title: Reports of insurance-based discrimination in health care and its association with access to care.
abstract: OBJECTIVE
  We examined reports of insurance-based discrimination and its association with insurance type and access to care in the early years of the Patient Protection and Affordable Care Act.
  
  
  METHODS
  We used data from the 2013 Minnesota Health Access Survey to identify 4123 Minnesota adults aged 18 to 64 years who reported about their experiences of insurance-based discrimination. We modeled the association between discrimination and insurance type and predicted odds of having reduced access to care among those reporting discrimination, controlling for sociodemographic factors. Data were weighted to represent the state's population.
  
  
  RESULTS
  Reports of insurance-based discrimination were higher among uninsured (25%) and publicly insured (21%) adults than among privately insured adults (3%), which held in the regression analysis. Those reporting discrimination had higher odds of lacking a usual source of care, lacking confidence in getting care, forgoing care because of cost, and experiencing provider-level barriers than those who did not.
  
  
  CONCLUSIONS
  Further research and policy interventions are needed to address insurance-based discrimination in health care settings.
authors.affiliation: At the time of the study, Xinxin Han was with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Kathleen Thiede Call, Jessie Kemmick Pintor, and Giovann Alarcon-Espinoza are with the University of Minnesota State Health Access Data Assistance Center, Minneapolis. Kathleen Thiede Call and Jessie Kemmick Pintor are also with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Giovann Alarcon-Espinoza is also with the Department of Applied Economics, University of Minnesota College of Food, Agricultural and Natural Resource Sciences, Minneapolis. Alisha Baines Simon is with Health Economics Program, Minnesota Department of Health, Minneapolis.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Han
authors.forename: Kathleen Thiede
authors.initials: KT
authors.lastname: Call
authors.forename: Jessie Kemmick
authors.initials: JK
authors.lastname: Pintor
authors.forename: Giovann
authors.initials: G
authors.lastname: Alarcon-Espinoza
authors.forename: Alisha Baines
authors.initials: AB
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D004192:Discrimination, Psychological; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D058991:Patient Protection and Affordable Care Act; D011795:Surveys and Questionnaires