Context matters: Where would you be the least worse off in the US if you were uninsured?

Background. There are about 47 million persons in the US without health insurance coverage (18% of the non-elderly population). Improving access to quality health care services for this vulnerable population is one of the most elusive health policy challenges today. Uninsured persons not only have poorer access to health care than insured persons, but they also have poorer health outcomes over time. Further, the local population without health insurance coverage may impose pecuniary (financial) and non-pecuniary (quality) spillovers on everyone else. Uninsurance spillovers have been shown to be substantial and unambiguous for the insured population for a wide variety of health care access, use and quality indicators. However, it is not entirely obvious that the same result (after considering the individual effect of being uninsured) applies for the uninsured population.

Objective. To examine the health care access, quality, and cost experienced by uninsured Latino mothers in two communities in Minnesota and Texas. These communities differ substantially by the size of the local population without health insurance coverage.

Methods. Four focus groups were conducted with uninsured Latino mothers who were caring for at least one child in their household. Seventeen mothers participated in each community (N=34). Groups were moderated by the same experienced staff from a non-profit, community-based research organization.

Results. Participants from Minnesota generally presented positive views of the safety net system services whereas Texas participants articulated more problems and complaints with their US-based safety net system of care. A distinction between the two communities was the sentiment among Minnesota mothers that you could receive care regardless of your ability to pay whereas in Texas the mothers simply felt they could not seek care unless they were sure they could find a way to pay. Women in both states explained that sometimes they need to delay seeking health care due to their inability to pay for health care services. Participants in Texas described having to go to Mexico to obtain health care services.

Conclusions. Uninsured individuals in low uninsurance communities are likely to benefit from insurance-related pecuniary and non-pecuniary spillovers. The health care needs of the uninsured population, and the potential policy responses, differ substantially by the structure of the local health care system. Communities with relative large uninsured populations might focus on reducing the number of individuals without coverage, which could have a substantial impact on health care quality given that most of the population is uninsured.