Health Insurance and Health Care Access: Measures and Trends During Pre - and Post - Implementation of the Patient Protection and Affordable Care Act (PPACA)

The Patient Protection and Affordable Care Act (PPACA) in 2010 sought to increase health insurance coverage and health care access. By 2014, over 8 million individuals had obtained health insurance coverage through the expansion of Medicaid and additional state-based legislation. Yet, among certain segments of the population, health insurance coverage and health care access remained problematic. This dissertation project examined the impact of the PPACA and state-based legislation on influencing health insurance coverage and health care access between 2010 and 2014. Nested logistic regression models and generalized linear mixed models were performed to explore the influence of sociodemographic factors on predicting health insurance coverage and health care access. Adapting a conceptual framework for health care utilization by Andersen (1995) and extending the social determinants of health framework, the interaction of environment- and individual-level factors on health insurance coverage and health care access was examined. Among lower income, lower educated, and minority racial/ethnic groups, health insurance coverage and health care access gaps remain; simply extending health insurance coverage was not enough. While no one act of legislation may sufficiently address the health care needs of the U.S., examining the underlying factors that compel populations to subscribe to health insurance coverage and access health care services will greatly benefit the development of future health care policy.