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Health Insurance and Poverty in Trajectories of OutofPocket Expenditure among LowIncome MiddleAged Adults

Objective: To assess the effects of longitudinal patterns of health insurance and poverty on outofpocket expenditures among lowincome late middleaged adults.

Data Sources/Study Setting: Six waves (2002–2012) of the Health and Retirement Study, in combination with RAND Center for the Study of Aging data, were used.

Study Design: A random coefficient regression analysis was conducted in a multilevel growth curve framework to estimate the impact of health insurance and poverty on outofpocket expenditures.

Principal Findings: At baseline, individuals with private insurance or unstable coverage were more likely to have outofpocket expenditures and financial burdens than public insurance holders. Over time, the poor who had no insurance, unstable coverage, or insurance type change had higher outofpocket expenditures; private coverage holders had higher odds of financial burden.

Conclusions: Unstable insurance coverage had a discernible effect on the longterm, outofpocket expenditures among lowincome adults. Findings have an important policy implication to protect poor late middleaged population; as this population enters old age, the high financial burden it faces may exacerbate persistent socioeconomic health disparity among older people with unstable insurance coverage.

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