title: Health characteristics associated with gaining and losing private and public health insurance: a national study.
abstract: BACKGROUND
  Millions of Americans lack or lose health insurance annually, yet how health characteristics predict insurance acquisition and loss remains unclear.
  
  
  OBJECTIVE
  To examine associations of health characteristics with acquisition and loss of private and public health insurance.
  
  
  METHODS
  Prospective observational analysis of 2000 to 2007 Medical Expenditure Panel Survey data for persons aged 18 to 63 on entry, enrolled for 2 years. We modeled year 2 private and public insurance gain and loss.
  
  
  METHODS
  
  
  
  METHODS
  year 2 insurance status [none (reference), any private insurance, or public insurance] among those uninsured in year 1 (N=13,022), and retaining or losing coverage in year 2 among those privately or publicly insured in year 1 (N=47,239).
  
  
  METHODS
  age, sex, race/ethnicity, education, income, region, urbanity, health status, health conditions, year 1 health expenditures, year 1 and 2 employment status, and (in secondary analyses) skepticism toward medical care and insurance.
  
  
  RESULTS
  In adjusted analyses, lower income and education were associated with not gaining and with losing private insurance. Poorer health status was associated with public insurance gain. Smoking and being overweight were associated with not gaining private insurance, and smoking with losing private coverage. Secondary analyses adjusting for medical skepticism yielded similar findings.
  
  
  CONCLUSIONS
  Social disadvantage and poorer health status are associated with gaining public insurance, whereas social advantage, not smoking, and not being overweight are associated with gaining private insurance, even when adjusting for attitudes toward medical care. Private insurers seem to benefit from relatively low health risk selection.
authors.affiliation: Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA 95817, USA. afjerant@ucdavis.edu
authors.forename: Anthony
authors.initials: A
authors.lastname: Jerant
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017149:Private Sector / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012737:Sex Factors; D014481:United States; D055815:Young Adult