People without health insurance don't get enough preventive care — simple but important things like vaccinations and blood tests.
But surely having insurance every now and then is better than none at all, because people can get caught up on their tests when they are covered, right?
That's a widely held view, and one that would be good news to the millions of people who go on and off health insurance each year. Some of them are losing or changing jobs. Others slide on and off Medicaid as they take on temporary work, marry or divorce.
But it's not reality, according to a new study of people with diabetes. For them, regular preventive care can mean the difference between a normal life and serious health problems like stroke, heart attack and amputation. But it's not happening.
"We found there was no threshold," says Rachel Gold, an assistant investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon. "You really have to have continuous coverage to have good preventive care."
The people in the study were going to the doctor; they had gone to federally funded "safety net" clinics in Oregon at least three times from 2005 through 2007. About half of the 3,384 people with diabetes in the study were uninsured, and about half had public insurance like Medicaid.
The people who had breaks in their insurance coverage were much less likely to get tests that diabetics are supposed to have at least once a year, including cholesterol screening, kidney function and HbA1c screening. In fact, they did no better than the people who never had any insurance coverage when it came to getting those tests done.
That might be because the uninsured people have to pay small copays, around $5. That may not seem like much, Gold says, but add up four tests, and "for someone who's low income, they might wait."
She doesn't have the data to prove that, but says the doctors in the 50 clinics who participated in the study say they think that's the case. Her results were published the January Journal of the American Board of Family Medicine.
Unfortunately for the people with diabetes, putting off tests like the A1c mean they'll have a lot harder time keeping their diabetes in control now, and they're more likely to have more serious complications later on. Gold told Shots: "You're being cheap in the present for something that's much more expensive in the future."
Missing out on regular preventive care also means a much bigger bill for taxpayers, who ultimately pay the cost for the uninsured when people are hospitalized. That's why the Affordable Care Act mandates coverage without copays or deductibles for diabetes tests and other preventive care. (Though as NPR's Julie Rovner recently reported, most people don't know that.)