Health insurance regain after a spell of uninsurance: a longitudinal comparison of youth with and without disabilities transitioning into adulthood

Severity of psychological distress among adults with and without disabilities

The aim of this study is to examine psychological distress and its individual symptoms between adults with and without disabilities, and among adults with disabilities, to examine whether an association exists between severity of distress and health-related factors. Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used for this study. Severity of psychological distress was assessed using the Kessler 6 scale of nonspecific psychological distress. Logistic regression analyses were performed to estimate predicted marginals and prevalence ratios. Nine percent of adults had mild to moderate psychological distress and 3.9% had serious psychological distress. The adjusted mean Kessler 6 total scores and individual item scores were higher for adults with disabilities, as was the average number of days that a mental health condition interfered with activities in the past 30 days. Among adults with disabilities, mild to moderate and serious psychological distress were particularly high among those who were unemployed or unable to work. Those who had either mild to moderate or serious psychological distress were significantly more likely than those with no psychological distress to be physically inactive, to smoke, and to report fair or poor health, life dissatisfaction, and inadequate social support. A dose-response relationship exists between categorical severity of psychological distress and examined health-related factors. These findings may inform the design of targeted public health strategies that aim to eliminate health disparities between people with and without disabilities.

Continuity of Public Insurance Coverage

Publicly financed insurance programs are tasked with maintaining coverage for eligible children, but published measures to assess coverage have not been evaluated. Therefore, we sought to identify and categorize measures of health insurance continuity for children and adolescents. We conducted a systematic review of Medline and HealthStar databases, review of reference lists of eligible articles, and contact with experts. We categorized measures into 8 domains based on a conceptual framework. We identified 147 measures from 84 eligible articles. Most measures evaluated the following domains: always insured (41%), repeatedly uninsured (36%), and transition out of coverage (29%), while fewer assessed single gap in coverage, always uninsured, transition into coverage, change in coverage, and eligibility. Only 18% of measures assessed associations between continuity of coverage and child and adolescent health outcomes. These results suggest that a number of measures of continuity of coverage exist, but few measures have assessed impact on outcomes.

Health-related unmet needs of supplemental security income youth after the age-18 redetermination

OBJECTIVE

Young adults who exit Supplemental Security Income (SSI) after their age-18 eligibility redetermination may have greater health-related unmet needs than those who remain on SSI. The objective of this paper is to determine the magnitude and causes of this gap.

DATA SOURCES

Uses the 2001-2002 National Survey of SSI Children and Families, a nationally representative survey of SSI youth.

STUDY DESIGN

Self-reported unmet medical, dental, and prescription drug needs of 869 individuals ages 19-23 who have had their SSI eligibility redetermined are compared. In addition to raw differences in unmet needs, logistic regressions are used to determine the sources of these differences.

PRINCIPAL FINDINGS

Young adults who exit SSI are almost twice as likely to have health-related unmet needs subsequent to their exit as those who remain on SSI after the age-18 redetermination. Access to care, particularly insurance coverage (either Medicaid or non-Medicaid), accounts for much of the difference between these two groups; measures of health status do not explain much of the difference.

CONCLUSION

Policies addressing access to health care are likely to be more successful in addressing unmet needs than policies focused on disability-specific issues in health for youth who lose access to SSI after their age-18 redetermination.