Insurance status alone doesn't eliminate cost barriers to asthma care

Published online March 25, 2025

Despite widespread efforts to improve health insurance coverage in the United States, many adults with asthma continue to face significant cost barriers to essential care. These barriers persist even among those with insurance, potentially explaining why better coverage has not always translated to improved asthma outcomes. This study examines how insurance coverage status affects different types of cost barriers and identifies which populations remain most vulnerable despite policy advances.

In the study published in The Journal of Allergy and Clinical Immunology: In Practice, Xie et al. analyzed data from nearly 26,000 U.S. adults with asthma to identify predictors of cost barriers across different insurance coverage groups. The researchers distinguished between three critical cost barrier categories: access to primary care, specialist care, and asthma medications. Using data from the CDC's Behavioral Risk Factor Surveillance System Survey Asthma Call Back Survey (2019-2021), they examined how demographic, socioeconomic, and clinical factors influenced these barriers across fully insured individuals and those with partial or no coverage.

The study revealed that while individuals with partial or no insurance unsurprisingly faced the greatest cost barriers, certain fully insured subgroups, particularly non-Hispanic Black patients, encountered significant financial challenges accessing asthma care. 

Specifically, among those with partial or no insurance (13.7% of participants), nearly half reported cost barriers, including 33% who couldn't afford medications and 28.4% who couldn't access primary care. Even among fully insured individuals, 10.6% still faced cost barriers. Particularly concerning, non-Hispanic Black patients with full insurance were nearly twice as likely to face primary care cost barriers compared to their White counterparts. Women struggled more than men to afford medications regardless of insurance status. The study also found that recent emergency department visits dramatically increased cost barriers across all groups, creating a troubling cycle where those needing care most face the greatest financial obstacles.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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