Sequence Analysis of U.S. Insurance Coverage Trajectories From Ages 25 to 37

Coverage gaps and periods of uninsurance are associated with decreased health care utilization, treatment nonadherence, and health-related work limitations. Yet little is known about long-term trajectories of insurance coverage. We used sequence analysis and a nationally representative cohort study to identify and describe three trajectories of health insurance coverage from ages 25 to 37: stable private coverage (40%); stabilizing public coverage (16%); and recurrent uninsurance (44%). Estimated time exposed to uninsurance for each group was 0.2, 1.7, and 5.2 years, respectively. Those with recurrent uninsurance were more likely to be male, Black or Hispanic, working part-time, in poorer health, or living in the U.S. South or West. Prolonged and cyclical uninsurance is common in the years following the transition to adulthood, with disadvantaged adults more likely to experience recurrent uninsurance. Furthermore, examining insurance status cross-sectionally underestimates long-term exposure to coverage instability and may impede effective interventions aimed at securing long-term access to coverage.