Volume 47 | Number 5 | October 2012

Abstract List

Ilana Graetz, Mary Reed, Vicki Fung Ph.D., William H. Dow Ph.D., Joseph P. Newhouse Ph.D., John Hsu M.D., M.B.A.


To help preserve continuity of health insurance coverage during the recent recession, the merican ecovery and einvestment ct provided a 65 percent onsolidated mnibus udget econciliation ct () premium subsidy for workers laid off in 2008–2010. We examined enrollment levels with the subsidy and the health, access, and financial consequences of enrollment decisions.

Study Design/Data Collection

Telephone interviews linked with health system databases for 561 respondents who were laid off in 2009 and eligible for the subsidy (80 percent response rate).

Principal Findings

Overall, 38 percent reported enrolling in and 54 percent reported having some gaps in insurance coverage since being laid off. After adjustments, we found that those who had higher cost‐sharing, who had higher incomes, were older, or were sicker were more likely to enroll in . enrollees less frequently reported access problems or that their health suffered because of poor access, but they reported greater financial stress due to health care spending.


Despite the substantial subsidy, a majority of eligible individuals did not enroll in , and many reported insurance coverage gaps. Nonenrollees reported more access problems and that their health worsened. Without a mandate, subsidies may need to be widely publicized and larger to encourage health insurance enrollment among individuals who suffer a negative income shock.