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Title: Trends in New York City Health Insurance Coverage, 2010-2018
Citation Type: Conference Paper
Publication Year: 2020
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Abstract: Background Following the implementation of the Patient Protection and Affordable Care Act (ACA), the New York City (NYC) uninsured rate reduced from 14.1% (13.6%-14.5%) in 2010 to 10.6% (10.2%-11%) in 2014. While expansion provisions significantly improved overall coverage, disparities remain. Studies have demonstrated that people without coverage are less likely than people who are insured to receive preventive care and services for chronic diseases. We examined citywide trends in uninsurance rates from 2010 to 2018 and the persisting disparities in coverage among subgroups of New Yorkers in 2018. Methods We analyzed data from the Public Microdata Sample (PUMS) of the 2010-2018 1-year American Community Survey to calculate prevalence of uninsurance in NYC and identify sociodemographic characteristics of uninsured residents. Age-adjusted prevalence estimates for each year were calculated from PUMS data and weighted to the 2000 U.S. Standard Population. Citywide estimates were produced and stratified by education, race/ethnicity, nativity, poverty level, age groups and neighborhood. Annual estimates were compared using t-tests. Results Between 2010 and 2018, the overall prevalence of uninsured decreased from 14.1% to 6.7%. In 2018, large disparities in uninsured rates were present across various demographic characteristics. The 2018 uninsured rate of the adult Hispanic population was 10.8% compared to 3.6% (p<.001) of the adult White non-Hispanic population; 20.5% among adults 24 years old and over without a high school degree compared to 4.2% (p<.001) of adults with a college degree or more; 11.3% among adults born outside of the US compared to 3.7% (p<.001) among adults born in the US; 10% in adults with an income 200% at or below the federal poverty level (FPL) compared to 5.4% (p<.001) of adults with an income greater than 200% of the FPL. Geographically, the Elmhurst and Jackson Heights neighborhoods in Queens had an uninsured rate in 2018 of 16.6% (13.5%-20.3%) and 16.2% (13.4%-19.5%), respectively, compared with the citywide average of 6.7% (6.4%-7.1%). Conclusions Despite reductions in the overall rate following the implementation of the ACA, high levels of uninsurance remain among the following NYC adult subgroups: Hispanic, foreign-born, those with less than a high school education, and those with an income at or below 200% of the FPL. At the neighborhood level, uninsurance rates in Elmhurst and Jackson Heights are comparable to the city’s average prior to the implementation of the ACA. The current uninsured population in NYC likely consists of those eligible for public health insurance and those ineligible due to their immigration status. It is critical that in addition to efforts to maximize health insurance enrollment rates, there are efforts to increase access to primary and preventive care, including for the uninsured. In NYC, the NYC Care program facilitates access to quality primary care for uninsured populations.
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Authors: DeLaRosa, J.; Baig, S.; Humphrey, J. L.
Conference Name: 7th Annual New York City Epidemiology Forum
Publisher Location: New York, NY
Data Collections: IPUMS USA
Topics: Health, Population Health and Health Systems
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