Health Insurance and Poverty in Trajectories of Out-of-Pocket Expenditure among Low-Income Middle-Aged Adults.

OBJECTIVE: To assess the effects of longitudinal patterns of health insurance and poverty on out-of-pocket expenditures among low-income late middle-aged adults.

DATA SOURCES/STUDY SETTING: Six waves (2002-2012) of the Health and Retirement Study, in combination with RAND Center for the Study of Aging data, were used.

STUDY DESIGN: A random coefficient regression analysis was conducted in a multilevel growth curve framework to estimate the impact of health insurance and poverty on out-of-pocket expenditures.

PRINCIPAL FINDINGS: At baseline, individuals with private insurance or unstable coverage were more likely to have out-of-pocket expenditures and financial burdens than public insurance holders. Over time, the poor who had no insurance, unstable coverage, or insurance type change had higher out-of-pocket expenditures; private coverage holders had higher odds of financial burden.

CONCLUSIONS: Unstable insurance coverage had a discernible effect on the long-term, out-of-pocket expenditures among low-income adults. Findings have an important policy implication to protect poor late middle-aged population; as this population enters old age, the high financial burden it faces may exacerbate persistent socioeconomic health disparity among older people with unstable insurance coverage.