Health Insurance Coverage and Financial Exclusion After the Affordable Care Act

• In Event: Upstream determinants of health and healthcare decision making, featuring a reproductive health perspective

Abstract

Objectives. We test whether financial exclusion is a barrier to health insurance coverage after the Affordable Care Act (ACA). We define financial exclusion as whether a household lacks a bank account, a credit card, or relies on “fringe banks” such as pawn shops, payday lenders, and other non-bank financial service providers.

Methods. We link two supplements of the Current Population Survey over three different years (2015, 2017, 2019). We assess the relationship between health insurance coverage and financial exclusion using a multivariate regression analysis. We analyze trends by income, digital exclusion, and health status subgroups.

Results. Uninsured adults are more likely to live in a household without a bank account, more reliant on fringe banks, and less likely to have a credit card or emergency savings than insured adults. This relationship persists after accounting for income, digital inclusion, and health status, with implications for achieving universal health insurance coverage.

Conclusions. Financial exclusion is an important social determinant of health, and a likely barrier to achieving universal health insurance coverage through current policy.

Author

• Katie Fitzpatrick, University of Wisconsin-Madison
  Presenting Author