Karen Y. Tang, BA, Wendy Chavkin, MD, MPH, and Diana Romero, PhD, MA. Department of Population and Family Health, Columbia University, 60 Haven Avenue, B-2, New York, NY 10032, 917-701-2304, kyt10@columbia.edu

Objectives: This study evaluated relationships between health insurance coverage, health status, and utilization of health services among low-income women in San Antonio and New York City.

Methods: Surveys were administered to mothers of chronically ill children presenting at clinical and welfare agency sites San Antonio, TX (N = 396) and New York, NY (N = 168). Data were collected regarding women’s insurance status, measures of health status, and health service utilization. Bivariate analyses were performed to assess associations between insurance coverage and health status, and between insurance coverage and service utilization.

Results: Only 45.5% of respondents in San Antonio were currently insured, compared with 78.0% in New York. In San Antonio, 68.9% of respondents had experienced recent gaps in coverage versus 31.5% in New York. Primary sources of coverage were Medicaid (51.7% San Antonio, 72.0% New York) and private, employment-based insurance (41.7% San Antonio, 21.4% New York). Insurance status was not associated with employment, with 50% and 20.6% of employed women lacking insurance in San Antonio and New York, respectively. Many employed women received insurance through Medicaid (25.5% San Antonio, 52.0% New York). Women in San Antonio without insurance coverage were significantly less likely to have had an annual gynecological exam, comply with medication regimens, or seek care for conditions such as asthma, headaches/migraines, and depression (p < .05). In contrast, insurance status was not associated with differences in health or service utilization in New York, though uninsured women were less likely to comply with prescribed medications (p < .01).

Conclusions:

Women in New York had higher insurance rates and fewer gaps in coverage, compared with San Antonio. As the majority of insured women in New York were Medicaid recipients, we speculate that these data may be a result of New York’s generous Medicaid eligibility policies. Employment was not associated with insurance in either city, with many employed women in San Antonio remaining uninsured, and half of employed women in New York receiving coverage through Medicaid. In New York, insurance was not associated with health utilization, possibly because uninsured women are able to access services through the city’s public hospital system. However, in San Antonio, where no equivalent safety net system exists, uninsured women were less likely to receive necessary health services. These results suggest possible health implications of federal welfare reform policies, which have mandated employment and altered Medicaid enrollment and eligibility for low-income women with children.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Identify the principal sources of medical care and health insurance coverage for low-income women, particularly the contributions of employment-based insurance versus publicly funded programs such as Medicaid.
• Describe the impact of insurance coverage on women’s utilization of health services and compliance with prescribed medication regimens.
• Discuss how federal welfare reform policies regarding Medicaid eligibility and mandated employment affect access to health insurance and health services for low-income women with children.

Keywords: Insurance-Related Barriers, Women's Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.