Working age adults with chronic conditions and disabilities: Risk factors for and effects of being uninsured

Statement of the problem. Individuals with chronic conditions and/or disabilities share an elevated need for health services that may put them at particular risk when uninsured. Yet, existing scholarship is hampered by a lack of consistent health and disability criteria and the dynamic nature of health insurance coverage. Substantial gaps exist in current knowledge of sociodemographics, insurance coverage, and utilization of health services as they differ on the basis of health and disability status among those aged 18-65.; Methods. Analysis of the 1997 Medical Expenditure Panel Survey is performed using a new algorithm of health and disability. Drawing upon theoretical and methodological works by Verbrugge & Jette (1994), Hwang, Weller, Ireys & Anderson (2001) and others, five population groups are created based upon medical and disability measures. Nationally representative estimates are computed by group. Multinomial logistic regression and loglinear techniques are used to model risk factors for periods uninsured and service utilization rates, respectively.; Findings. Individuals who are essentially healthy and without disability are among those most likely to be uninsured, whether part year (12.6% +/- 1.5%) or all year long (27.2% +/- 2.2%). However, a substantial percentage of those with the most severe disabilities report at least some period uninsured during the year (part year: 12.1% +/- 2.7%; all year: 11.9% +/- 2.1%). Significant differences are found in service use, SES, coverage sources, and periods uninsured within and between these five study groups.; Policy implications. Due to differences in each of these domains, these five groups face not only distinct differences in risk factors for being uninsured, but in health risks that are assumed when coverage is interrupted or absent. In light of these findings, consideration is given to the merits of the most prominent contemporary policy proposals aimed at closing the gaps in insurance coverage among working aged adults in the United States.