To cover individuals or families? Families with multiple sources of insurance and access to care

President Barack Obama recently signed into law the most ambitious reform of the United State’s health insurance system since the creation of Medicaid and Medicare in the 1960s. As a result, approximately 30 million currently uninsured Americans are expected to have access to affordable insurance in the coming years, and are consequently expected to have better access to needed health care services.;Reform is unlikely to simplify the fragmented health insurance system. Most Americans receive insurance through their or a family member’s employer. Those who do not must seek insurance on the private market, where coverage is often only available to the young and healthy who can afford to pay. Some low-income families may qualify for public coverage, as do nearly all of the nation’s seniors. Often, different members of a family will receive coverage from different sources due to the fragmented nature of eligibility. For example, some low-income children may qualify for public health coverage but their parents do not.;While possessing insurance is an important predictor of access to health care services, the characteristics of insurance matter. Individuals with unstable access to insurance – either those who experience periods of uninsurance or frequently change insurance – have reduced access. So do those whose insurance is inadequate, either because it does not have a robust provider or does not protect from financial risk.;This analysis uses data from the nationally-representative 2007 Medical Expenditure Panel Survey in logistic regression models to compare individuals in families where all members are insured, but are insured through different sources of insurance, to individuals in families where all members are covered through the same source of insurance – as well as to individuals in families where some or all members are uninsured. Access to health care services is measured by whether an individual was able to access needed care in the previous 12 months, whether an individual has a usual source of care other than the hospital, and whether an individual visited a medical provider during the year.;The findings indicate that individuals in fully insured families with multiple sources of insurance do not have significantly different access to care than individuals in families with a single source of insurance. However, the findings do indicate that children in partially or fully uninsured families are less likely to have a usual source of care than children in fully insured families, including those with mixed sources of insurance. The findings suggest that expanding coverage through health reform, even without a focus on increasing family-based insurance, could improve basic access to health care. More research on family insurance status may be warranted to determine if there are more subtle effects of having multiple sources of coverage on the quality of access to care.