Experiences of unfair treatment in health care settings have been associated with unmet health needs that can result in poorer health care quality and contribute to health inequities. Understanding who is experiencing unfair treatment and why is necessary so that policymakers and payers can implement effective policies to prevent such treatment. Drawing on data from the April 2021 Health Reform Monitoring Survey, our study provides a national picture of the extent to which adults with full-year private coverage, full-year public coverage, and who were uninsured all year perceive they are being treated unfairly because of their type of health insurance coverage and other reasons when seeking care. Key findings include the following:

• Adults with public coverage and those who were uninsured were more than twice as likely as adults with private coverage to report that they had experienced unfair treatment for one or more reasons (17.4 percent and 13.9 percent versus 6.4 percent) and more than five times as likely to report experiencing unfair treatment because of their coverage type (9.6 percent and 7.4 percent versus 1.3 percent).
• Adults with public coverage and those who were uninsured were also more likely than adults with private coverage to report experiencing unfair treatment because of health insurance and another reason.
• Differences in the shares of people reporting unfair treatment due to coverage type between publicly insured and privately insured adults and between uninsured and privately insured adults remain after adjusting for observed characteristics of adults in the sample.
• Having a disability, a physical health condition, or a behavioral health condition was also associated with a greater likelihood of reporting unfair treatment due to health insurance coverage both when adjusting and not adjusting for selected demographic and other characteristics.
• Adults with public coverage were more likely to report insurance-related hassles than those with private coverage (16.2 versus 11.0 percent), after adjusting for observed differences between privately and publicly insured adults.

The higher rates of unfair treatment experienced by publicly insured and uninsured adults could have many causes, including providers’ and office staff members’ biases, payment and administrative barriers in Medicaid, and affordability issues facing uninsured people. Identifying policy solutions to address unfair treatment will depend on further work to understand the extent to which such treatment is related to these reasons.