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From Health Law Daily, July 18, 2014

Uninsured neighbors could be bad for your health

By Bryant Storm, JD

A study, which asked whether community uninsurance rates have a measurable impact on health care for insured individuals within the community, found that a higher uninsurance rate does reduce the quality of health care outcomes for those with insurance. The University of California, Los Angeles, School of Medicine and RAND Corporation study evaluated the effect of community uninsurance on hypertension. The findings revealed that higher uninsurance rates reduced insured community members’ ability to access treatment and medication, and also reduced the probability of blood pressure control for those community members. According to the researchers, the findings, which were detailed in a results report by the Robert Wood Johnson Foundation (RWJF), have important policy implications in light of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) and dropping uninsurance rates.

The study. The research intended to improve on earlier studies by evaluating not just how community uninsurance rates affected things like satisfaction and access, but also how they affected treatment and health care outcomes. To understand how blood pressure awareness, treatment, and control were impacted for insured community members by the uninsurance rate of their community, the researchers looked to data from the National Health and Nutrition Examination Survey (NHANES).

Data. The NHANES data includes interview information, as well information from physical examinations and laboratory analyses of blood samples. The NHANES data is unique in that it allows researchers to identify individuals in certain community circumstances that have a condition like hypertension, but do not know that they do. The data allowed researchers to reliably evaluate whether subjects’ high blood pressure was well controlled. The study evaluated 7,213 non-pregnant adults who had: (1) hypertension; (2) private insurance or Medicare; and (3) lived in a metropolitan area where there was reliable uninsurance data.

Findings. The study led to several key findings:

  • A 10 percent increase in a community uninsurance rate decreased the probability that an insured community member would receive treatment by 4.2 percent

  • A 10 percent increase in a community uninsurance rate decreased the probability that an insured community member would receive anti-hypertensive medication by 5.5 percent

  • A 10 percent increase in the community uninsurance rate decreased the probability that an insured community member would have blood pressure control by 6.8 percent

Limitations. The researchers acknowledged that they were limited by their data set. The most significant limitations arose from the fact that their findings were based upon patient blood pressure readings from a single day and because the study sample only evaluated individuals who live in larger metropolitan areas.

Policy. The study was the first to find that community uninsurance has adverse consequences on the treatment and control of a major health problem. The researchers believe the novel findings have particular relevance in light of the new health care law. Because the ACA was designed to dramatically reduce populations without coverage, the findings suggest that in addition to providing coverage for individuals who were previously uninsured, the ACA could have positive effects on health care outcomes for individuals who already have insurance. According to RWJF, the researchers suggest it is now important to conceive about how the ACA impacts not just the uninsured, but the insured, as well.

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