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Research ArticleResearch Letter

Underinsurance Before the Implementation of the Affordable Care Act: From the Research Involving Outpatient Settings Network (RIOS Net)

Gina Cardinali, Robert L. Rhyne, Anthony Fleg, Bernadette N. Corum, Dechen Tsewang, Angela Jo, Josh Leiderman and Charles North
The Journal of the American Board of Family Medicine November 2014, 27 (6) 855-857; DOI: https://doi.org/10.3122/jabfm.2014.06.140033
Gina Cardinali
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
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Robert L. Rhyne
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
MD
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Anthony Fleg
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
MD, MPH
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Bernadette N. Corum
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
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Dechen Tsewang
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
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Angela Jo
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
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Josh Leiderman
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
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Charles North
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
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Article Figures & Data

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    Table 1. Demographic Characteristics, Insurance Status, and Results of Survey Respondents
    CharacteristicsSample (N = 271)Insurance StatusUnderinsured vs. Adequately Insured (n = 220), Logistic Regression Odds Ratio (95% CI)
    Underinsured (n = 97; 35.8%)Adequately Insured (n = 123; 45.4%)Uninsured (n = 51; 18.8%)
    Age (years)
        18–2963 (23.2)20 (20.6)23 (18.7)20 (39.2)3.02 (0.72–12.62)
        30–4997 (35.8)41 (42.3)38 (30.9)18 (35.3)2.73 (0.67–11.10)
        50–6480 (29.5)23 (23.7)48 (39.0)9 (17.7)1.82 (0.48–6.90)
        ≥6519 (7.0)8 (8.3)10 (8.1)1 (2.0)1.00 (1.00–1.00)
        Unknown12 (4.4)5 (5.2)4 (3.3)3 (5.9)2.80 (0.43–18.44)
    Race/ethnicity
        Hispanic154 (56.8)52 (53.6)61 (49.6)41 (80.4)1.30 (0.64–2.67)
        White75 (27.7)29 (29.9)39 (31.7)7 (13.7)1.00 (1.00–1.00)
        American Indian7 (2.6)3 (3.1)4 (3.3)0 (0)1.10 (0.20–6.17)
        Asian8 (3.0)1 (1.0)5 (4.1)2 (3.9)0.033 (0.03–3.28)
        African American5 (1.9)1 (1.0)4 (3.3)0 (0)0.48 (0.04–5.21)
        Other15 (5.5)6 (6.2)8 (6.5)1 (2.0)0.39 (0.11–1.43)
        Unknown7 (2.6)5 (5.2)2 (1.6)0 (0)—
    Annual income (USD)
        ≤25,000186 (68.6)67 (69.1)77 (62.6)42 (82.4)8.18 (1.46–45.89)*
        25,000–50,00029 (10.7)12 (12.4)15 (12.2)2 (3.9)6.34 (0.98–40.96)
        ≥50,00115 (5.5)4 (4.1)10 (8.1)1 (2.0)1.00 (1.00–1.00)
        Unknown41 (15.1)14 (14.4)21 (17.16 (11.8)3.52 (0.53–23.34)
    General health status
        Good, very good, or excellent159 (58.7)59 (55.3)68 (60.8)32 (62.8)1.00 (1.00–1.00)
        Fair or poor94 (34.7)31 (39.2)48 (32.15 (29.4)1.46 (0.76–2.84)
        Unknown18 (6.6)7 (5.7)7 (7.2)4 (7.8)0.32 (0.06–1.77)
    Insurance status
        Uninsured51 (18.6)————
        Insured—————
            Medicare only24 (8.8)12 (12.4)12 (9.8)—0.97 (0.42–2.28)
            Medicaid only44 (16.1)25 (25.8)19 (15.4)—0.57 (0.26–1.26)
            State coverage insurance (county indigent fund)69 (25.2)26 (26.8)4 (35.0)—1.56 (0.73–3.32)
            Medicare and Medicaid14 (5.2)5 (5.2)9 (7.3)——
            Private only15 (5.5)5 (5.2)10 (8.1)——
            Indian Health Services only2 (0.7)2 (2.1)0 (0)——
            Combined (public and private)31 (11.3)13 (13.4)18 (14.6)——
            Unknown21 (7.7)9 (9.3)12 (9.8)——
    Health suffered from inability to get care because of cost
        Yes—22 (22.7)22 (17.9)20 (39.2)—
        No—62 (63.9)86 (69.9)22 (43.1)—
        Unknown—13 (13.4)15 (12.2)9 (17.7)—
    • Data are n (%) unless otherwise indicated.

    • ↵* P = .039.

    • CI, confidence interval.

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The Journal of the American Board of Family     Medicine: 27 (6)
The Journal of the American Board of Family Medicine
Vol. 27, Issue 6
November-December 2014
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Underinsurance Before the Implementation of the Affordable Care Act: From the Research Involving Outpatient Settings Network (RIOS Net)
Gina Cardinali, Robert L. Rhyne, Anthony Fleg, Bernadette N. Corum, Dechen Tsewang, Angela Jo, Josh Leiderman, Charles North
The Journal of the American Board of Family Medicine Nov 2014, 27 (6) 855-857; DOI: 10.3122/jabfm.2014.06.140033

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Underinsurance Before the Implementation of the Affordable Care Act: From the Research Involving Outpatient Settings Network (RIOS Net)
Gina Cardinali, Robert L. Rhyne, Anthony Fleg, Bernadette N. Corum, Dechen Tsewang, Angela Jo, Josh Leiderman, Charles North
The Journal of the American Board of Family Medicine Nov 2014, 27 (6) 855-857; DOI: 10.3122/jabfm.2014.06.140033
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  • Affordable Care Act
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