Past Disruptions in Health Insurance Coverage and Access to Care Among Insured Adults

Introduction: Although 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 con-temporaneous 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.Methods: Analysis 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 esti-mated 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.Results: Among insured nonelderly adults, the risk of being without a usual source of care pro-vider 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.Conclusions: Previous disruptions in health insurance coverage continued to be negatively associ-ated 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 continu-ity among individuals with insurance coverage rather than focusing exclusively on helping unin-sured individuals to gain coverage.