++
Access to health care is the ability to obtain health services when needed. Lack of adequate access for millions of people is a crisis in the United States.
++
Access to health care has many components. One of the most influential “enabling” components is the ability to pay (Aday & Andersen, 1974). Because of the high cost of health services, insurance coverage is instrumental in determining a person’s ability to afford care. This chapter focuses on financial barriers to care, specifically the access challenges faced by the uninsured and the underinsured. Chapter 5 addresses other enabling factors for access to care, such as the availability of health care personnel and facilities and linguistically and culturally congruent care, and provides a broader framework for understanding health equity.
++
In 2015, Dan Coverless noticed that he was urinating a lot and feeling weak. He lived in South Carolina and earned $12,500 per year working part-time as a construction worker. Because South Carolina did not elect to participate in the Affordable Care Act’s Medicaid expansion, Mr. Coverless was not eligible for Medicaid despite his low income. He also did not qualify for federal tax subsidies to purchase private insurance. His friend told him that his symptoms might mean that he had diabetes and that he should go see a doctor, but lacking health insurance, Mr. Coverless was afraid of the cost. Eight days later, his friend found him in a coma. He was hospitalized for diabetic ketoacidosis.
++
Health insurance coverage, whether public or private, is a key factor in making health care accessible. Despite gains in insurance coverage since the Affordable Care Act (ACA) was passed in 2010, 27 million people in the United States in 2021 had no health insurance whatsoever (Fig. 3–1). Table 3–1 shows sources of health insurance for the US population.
++++++
For many people in the United States, who do not have insurance, the unaffordability of health care is an insurmountable barrier. People lacking health ...