Insurance-Based Discrimination Reports and Access to Care Among Nonelderly US Adults, 2011–2019

Objectives. To report insurance-based discrimination rates for nonelderly adults with private, public, or no insurance between 2011 and 2019, a period marked by passage and implementation of the Affordable Care Act (ACA) and threats to it. Methods. We used 2011–2019 data from the biennial Minnesota Health Access Survey. Each year, about 4000 adults aged 18 to 64 years report experiences with insurance-based discrimination. Using logistic regressions, we examined associations between insurance-based discrimination and (1) sociodemographic factors and (2) indicators of access. Results. Insurance-based discrimination was stable over time and consistently related to insurance type: approximately 4% for adults with private insurance compared with adults with public insurance (21%) and no insurance (27%). Insurance-based discrimination persistently interfered with confidence in getting needed care and forgoing care. Conclusions. Policy changes from 2011 to 2019 affected access to health insurance, but high rates of insurance-based discrimination among adults with public insurance or no insurance were impervious to such changes. Public Health Implications. Stable rates of insurance-based discrimination during a time of increased access to health insurance via the ACA suggest deeper structural roots of health care inequities. We recommend several policy and system solutions. (Am J Public Health. Published online ahead of print December 8, 2022:e1–e11. https://doi.org/10.2105/AJPH.2022.307126 )