different spatial contexts. Using county-level data from the 2009/2013 American Community Survey, I find that early new destinations (i.e., those that experienced rapid Hispanic population growth during the 1990s) have the lowest Hispanic adult health insurance coverage rates, with little variation by metropolitan status. Conversely, among the most recent new destinations that experienced significant Hispanic population growth during the 2000s, metropolitan counties have Hispanic health insurance rates that are similar to established destinations, but rural counties have Hispanic health insurance rates that are significantly lower than those in established destinations. Findings demonstrate that the new destination disadvantage is driven entirely by higher concentrations of immigrant non-citizen Hispanics in these counties, but labor market conditions were salient drivers of the spatially uneven distribution of foreign-born non-citizen Hispanics to new destinations, particularly in rural areas.

Disparities in health insurance coverage among children and young adults in Georgia and the U.S.

Background: In this brief report, I compare rates of health insurance coverage for children and young adults in Georgia and the United States.

Health Literacy and Access to Care

Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forgo needed care or to report difficulty finding a provider, even after we controlled for other factors, including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after we controlled for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way.

Healthcare Mentoring for Uninsured Children

Almost 6 million U.S. children are uninsured, even though most are eligible for coverage through Medicaid or the Children's Health Insurance Program (CHIP). Minority children are at special risk for lacking insurance, but the best way to get and keep them enrolled has not been determined. To test whether the use of parent mentors would improve the rate of health insurance coverage for minority children, …

Race-based socioeconomic and treatment disparities in adolescent and young adults with stage II-III rectal cancer.

714 Background: Stage II-III rectal cancer (CA) requires a multidisciplinary approach to optimize outcomes. This study explores whether treatment disparities account for racial differences in outcomes of AYA (ages 15-39) patients. Methods: AYAs with clinical stage II-III rectal CA were identified in the National Cancer Database. Demographic, clinical, and pathologic features predictive of receipt of adjuvant and surgical therapies were examined as well as factors associated with overall survival (OS). Results: Most of the 3,295 patients were white (72.0%), male (57.5%) and free of comorbidities (93.8%). Income, education levels, and rates of health insurance coverage were higher for whites than for blacks or Hispanics. Clinical stage was balanced by race, but more blacks and Hispanics did not receive radiation (24.5% and 27.1%, respectively, vs 16.5% for whites), surgery (22.4% and 15.3%, vs 12.3%), or chemotherapy (21.5% and 24.1%, vs 16.7%; p < 0.05). Additionally, the average number of days before treatment was 34.0 for blacks and 33.3 for Hispanics, versus 27.5 for whites (p < 0.05). Multivariate analysis showed that receipt of neoadjuvant chemoradiation was less likely when patients were black (OR 0.7, 95%CI 0.5-0.9, p = 0.014), Hispanic (OR 0.6, 95%CI 0.4-0.9, p = 0.012), female (OR 0.8, 95% CI 0.63-0.94, p = 0.011), without insurance (OR 0.5, 95%CI 0.36-0.69, p < 0.001), or treated at a community cancer center (OR 0.5, 95%CI 0.36- 0.74, p < 0.05). Race significantly influenced treatment, regardless of disease stage. Although 5-year OS was lower (p < 0.05) in blacks (59.8±3.3%) and Hispanics (65.9±3.5%) compared to whites (74.9±1.1%), race did not impact mortality on Cox regression. Instead, mortality was associated with male sex (HR 1.5, 95%CI 1.1-2.0, p = 0.009), nodal positivity (HR 2.6, 95%CI 1.9-3.6, p < 0.001), nonsurgical therapy (HR 7.1, 95%CI 2.8-18.2, p < 0.001), no chemotherapy (HR 1.9, 95%CI 1.03-3.6, p = 0.04), poorly differentiated histology (HR 3.0, 95%CI 1.3-6.5, p = 0.007), and no insurance (HR 1.7, 95%CI 1.1-2.7, p = 0.022). Conclusions: Race-based socioeconomic and treatment disparities may contribute to survival differences among AYAs with rectal cancer.

Insurance Coverage for Rehabilitation Therapies and Association with Social Participation Outcomes among Low-Income Children.

(1) To profile children's health insurance coverage rates for specific rehabilitation therapies; (2) to determine whether coverage for rehabilitation therapies is associated with social participation outcomes after adjusting for child and household characteristics; (3) to assess whether rehabilitation insurance differentially affects social participation of children with and without disabilities. We conducted a cross-sectional analysis of secondary survey data on 756 children (ages 3-17) from 370 households living in low-income neighborhoods in a Midwestern U.S. city. Multivariate mixed effects logistic regression models were estimated. Significantly higher proportions of children with disabilities had coverage for physical therapy, occupational therapy, and speech and language pathology, yet gaps in coverage were noted. Multivariate analysis indicated that rehabilitation insurance coverage was significantly associated with social participation (OR = 1.67, 95% CI: 1.013-2.75). This trend was sustained in subgroup analysis. Findings support the need for comprehensive coverage of all essential services under children's health insurance programs.

Differences in the public medical insurance systems for inflammatory bowel disease treatment in Asian countries.

Background/AimsThe cost of caring for patients with inflammatory bowel disease (IBD) is high. Without government support, the cost burden will unavoidably rest on the patients and their family. However, the government providing full support will place a large financial burden on the health-care systems of a country. The aim of this study is to understand the current status of public medical insurance systems in caring for IBD patients among Asian countries.MethodsQuestionnaires inquiring about the availability of public health systems; medical, diagnostic, and endoscopy costs; and coverage rate of biologics use were designed and sent to IBD experts in each of the Asian countries studied. The results were summarized according to the feedback from the responders.ResultsThe public health insurance coverage rate is high in Taiwan, Japan, South Korea, China, Hong Kong, and Singapore; but low in Malaysia and India. This probably affected the use of expensive medications mostly, such as biologics, as we found that the percentage of Crohn's disease (CD) treated with biologics were as high as 30%–40% in Japan, where the government covers all expenses for IBD patients. In India, the percentage maybe as low as 1% for CD patients, most of whom need to pay for the biologics themselves.ConclusionsThere were differences in the public health insurance systems among the Asian countries studied. This reportprovidesthe background information to understand the differences in the treatment of IBD patients among Asian countries.

Results of the first survey for the current status of inflammatory bowel disease management in Asian countries.

Results of the first survey for the current status of inflammatory bowel disease management in Asian countries.

Abstract P1-17-01: Anticipating ACA's impact on breast cancer screening for medically underserved women reached through the Avon Breast Health Outreach Program: Understanding the Massachusetts experience

Abstract Background The Avon Breast Health Outreach Program (BHOP) supports community-based organizations to conduct education and outreach to link low-income and uninsured women to routine breast cancer screening and care. Through the Affordable Care Act (ACA), the number of uninsured individuals is expected to decrease as of 2014. While ACA implementation varies by state, BHOP grantees may benefit from understanding the health reform experience in Massachusetts (MA) in 2006 and its impact on the number and proportion of uninsured clients served over time. Objective Describe changes in client volume, health insurance status, and demographics following implementation of health reform in MA to anticipate upcoming impact of ACA on BHOP grantees. Methods Confidential client intake records of continuously funded BHOP grantees from 2004-2012 were analyzed; dataset included females aged 40-64, recruited for breast cancer screening. We compared records for 11,199 clients served by 4 ‘MA’ BHOP programs with 283,720 clients served by 52 ‘control’ agencies funded in the US during the same time period. We examined trends across years in agency-specific rates of health insurance coverage, and client volume adjusting for annual funding. Changes in key demographic characteristics over time were also analyzed. Results The proportion of uninsured MA clients decreased dramatically from 46.6% to 6.2% from 2004-2012, with the biggest decrease occurring in the 3 years following health reform (42.1% to 13.0% from 2006-2009); as compared to only a slight drop among controls from 2004-2012 (69.3% to 67.4%). After adjusting for changes in annual BHOP funding, MA experienced a 74% increase in client volume from 2006-2009, compared with a 15% increase among controls. From 2004-2012, the mean age of clients (53 years) remained stable and similar for MA and controls. The proportion of racial/ethnic minorities served increased considerably in MA, from 62.0% to 77.7%, versus a smaller increase of 60.1% to 63.0% in controls. Likewise, the proportion of clients born outside the US rose from 37.2% to 50.7% in MA, compared with 33.7% to 36.6% among controls. However, the proportion of low-income clients (annual household income <$25,000) decreased overall from 90.4% to 83.1% in MA, and from 83.1% to 79.1% for controls. Conclusion In BHOP, Massachusetts observed a marked decrease (most noticeably in the 3 years following health reform) in the proportion of uninsured clients served, while overall client volume and the proportion of racial/ethnic minorities and foreign-born women increased. Discussion Historically, many BHOP grantees have relied on funding from the CDC’s National Breast and Cervical Cancer Early Detection Program or charity funds to pay for screening services for uninsured clients. As more clients nationally gain access to health insurance, BHOP grantees need to be prepared for the changing landscape and potential increase in client volume, as experienced by MA. Additionally, grantees should plan to update systems that aid in health insurance eligibility determination, assist with enrollment, and strengthen provider partnerships and referral systems that accept multiple types of insurance. Citation Format: Lindsay Senter, Marvin R Aliaga, Yixin Hu, Kelly Morrison Opdyke, Kathryn Gates-Ferris, Marc Hurlbert. Anticipating ACA's impact on breast cancer screening for medically underserved women reached through the Avon Breast Health Outreach Program: Understanding the Massachusetts experience [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-17-01.

Abstract P1-17-03: Impact of a culturally syntonic door-to-door breast cancer early detection intervention

Abstract Introduction. Disparities in the detection of breast cancer persist despite efforts to reach underserved populations and increase mammography utilization. Black and Hispanic women are more likely to be diagnosed at a later stage compared to White women. Lack of health insurance and limited awareness of breast cancer are significant predictors of screening behaviors; other reasons remain poorly understood and warrant further research. Our study presents highlights of the Women’s Breast Health Initiative Florida Affiliate (WBHI) intervention and key findings related to its impact. Methods. The intervention targeted single-family home neighborhoods with high incidence of late-stage breast cancer, median income at 200% of the poverty level, and access to affordable health clinics. Neighborhood mobile mammography or transportation to local facilities was provided, followed by navigation to assure proper follow up. Eligible women were uninsured, ≥40 years of age and were qualified for an annual screening mammogram. During 2011-2012Intervention Days45Educational Materials21,079Volunteers*2,025Women Interviewed5,441Eligible Women643Appointments Scheduled581Screening Days15Screening Mammograms Completed409*culturally relevant & trained Descriptive and inferential statistical methods were used to analyze participant data divided into 3 groups based on neighborhood racial demographics: "Black" or "Hispanic" data groups had ≥75% Black or Hispanic residents respectively, while the "Other" did not have a predominant race. Post-visit phone surveys of 1,871 participants were conducted within 30 days. Results. The intervention significantly increased screening rates amongst eligible women from 22% to 64%, had a 0.24% breast cancer diagnosis rate and motivated 59% of the women to propagate awareness. Health insurance coverage rates did not differ significantly between the 3 groups. Notably, amongst the insured, those from "Hispanic" neighborhoods had the highest recent mammogram rate while, amongst the uninsured, those from "Black" neighborhoods had the highest. Neighborhood culture and prior mammogram history impacted the efficacy of the intervention. Among the "Hispanic" and "Other" groups, women with no prior mammograms were less receptive to receiving one compared to those who had prior mammograms. This phenomenon was not observed in the "Black" group. Women’s responses and perceived benefit to the educational package differed according to the neighborhood race and ethnicity: "Black""Hispanic""Other"Benefited70%85%88%Spread the Word54%57%65% Discussion. WBHI reached the goal of increasing screening rates in this underserved population, thus showing that this type of intervention can be effective. Educational packages presented in a face-to-face format within a door-to-door context were found useful by most women. Our findings highlight disparities beyond a woman’s access to breast healthcare and education by showing that neighborhood culture impacts response to outreach intervention and breast healthcare. This generates the hypothesis that given equal access to care, disparities in using screening mammography will remain. Educational methods further tailored to racial and ethnic characteristics may play a significant role in closing disparity gaps. Citation Format: Carmen J Calfa, Julie G Wilkinson, Mindy M Williams, James M Pann, Angela Yehl, Stephanie E Hoogenbergen, Andrea D Ivory. Impact of a culturally syntonic door-to-door breast cancer early detection intervention [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-17-03.

Should patients with hypertension be screened for psychological distress?

disparities exist across racial and age groups. We hypothesized that rate of wellness assessment indexed by fasting blood sugar and blood lipid levels varied across race and age among individuals with hypertension, regardless of the status of their insurance coverage. Methods: To test our hypotheses, we used the 2010-2013 NHIS dataset. Hypertension was self-reported. Results: Of the sample, 52% were female; mean age ( SEM) was 59.5 0.05 years and mean BMI was 29.5 0.02 kg/m2. Analysis also showed 74% were white; 20%, black; and 4%, Asian. Ten percent reported no insurance coverage. Chi square analysis showed that there were 9% non-insured whites, 13% non-insured blacks, and 9% non-insured Asians (p< 0.01). The rate of non-coverage was 30% for very young adults (18-25 years), 23% for young adults (26-34 years), 15% formiddle age adults (35-64 years), and 1% for older adults ( 65 years) (p < 0.01). Among 18-25 years, assessment rates of fasting blood sugar level were 22.1% versus 35.5%, p<0.01; among 25-34 years, they were 25.1% versus 49.7%, p<0.01; among 35-64 years, they were 45.8% versus 68.0%, p<0.01; among those 65 years, they were 58.6% versus 71.2%, p<0.01. Similarly, lower rates of fasting blood lipid were noted for non-insured hypertensives across the age groups. Among 18-25 years, 32.5% versus 50.1%, p<0.01; among 25-34 years, they were 35.2% versus 66.2%, p<0.01; among 35-64 years, they were 58.1% versus 86.1%, p<0.01; among those 65 years, they were 73.1% versus 92.2%, p<0.01. Race-based wellness care contrasts between noninsured and insured hypertensives revealed that the rates of annual fasting blood sugar assessment rates were lower among the non-insured. Among Asians rates were (44.1% versus 68.3%, p<0.01); blacks (42.6% versus 66.4%, p<0.01); whites (40.6% versus 72.5%, p<0.01). The non-insured also had fewer assessment rates for fasting lipid. Among Asians rates were (57.2% versus 88.3%, p<0.01); blacks (61.7% versus 88.0%, p<0.01); whites (57.2% versus 87.3%%, p<0.01). Conclusion: Consistent with our hypotheses, individuals with hypertension had varying rates of wellness assessment for blood sugar and blood lipid levels. Results also suggested that the rates of health insurance coverage differed by individuals’ age group and race. Support: NIH (R01MD007716), NINDS (U54NS081765), and the NHLBI (K24HL111315).

Trends in cancer screening by citizenship and health insurance, 2000-2010.

While early detection through screenings for breast, cervical, and colorectal cancer is essential in improving cancer survival, it is not evenly utilized across class, race, ethnicity, or nativity. Given that utilization of early detection through screenings is not evenly distributed, immigrants who have much lower rates of health insurance coverage are at a disadvantage. We use National Health Interview Survey data linked with the Medical Expenditures Panel Survey to examine the trend in screening rates for breast, cervical, and colorectal cancer from 2000 to 2010, comparing U.S.-born natives, foreign-born citizens, and foreign-born non-citizens. We find that citizenship is clearly advantageous for the foreign-born, and that screening rates are higher among citizens compared to non-citizens overall, but uninsured non-citizens sometimes have higher screening rates that uninsured natives. Health insurance is pivotal for higher screening rates with clear differences among the insured and uninsured. Policies aimed at reducing disparities in cancer screening need to take into account nativity, citizenship, and access to health insurance.

Public insurance is increasingly crucial to American families even as employer-sponsored health insurance coverage ends its steady decline.

Americans under age 65 rely on a healthy labor market for almost all facets of economic security. While 2012 marked the first year in more than a decade that the employer-sponsored health insurance (ESI) coverage rate for the under-65 population did not decline, employer-sponsored health insurance continues to fail American families. If the coverage rate had not fallen 10.8 percentage points as it did from 2000 to 2012, as many as 29 million more people under age 65 would have had ESI in 2012. Even with the end of its longstanding decline, ESI coverage rates among men and women, white and non-white, high and low income, white and blue collar, young and old remain far lower than they were in 2000. Over this period, the increase in uninsured Americans was not as steep as the fall in ESI because of increases in public coverage, including Medicaid, the Children's Health Insurance Program, and Medicare. These programs were particularly effective in reducing the share of children uninsured over the 2000s. Additionally, key components in the Patient Protection and Affordable Care Act shielded young adults from further coverage losses.

Will health care reform reduce disparities in insurance coverage?: Evidence from the dependent coverage mandate.

We used data from the Medical Expenditure Panel Survey to assess the impact of the Affordable Care Act's dependent coverage mandate on disparities in health insurance coverage rates and evaluated whether non-Hispanic blacks and Hispanics gained coverage at the same rates as non-Hispanic whites. To estimate changes in insurance rates, we employed a difference-in-difference regression approach comparing 7962 young adults aged 19-25 to 9321 adults aged 27-34. Separate regressions were estimated for non-Hispanic blacks, Hispanics, and non-Hispanic whites to understand whether the mandate had differential effects by race/ethnicity. Separate regressions by income level and race/ethnicity were also estimated. Insurance rates increased by 9.3 percentage points among non-Hispanic whites, 7.2 percentage points among Hispanics, and 9.4 percentage points among non-Hispanic blacks. These changes were not significantly different from each other. Among individuals with income of <133% of the Federal Poverty Level, non-Hispanic whites experienced significantly larger gains, whereas at higher-income levels, non-Hispanic blacks experienced significantly larger gains than other racial/ethnic groups. The dependent coverage mandate of the Affordable Care Act increased insurance rates among all racial and ethnic groups but did not change overall disparities. Disparities may have widened among low-income populations which highlights the importance of Medicaid expansions in reducing disparities. Among higher-income populations, disparities between non-Hispanic blacks and non-Hispanic whites were reduced.

State fiscal considerations and research opportunities emerging from the Affordable Care Act's Medicaid expansion.

As enacted, the Affordable Care Act (ACA) directed states to provide Medicaid coverage to most nonelderly adults with incomes up to 138% of the Federal Poverty Level (the “Medicaid expansion group”) beginning in 2014. The Medicaid expansion provision of the ACA is an integral component of fulfilling the ACA’s primary objective to achieve near-universal health insurance coverage rates across the United States.Title XIX of the Social Security Act (Title XIX) is Medicaid’s enabling statute. Medicaid is a medical assistance program for certain low-income individuals, jointly funded and administered by federal and state governments. Certain features of the Medicaid program provide a framework within which the ACA and subsequent Supreme Court decision National Federation of Independent Business (NFIB) v. Sebelius can be understood.

Health Insurance Coverage and Racial Disparities in Breast Reconstruction After Mastectomy

BackgroundBreast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities. MethodsWe used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics. FindingsMinority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p < .001). Uninsured women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p < .001) than privately insured women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity. ConclusionsInsurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings—which reveal persistent health care disparities not explained by patient health status—should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer.

Winners and Losers in Health Insurance: Access and Type of Coverage for Women in Same-Sex and Opposite-Sex Partnerships

Using data from the American Community Survey, 2009 (N = 580,754), we compared rates of health insurance coverage and types of coverage used between women in same-sex and opposite-sex partnerships. This large, national dataset also allowed us to investigate regional variation in insurance coverage for women in same-sex partnerships by comparing “gay-tolerant” states versus other states. Multivariate analyses revealed that women in same-sex partnerships consistently had lower rates of health insurance coverage than married women in opposite-sex partnerships, but always more than unmarried women in opposite-sex partnerships. We also found that state-level variation in gay tolerance did not contribute to the access or type of coverage used by women in same-sex partnerships.

Women and Health Reform: How National Health Care Can Enhance Coverage, Affordability, and Access for Women (Examples From Massachusetts)

BackgroundMassachusetts women have the highest rates of health insurance coverage in the nation and women's access to care has improved across all demographic groups. However, important challenges persist. As national health reform implementation moves forward under the Affordable Care Act (ACA), states will likely encounter many of the same women's health challenges experienced in Massachusetts over the past 7 years. MethodsA review of the literature and data analyses comparing health care services access, utilization, and cost, and health outcomes from Massachusetts pre- and post-2006 health care reform identified two key challenges in women's continuity of coverage and affordability. ConclusionThese areas are crucial for state and national policymakers to consider in improving women's health as they work to implement health care reform at the state and federal levels.

The Determinants of Rising Inequality in Health Insurance and Wages

Over the last 30 years in the U.S., less educated workers have experienced a sharp decline in health insurance coverage rate and stagnant wage growth. In contrast, more educated workers' health insurance coverage rate has stayed relatively stable and their wages have rapidly grown. This paper investigates the determinants of the increase in inequality in health insurance coverage and wages by estimating an overlapping generations equilibrium model of labor and health insurance markets' demand and supply. The estimated model is used to quantify the effects of changes in aggregate factors (including rising cost of medical care services, Medicaid eligibility expansion, skill-biased technological changes in the labor market, and changes in the labor force composition) on the inequality of health insurance coverage and wages. I find that the interaction between the rising cost of medical services and labor market technological change is the most important determinant of the widening gap of health insurance coverage.