Life Course Transitions and Instability in Health Insurance Coverage.

Abstract

The piecemeal system of health insurance coverage in the United States is not structured to easily adapt to normal life course transitions. The typical routes by which individuals and families access insurance coverage are frequently threatened in times of change, and alternative, affordable sources of coverage are often difficult to come by. This dissertation examines the linkages between life course transitions and instability in health insurance coverage in the late 1990s and early 2000s. The three substantive chapters consider the extent to which divorce, job loss, and the transition to adulthood threaten the stability and continuity of health insurance, and how these linkages can be modified through changes in public policy. In Chapter 2, “Divorce and Women’s Risk of Health Insurance Loss,” I document that many women experience a significant risk of health insurance loss in the months following divorce, and that overall coverage rates remain depressed for more than two years after divorce. Chapter 3, “Job Loss and Health Insurance in the Great Recession: Did the COBRA Subsidy Work?,” considers the difficulty of maintaining insurance coverage following job loss, and evaluates the effects of temporary policy change which reduced the price of purchasing COBRA through a former employer. Although workers with access to the subsidy purchased COBRA at moderately higher rates, many still experienced gaps in coverage after job loss. In Chapter 4, “Health Insurance in Young Adulthood: Less Instability Since the Affordable Care Act?,” I assess changes in the level and stability in health insurance coverage of young adults following the Affordable Care Act’s expansion of parental dependent coverage up to age 26. I find that the policy change increased overall coverage rates for young adults primarily by filling gaps in coverage for those with higher-SES parents, rather than increasing coverage for the chronically uninsured. Looking forward, the full implementation of the Affordable Care Act in January 2014 may both enable greater access to health insurance for low-income individuals and families who currently face chronic barriers to coverage and enhance the security of health insurance over the life course.