Access to Health Care Strengthens Communities

[Music] this study is looking at the social costs of not having health insurance in communities we know that health insurance matters for individual health outcomes we know that it matters for how much you pay when you go to get care it also matters for communities when you have a community with high levels of uninsurance the quality of care in some of those communities can go down so we actually take this premise of it further and look at how that actually affects social life in communities particularly

things like trust feelings of obligation that neighbors might have towards one another and these kinds of things something we call social cohesion we find that when you live in a community without insurance with high levels of uninsurance you have you feel less of this trust and less of this mutual obligation for your neighbors and we actually look at this over time and we look at this in ways that allow us to adjust for other competing factors right that might also predict whether or not you trust your neighbors right like

whether you're married or not your education level whether you've been exposed to crime in your neighborhood and then other elements of the neighborhood's composition such as the racial ethnic composition of that neighborhood whether or not that neighborhood has a high percentage of poor people and so on so we're able to actually drill down and see this effect for what it is controlling for all of these other factors that you might think would explain this effect as well for our society health is a prerequisite for participation you can't go to a job if

you're sick all the time you can't you know participate in your kids school activities if you're sick all the time if you're worrying about medication or how to pay for them so there's been previous research that suggests that people who lose health insurance or just don't have access to it actually feel this really acutely they feel like they are excluded from society they feel like they're excluded from their broader community because they aren't able to access this one thing that we all think we need which is health right it also moves through a couple other indirect pathways people who don't have health

insurance pay more out-of-pocket so this can exacerbate some economic inequalities and communities which can create more tensions between community members and then also at the kind of level of local government people might have to kind of compete for public funds in a ways that don't necessarily always put the uninsured at the top of people's concerns right so we're also thinking about the uninsured competing for money against things like firefighters or police or schooling and so that can also

create tensions in a community well I think we missed a big opportunity in terms of solving some of these issues with not expanding Medicaid to all the states because we could have actually created a system that was pretty much universal the very poor have access to things like Medicaid so it's this working poor through kind of lower middle class that are affected by these issues because we see over the last decade or so a decrease in people getting insurance from their jobs [Music]