Health insurance in the United States: A case of effectively maintained inequality?

The theory of Effectively Maintained Inequality (EMI) (Lucas, 2001) posits that goods have both quantitative (how much?) and qualitative (what kind?) dimensions. Coupled with the hypothesized mechanisms of EMI, this simple observation greatly complicates research and policy development concerning inequality. First applied to explain educational inequality in the United States, evidence for the theory has been found in education systems in over 20 countries, including Chile, China, the Czech Republic, Denmark, Egypt, Germany, Greece, Ireland, Nigeria, South Africa, and South Korea. Yet, while EMI was proposed as a general theory of inequality, to date no research has assessed its applicability to domains outside education. This work uses nearly two decades of National Health Interview Survey data (N = 451,161) to provide the first effort to assess whether EMI illuminates of inequality outside education, by taking up the issue of health insurance in the United States.