A new survey by the Commonwealth Fund shows that the impact of losing health insurance coverage is profound and often long lasting. Because most Americans obtain their health insurance through work, a change in job status sometimes results in a gap in coverage. With few affordable health insurance options for unemployed adults, gaps in coverage can be lengthy. The number of adults experiencing such gaps and the length of those gaps has increased because of the 2008 recession.

The study found that 26% of U.S. adults 19 to 64 years of age had a gap in their insurance in 2011; in 69% of those, the gap lasted longer than a year.

The lack of coverage affected the quality of care received. Only 76% of adults who had a gap in coverage had a regular physician, compared with 92% of those with continuous coverage, and only 46% of adults who had a gap lasting more than a year had a regular provider. Compared with people who had continuous coverage, those with gaps lasting longer than a year had far fewer routine tests: only 33% had had a cholesterol test in the past five years, compared with 70% among those with continuous coverage; only 28% of women 40 to 64 years had had a mammogram in the past two years, compared with 74% of those with continuous coverage.

Fortunately, the study also reports that two provisions of the Patient Protection and Affordable Care Act that took effect in 2010 have begun to ease the burden: insurance companies must now allow children younger than 26 to remain on or join their parents' policies, and the new Pre-Existing Condition Insurance Plan was created to provide coverage to those with chronic conditions. The study revealed that some patients-especially those who are poorer and less educated-aren't aware of these sources of coverage; bringing this information to light as part of patient education is one important way for nurses to help their patients.-David Carter

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