Social Forces Colloquium Series: Carmen Gutierrez,UNC Public Policy

Social Inequalities in Health: An Institutional Perspective

Since the mid-20th century, U.S. healthcare policies have required working-age Americans to access health insurance through their linkages to employers, spouses, or children. Recent changes to U.S. healthcare policy prompted by the passage of the Patient Protection and Affordable Care Act (ACA), however, provide adults with a new pathway for obtaining health insurance decoupled from their labor market, marriage, and family attachments. Taking advantage of this fundamental shift in the country’s healthcare system, I use data from the National Survey on Drug Use and Health (NSDUH) to explore patterns of health insurance coverage from before and after the ACA became active in 2014. Results from this study show that the salience of labor market, marriage, and family attachments as pathways to coverage significantly declined in the first three years following the passage of the ACA. In doing so, the ACA helped close longtime gaps in health insurance coverage across gender, race and ethnicity, and education. Given the unequal risks associated with being unemployed, unmarried, and childless, these findings demonstrate how the ACA raises the floor in health care by improving access to health insurance for the population’s most disadvantaged groups.