Health Coverage and Access to Care

Since its inception, SHADAC has been dedicated to conducting research and providing technical assistance in order to examine characteristics of and trends in health insurance coverage and access to care and associations with overall physical, social, and mental health status. Our work on these topics includes technical briefs describing the complexity of measuring health insurance coverage and understanding the strengths and weaknesses of various data sources, e.g., federal and state-specific surveys, towards the goal of improving estimates of health insurance coverage, which is critical to the evaluation of federal and state health reform efforts. We also have conducted research studies of access to care during the coronavirus pandemic, insurance churning in Medicaid, and insurance-based discrimination. We have helped states field their own health insurance surveys or used federal data to help states target their coverage-related efforts as well as produced 50-state analyses of geographic disparities in coverage and key measures of health care access with data from State Health Compare.

Related SHADAC work
Click on any title below to learn more about the project.

Disparities in Access to Care During the Pandemic in California

This data brief examines whether and how access to care shifted during the pandemic for people with Medi-Cal, compared to those with employer coverage. Researchers compared data from the 2017–18 and 2020–21 California Health Interview Survey (CHIS). Data show that the pandemic did not widen differences in access to care for people with Medi-Cal coverage compared to those with employer coverage.  among adults, there was some narrowing of differences on select measures. However, this is not a positive development, as it appears to have been caused by worsening access to care for adults with employer-sponsored insurance coverage during the pandemic rather than improvements for adults with Medi-Cal.

Minnesota’s Community and Uninsured Profile

The Community and Uninsured Profile provides rates and counts of Minnesotans at a range of geographic levels using data from the American Community Survey (ACS). This resource was originally developed as part of “Minnesota’s Uninsured and the Communities in Which They Live,” a project funded by the Blue Cross Blue Shield Foundation of Minnesota that supports targeted outreach and enrollment activities of health insurance navigators and provides information about the uninsured to Minnesota policymakers as they develop strategies to reach the remaining uninsured in Minnesota. Users can explore characteristics of the total population and the uninsured population in a specific ZIP code while also overlaying in-depth community characteristics. In addition, users can look at rates and characteristics of the community and uninsured within the state as a whole, by region, county, and state legislative district. Users can also filter by MNsure rating areas -- the geographic regions health insurers use to set premiums on MNsure. You can also case studies highlighting how the profile can support the enrollment efforts of local organizations and departments in our blog on the topic here.

Telehealth Use and Experiences Among California Adults

This California Health Care Foundation (CHCF) issue brief authored by SHADAC's Senior Research Fellow Lacey Hartman uses data from the 2021 California Health Interview Survey (CHIS) to explore how telehealth use varies across subpopulations of adults in the state and reports how people rate their telehealth experience compared to in-person care. The brief concludes with a discussion of potential policy implications of the findings, and areas for future data collection and research.

Examining Gender-Based Discrimination in Health Care Access by Gender Identity in Minnesota

The biennial 2021 Minnesota Health Access Survey (MNHA) asked respondents how often their gender, sexual orientation, gender identity, or gender expression causes health care providers to treat them unfairly. We compared rates of gender-based discrimination and health care access in the Minnesota adult population and examined differences in access to care among cisgender (cis) and gender minorities who report gender-based discrimination. We explored the impact of gender-based discrimination on health care access by comparing access rates among people who did and did not experience discrimination for cis men, cis women, transgender and non-binary populations in Minnesota. Click on the title above to learn more, and read more on Sexual Orientation and Gender Identity (SOGI) discrimination in our blog here where we further examine 2021 MNHA data.

Minnesota Health Access (MNHA) Survey

The Minnesota Health Access (MNHA) Survey, conducted collaboratively between SHADAC and the Minnesota Department of Health (MDH), is a large-scale telephone and mail survey that collects information on the health of Minnesotans and how they access health insurance and health care services. The survey is conducted every two years and results are presented in a follow-up report from MDH.

Past Work

Reduced Access to Health Care due to Coronavirus Pandemic - SHADAC COVID-19 Survey

SHADAC conducted a two-part survey initially designed to measure the impacts of the novel coronavirus on a variety of experiences for adults in the United States. The survey was conducted as part of the AmeriSpeak omnibus survey conducted by NORC at the University of Chicago using a mix of phone and online modes among a nationally representative sample of 1,007 respondents age 18 and older. The first iteration of the survey was fielded in late April 2020, and questions focused on health insurance coverage, access to and cost of care during the pandemic, as well as COVID-related stressors and coping mechanisms. A second version of the survey was again fielded in April of 2021, with questions aimed at understanding respondents’ experiences with illness and death due to COVID-19 for themselves, their families, and their contacts. A collective list of products we have produced using results from the SHADAC COVID-19 Survey can be found here.

Impacts of the Affordable Care Act Medicaid Expansion in California

With funding from the California Health Care Foundation, SHADAC conducted an analysis of the impact of the Medicaid expansion on healthcare coverage, access, health status, affordability, and disparities in these outcomes by race/ethnicity for low-income Californians. Researchers on this project used nationally representative survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS) 2011-2019 data years and a difference-in-differences approach that compared California with non-expansion states.

MACPAC Analysis of Insurance Churning

SHADAC conducted a quantitative analysis for MACPAC that explored the magnitude and type of churn among the Medicaid population. Specifically, the study used the Survey of Income and Program Participation Panel (SIPP) to examine the characteristics of those who churned with those who had continuous Medicaid coverage throughout the year and explored possible causes of churn. The study produced descriptive statistics to address many of the research questions and regression analysis to explore life events that potentially cause churn. The study team was able to produce state-level estimates by leveraging the large sample size of the American Community Survey (ACS) to enhance the statistical power of the SIPP by post stratifying the individual weights to match a variety of relevant population estimates in the ACS.

The Intersection of Structural Risk Factors and Insurance-based Discrimination on Healthcare Access Inequities

Social risk factors independently influence experiences of discrimination and they converge leaving some people even more vulnerable leading to worse access to healthcare. Supported by a grant from the Robert Wood Johnson Foundation (RWJF) and in collaboration with the Minnesota of Department of Health and Minnesota Department of Human Services, researchers conducted an evaluation on the effects of insurance-based discrimination and other social risk factors (e.g., low income, minority status) on disparities in access to healthcare services.