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From Health Affairs:


State Variation In Health Insurance Dynamics


Bethesda, MD -- A new study, being released today as a Web First by Health Affairs, analyzes state variation in the percentage of adults losing health insurance and the lengths of their uninsured spells. The authors find that adults with public insurance were more likely to lose coverage than adults with private insurance. But of the adults who did lose coverage, those who had been covered by public insurance typically spent less time uninsured than those who lost private coverage.


The study also found significant regional differences. For example, between 2009 and 2012, nearly 50 percent of the nonelderly adult population in Florida, Nevada, New Mexico, and Texas experienced an uninsured spell; in Massachusetts, only 18 percent went uninsured during the same period. The authors' findings demonstrate considerable turnover in the US health insurance system. Their results can help policy makers anticipate whether the coverage expansion programs in their state are more likely to be used as a long-term insurance option or as a short-term stopover for people in between jobs.


Understanding State Variation In Health Insurance Dynamics Can Help Tailor Enrollment Strategies For ACA Expansion


By John A. Graves and Katherine Swartz


Graves is affiliated with Vanderbilt University in Nashville and Swartz with Harvard School of Public Health in Boston.


Support for this study, which will also appear in Health Affairs' October issue, was provided by the Robert Wood Johnson Foundation.


The authors' primary data source was a panel of adults from the 2008 Survey of Income and Program Participation from the US Census Bureau, which provided longitudinal monthly information on health insurance between May 2008 and March 2012. In view of these regional differences, the authors' posit that "differences in length of time without insurance are just as important as differences in income for policy makers." "The current variations in the incidence and duration of new spells of being uninsured across states suggest that states will need to take different approaches to minimizing those spells and ensuring continuity in coverage," they conclude. "The study's findings can assist states as they tailor outreach and enrollment strategies for the coverage expansion programs created by the Affordable Care Act."

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.