Abstract
U.S. nonelderly adults rely on a patchwork of private and public sources for health insurance. Without universal coverage, changes in employment, income, and public policy can increase individuals’ risk of coverage disruptions. Using data from the Medical Expenditure Panel Survey-Household Component, we examine changes in patterns of coverage, including transitions between sources and discontinuities (temporary or prolonged uninsurance), during three policy-relevant time periods: pre-Affordable Care Act (ACA), 2008 to 2009; post-ACA, 2015 to 2016; and the COVID-19 public health emergency, 2021 to 2022. We also examine associations of coverage patterns with health care access and utilization. Despite coverage gains, relatively high rates of coverage discontinuities persisted across the study periods, affecting 25.3% of adults in 2021 to 2022. Relative to those with continuous private coverage, individuals with coverage discontinuities were less likely to receive any office visits or prescriptions. Rates of delayed or forgone care due to cost among those with coverage discontinuities also grew significantly over time.