More than 20% of adults uninsured, nearly 10 years after Affordable Care Act signed into law
About one in five adults treated at community health centers in 11 states that expanded Medicaid eligibility did not have health insurance during a period that it was required by the Affordable Care Act to have such coverage, according to findings recently published in Annals of Family Medicine.
“Primary care use among community health center patients who remained uninsured post-ACA ... is largely unknown,” Nathalie Huguet, PhD, of the department of family medicine at Oregon Health & Science University, and colleagues wrote.
“A recent survey of patients seen at community health center found that those who were uninsured were more likely to report difficulty accessing care than insured patients, though it is unclear from these data if the barriers were more or less prevalent post-ACA because they did not compare these post-ACA findings to the pre-ACA period,” they added.
Researchers evaluated ambulatory care use among a group of 138,246 community health center patients aged 19 to 64 years who were uninsured from Jan. 1, 2012, to Dec. 31, 2013, and then followed them from Jan. 1, 2014, to Dec. 31, 2015.
They found that 20.9% of these patients were continuously uninsured, 15% gained Medicaid, 12.4% gained other insurance and 51.7% had no ambulatory care visits during the follow up period.
“These results indicate that despite their uninsured status, patients continue to have frequent visits, consequently ensuring appointments availability to uninsured patients is critical for continuity of care. The findings also denote gaining insurance led to more frequent visits, especially in preventive services. Primary care physicians whose patients gained insurance can emphasize receipt of overdue preventive services among patients who may have been reluctant while uninsured,” Huguet told Healio Primary Care.
She and her co-authors also wrote that the results “suggest that the ACA did a good job extending coverage but did not provide coverage for all as it was intended to do. With the recent proposed changes to the ACA (eg, alteration of the preexisting condition provision and/or Medicaid eligibility or work requirement), more patients are at risk of becoming uninsured once again. These potential revisions to the ACA could greatly affect community health centers’ ability to serve socioeconomically disadvantaged patient populations.”
“Rather than limiting insurance options and coverage, policy makers could focus on understanding and removing the remaining barriers to access to care and simplifying enrollment eligibility. Community health centers provide high quality care at reduced cost, and policy makers could learn to promote access to care for all and reduce overall health care expenditures by community health centers,” they added.
In the interview, Huguet said that the findings can also serve as a point of reference when clinicians advocate for health insurance coverage on their patients’ behalf.
Meanwhile, “all primary care physicians and care teams should be aware of assistance programs such as financial aid to pay medical bills, free preventive screening programs, or medication assistance. These programs could lead to early detection of chronic health problems and better health care management,” she told Healio Primary Care. – by Janel Miller
Disclosures: Huguet and colleagues report no relevant financial disclosures. Healio Primary Care was unable to obtain other relevant financial disclosures prior to publication.