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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)213-223
Number of pages11
JournalAmerican journal of public health
Issue number2
StatePublished - Feb 2023

Bibliographical note

Funding Information:
This research was supported by the Minnesota Department of Health, Minnesota Department of Human Services, and SHADAC through a grant from the Robert Wood Johnson Foundation. We appreciate the contributions of Neha Potla-palli and Sydney Bernard, who conducted literature searches to support this research. We are grateful for the magic of SHADAC staff members Andrea Stewart for copyediting and Lindsey Theis for graphics. We thank Kelly McAnnany for her review of an earlier version of the article and many helpful insights. Finally, we are thankful to the talented staff at SSRS for administering the survey and the thousands of Minnesotans over the years who took the time to complete the survey and share their experiences with insurance coverage and access.

Publisher Copyright:
© 2023 American Public Health Association Inc.. All rights reserved.


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