title: State-Level Surveillance of Underinsurance and Health Care-Related Financial Burden.
abstract: BACKGROUND
  The Affordable Care Act (ACA) has reduced uninsurance, but underinsurance, health care-related financial burden, and dental uninsurance may not follow suit. Underinsurance is associated with reduced access to care, household debt, and bankruptcy but has been difficult to track without economic data.
  
  
  METHODS
  We used readily available state-level survey data to build a model that states can adopt to implement surveillance over underinsurance and health care-related financial burden, as well as assess related disparities and health profiles.
  
  
  RESULTS
  The state prevalence of underinsurance and dental uninsurance did not change in the first year of the ACA's individual mandate. Underinsurance was associated with poorer health-related quality-of-life measures: compared with the fully insured, underinsured adults had an adjusted odds ratio of 2.40 (95% CI, 1.71-3.38) of fair or poor general health.
  
  
  CONCLUSIONS
  Tracking underinsurance and medical debt can help public health and health care access stakeholders evaluate which mechanisms (deductibles, co-pays, uncovered services, or is proportionately priced health care services and products) are barriers to care and improved health outcomes.
authors.affiliation: Rhode Island Department of Health, Providence, Rhode Island (Dr Dumont and Mss Oh and Cooper); and Department of Epidemiology, Brown University, Providence, Rhode Island (Dr Dumont).
authors.forename: Dora M
authors.initials: DM
authors.lastname: Dumont
authors.forename: Junhie
authors.initials: J
authors.lastname: Oh
authors.forename: Tara
authors.initials: T
authors.lastname: Cooper