wow-inequalities/02-data/intermediate/wos_sample/905847cba4f507236cff3df1817d50aa-okoro-catherine-a./info.yaml

abstract: 'Problem/Condition: As a result of the 2010 Patient Protection and

  Affordable Care Act, millions of U.S. adults attained health insurance

  coverage. However, millions of adults remain uninsured or underinsured.

  Compared with adults without barriers to health care, adults who lack

  health insurance coverage, have coverage gaps, or skip or delay care

  because of limited personal finances might face increased risk for poor

  physical and mental health and premature mortality.

  Period Covered: 2014.

  Description of System: The Behavioral Risk Factor Surveillance System

  (BRFSS) is an ongoing, state-based, landline- and cellular-telephone

  survey of noninstitutionalized adults aged 18 years residing in the

  United States. Data are collected from states, the District of Columbia,

  and participating U.S. territories on health risk behaviors, chronic

  health conditions, health care access, and use of clinical preventive

  services (CPS). An optional Health Care Access module was included in

  the 2014 BRFSS.

  This report summarizes 2014 BRFSS data from all 50 states and the

  District of Columbia on health care access and use of selected CPS

  recommended by the U.S. Preventive Services Task Force or the Advisory

  Committee on Immunization Practices among working-aged adults (aged

  18-64 years), by state, state Medicaid expansion status, expanded

  geographic region, and federal poverty level (FPL). This report also

  provides analysis of primary type of health insurance coverage at the

  time of interview, continuity of health insurance coverage during the

  preceding 12 months, and other health care access measures (i.e., unmet

  health care need because of cost, unmet prescription need because of

  cost, medical debt {[}medical bills being paid off over time], number of

  health care visits during the preceding year, and satisfaction with

  received health care) from 43 states that included questions from the

  optional BRFSS Health Care Access module.

  Results: In 2014, health insurance coverage and other health care access

  measures varied substantially by state, state Medicaid expansion status,

  expanded geographic region (i.e., states categorized geographically into

  nine regions), and FPL category. The following proportions refer to the

  range of estimated prevalence for health insurance and other health care

  access measures by examined geographical unit (unless otherwise

  specified), as reported by respondents. Among adults with health

  insurance coverage, the range was 70.8\%-94.5\% for states,

  78.8\%-94.5\% for Medicaid expansion states, 70.8\%-89.1\% for

  nonexpansion states, 73.3\%-91.0\% for expanded geographic regions, and

  64.2\%-95.8\% for FPL categories. Among adults who had a usual source of

  health care, the range was 57.2\%-86.6\% for states, 57.2\%-86.6\% for

  Medicaid expansion states, 61.8\%-83.9\% for nonexpansion states,

  64.4\%-83.6\% for expanded geographic regions, and 61.0\%-81.6\% for FPL

  categories. Among adults who received a routine checkup, the range was

  52.1\%-75.5\% for states, 56.0\%-75.5\% for Medicaid expansion states,

  52.1\%-71.1\% for nonexpansion states, 56.8\%-70.2\% for expanded

  geographic regions, and 59.9\%-69.2\% for FPL categories. Among adults

  who had unmet health care need because of cost, the range was

  8.0\%-23.1\% for states, 8.0\%-21.9\% for Medicaid expansion states,

  11.9\%-23.1\% for nonexpansion states, 11.6\%-20.3\% for expanded

  geographic regions, and 5.3\%-32.9\% for FPL categories. Estimated

  prevalence of cancer screenings, influenza vaccination, and having ever

  been tested for human immunodeficiency virus also varied by state, state

  Medicaid expansion status, expanded geographic region, and FPL category.

  The prevalence of insurance coverage varied by approximately 25

  percentage points among racial/ethnic groups (range: 63.9\% among

  Hispanics to 88.4\% among non-Hispanic Asians) and by approximately 32

  percentage points by FPL category (range: 64.2\% among adults with

  household income <100\% of FPL to 95.8\% among adults with household

  income >400\% of FPL). The prevalence of unmet health care need because

  of cost varied by nearly 14 percentage points among racial/ethnic groups

  (range: 11.3\% among non-Hispanic Asians to 25.0\% among Hispanics), by

  approximately 17 percentage points among adults with and without

  disabilities (30.8\% versus 13.7\%), and by approximately 28 percentage

  points by FPL category (range: 5.3\% among adults with household income

  >400\% of FPL to 32.9\% among adults with household income <100\% of

  FPL).

  Among the 43 states that included questions from the optional module, a

  majority of adults reported private health insurance coverage (63.4\%),

  followed by public health plan coverage (19.4\%) and no primary source

  of insurance (17.1\%). Financial barriers to health care (unmet health

  care need because of cost, unmet prescribed medication need because of

  cost, and medical bills being paid off over time {[}medical debt]) were

  typically lower among adults in Medicaid expansion states than those in

  nonexpansion states regardless of source of insurance. Approximately

  75.6\% of adults reported being continuously insured during the

  preceding 12 months, 12.9\% reported a gap in coverage, and 11.5\%

  reported being uninsured during the preceding 12 months. The largest

  proportion of adults reported >= 3 visits to a health care professional

  during the preceding 12 months (47.3\%), followed by 1-2 visits

  (37.1\%), and no health care visits (15.6\%). Adults in expansion and

  nonexpansion states reported similar levels of satisfaction with

  received health care by primary source of health insurance coverage and

  by continuity of health insurance coverage during the preceding 12

  months.

  Interpretation: This report presents for the first time estimates of

  population-based health care access and use of CPS among adults aged

  18-64 years. The findings in this report indicate substantial variations

  in health insurance coverage; other health care access measures; and use

  of CPS by state, state Medicaid expansion status, expanded geographic

  region, and FPL category. In 2014, health insurance coverage, having a

  usual source of care, having a routine checkup, and not experiencing

  unmet health care need because of cost were higher among adults living

  below the poverty level (i.e., household income <100\% of FPL) in states

  that expanded Medicaid than in states that did not. Similarly, estimates

  of breast and cervical cancer screening and influenza vaccination were

  higher among adults living below the poverty level in states that

  expanded Medicaid than in states that did not. These disparities might

  be due to larger differences to begin with, decreased disparities in

  Medicaid expansion states versus nonexpansion states, or increased

  disparities in nonexpansion states.

  Public Health Action: BRFSS data from 2014 can be used as a baseline by

  which to assess and monitor changes that might occur after 2014

  resulting from programs and policies designed to increase access to

  health care, reduce health disparities, and improve the health of the

  adult population. Post-2014 changes in health care access, such as

  source of health insurance coverage, attainment and continuity of

  coverage, financial barriers, preventive care services, and health

  outcomes, can be monitored using these baseline estimates.'
affiliation: 'Okoro, CA (Corresponding Author), CDC, Natl Ctr Chron Dis Prevent \&
  Hlth Promot, Div Populat Hlth, Atlanta, GA 30333 USA.

  Okoro, Catherine A.; Zhao, Guixiang; Town, Machell, CDC, Natl Ctr Chron Dis Prevent
  \& Hlth Promot, Div Populat Hlth, Populat Hlth Surveillance Branch, Atlanta, GA
  30333 USA.

  Fox, Jared B., CDC, Policy Res Anal \& Dev Off, Atlanta, GA 30333 USA.

  Eke, Paul I.; Greenland, Kurt J., CDC, Natl Ctr Chron Dis Prevent \& Hlth Promot,
  Div Populat Hlth, Atlanta, GA 30333 USA.'
author: Okoro, Catherine A. and Zhao, Guixiang and Fox, Jared B. and Eke, Paul I.
  and Greenland, Kurt J. and Town, Machell
author-email: cokoro@cdc.gov
author_list:
- family: Okoro
  given: Catherine A.
- family: Zhao
  given: Guixiang
- family: Fox
  given: Jared B.
- family: Eke
  given: Paul I.
- family: Greenland
  given: Kurt J.
- family: Town
  given: Machell
da: '2023-09-28'
files: []
issn: 1545-8636
journal: MMWR SURVEILLANCE SUMMARIES
keywords-plus: 'DEPENDENT COVERAGE EXPANSION; CLINICAL PREVENTIVE SERVICES;

  YOUNG-ADULTS; INSURANCE-COVERAGE; OREGON EXPERIMENT; MENTAL-HEALTH; ACT;

  MORTALITY; MEDICAID; REFORM'
language: English
month: FEB 24
number: '7'
number-of-cited-references: '54'
pages: 1-41
papis_id: 798068307209f61ea6eb981573276908
ref: Okoro2017surveillancehealth
times-cited: '69'
title: Surveillance for Health Care Access and Health Services Use, Adults Aged 18-64
  Years-Behavioral Risk Factor Surveillance System, United States, 2014
type: article
unique-id: WOS:000397075300001
usage-count-last-180-days: '2'
usage-count-since-2013: '21'
volume: '66'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2017'