Abstract
In 2021, there are over 132,000 Nebraskans without health insurance coverage compared to 157,900 in 2017. Over time, many have qualified for health insurance through Medicaid, the health insurance marketplace created through the Affordable Care Act, or insurance through an employer. The purpose of this grounded-theory qualitative study was to explore the role of self-concept among 19-64 with and without health insurance. Twenty-five participants were recruited to take part in this qualitative study with one residing in another state. All interviews took place during the summer of 2020, were transcribed, and hand-coded. Three themes emerged centered on self-concept, integration of health insurance and healthcare, and cultural health capital. The first theme found self-concept is influenced by the individual's insured status. For many uninsured individuals, a negative self-concept was reported while a positive self-concept occurred among those with health insurance. The second theme is that health insurance and health care are intertwined. While the questions asked were focused on health insurance, many responses focused on health care. Lastly, the final theme centers on cultural health capital, a phenomenon that describes the provider-patient power exchange. Participants discussed their personal experiences with providers that highlighted the challenges of being heard within a cis-heteronormative medical system. Solutions proposed include revamping mental health benefits for those with health insurance given the connection between self-concept and health insurance plus any negative experiences with providers. Another solution proposed is updating the Health Belief Model to include the important role self-concepts plays along with health insurance status.Keywords: self-concept, health insurance, uninsured, insured, cultural health capital