Access to health care strengthens communities

The study, "Beyond Health Effects? Examining the Social Consequences of Community Levels of Uninsurance Pre-ACA," published by the Journal of Health and Social Behavior, is an effort by researchers Tara McKay and Stefan Timmermans to "broaden the conversation" about the effects of the Affordable Care Act (ACA).

"Given the strain that uninsurance places on individuals, providers and health care markets, it is not unreasonable to imagine that the consequences of uninsurance are likely to go beyond health and health care and impact the social lives of individuals and communities," said McKay, assistant professor of Medicine, Health and Society at Vanderbilt University.

Timmermans is a professor of sociology at UCLA. "We find that living around a lot of people who have insurance makes you more likely to trust the people you live around, makes you more likely to have common goals and values and feel like those goals and values are shared," McKay said of the results of the study. "That's true for everyone in such a community, even those who don't have health insurance. Conversely, low levels of insurance in a community strain relationships and trust among people who do live here."

ACA Endangered

McKay and Timmermans' research appears while the ACA, which has resulted in health insurance coverage for more than 20 million Americans, is endangered because of pledges from Republicans in Congress to repeal and replace the ACA in 2017. President-elect Donald Trump denounced the ACA during the presidential campaign.

Surveys conducted in 2000-2002 and 2006-2008 by the Los Angeles Family and Neighborhood Survey (L.A.FANS), provided data for the study along with information from the U.S. Census Bureau. The Vanderbilt study was funded by the National Science Foundation and Robert Wood Johnson Foundation.

Social cohesion increases by a third

L.A.FANS, a multistage probability sample of adults in Los Angeles County, was designed to probe the neighborhood effects on the health and well-being of a random sample of adults and children. These data have been used to examine a broad array of issues, including neighborhood and household effects on health and mortality, and health care access and utilization.

McKay and Timmermans based their analysis on 1,195 L.A.FANS survey respondents, and a series of multilevel regression analyses to "demonstrate that prior to the enactment of ACA, individuals living in communities with lower levels of insurance reported lower levels of social cohesion," McKay said.

"After adjusting for individual and community characteristics, we find a 34 percent decrease in social cohesion scores when moving from a neighborhood with the highest levels of insurance to one with the lowest levels of insurance," McKay said.

The L.A.FANS data were collected in a way in which it can account for potentially confounding factors, such as the age, race-ethnic, nativity and income composition of the communities.

Social cohesion continues to rise

Importantly, when the researchers estimate the effects of an ACA-type insurance expansion on the same respondents, they find that social cohesion increases over time.

"I think this is an important step -- to consider the other ways that policies actually affect people beyond health and health care access. This can change how we see ourselves and how we interact with our communities too," McKay said.

"You can't participate in social life and civic engagement without having health first, right?"