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PURPOSEThe Affordable Care Act of 2010 supports marked expansions in Medicaid coverage in the United States. As of January 1, 2014, a total of 25 states and the District of Columbia expanded their Medicaid programs. We tested the hypothesis that rates of uninsured safety net clinic visits would significantly decrease in states that implemented Medicaid expansion, compared with states that did not. METHODSWe undertook a longitudinal observational study of coverage status for adult visits in community health centers, from 12 months before Medicaid expansion (January 1, 2013 to December 31, 2013) through 6 months after expansion (January 1, 2014 to June 30, 2014). We analyzed data from 156 clinics in the OCHIN practice-based research network, with a shared electronic health record, located in 9 states (5 expanded Medicaid coverage and 4 did not). RESULTSAnalyses were based on 333,655 nonpregnant adult patients and their 1,276,298 in-person billed encounters. Overall, clinics in the expansion states had a 40% decrease in the rate of uninsured visits in the postexpansion period and a 36% increase in the rate of Medicaid-covered visits. In contrast, clinics in the nonexpansion states had a significant 16% decline in the rate of uninsured visits but no change in the rate of Medicaid-covered visits.CONCLUSIONS There was a substantial decrease in uninsured community health center visits and a significant increase in Medicaid-covered visits in study clinics in states that expanded Medicaid in 2014, whereas study clinics in states opting out of the expansion continued to have a high rate of uninsured visits. These findings suggest that Affordable Care Act-related Medicaid expansions have successfully decreased the number of uninsured safety net patients in the United States.

Purpose To examine associations between the number and types of patients’ chronic diseases and being up-to-date for breast, cervical and colorectal cancer screening. Methods Data were abstracted from medical charts at four primary care clinics located in two rural Oregon communities. Eligibility criteria included being at least 55 years of age, having had at least one clinic visit in the last two years. Results Of 3,433 included patients, 503 (15%) had no chronic illness, 646 (19%) had one, 786 (23%) had two, and 1,498 (44%) had three or more chronic conditions. Women with asthma/chronic lung disease and with cardiovascular disease were less likely to be up-to-date for mammography screening (OR 0.59, 95%CI 0.43–0.80), and those with chronic digestive disorders were more likely to be up-to-date for mammography (OR 1.31, 95%CI 1.03–1.66) compared to those without chronic conditions. Women with arthritis, diabetes mellitus, and hypertension were less likely to be up-to-date for cervical cancer screening (OR 0.38, 95%CI 0.21–0.68) compared to those without chronic conditions. Men with cardiovascular disease were less likely to be up-to-date for colorectal cancer screening (adjusted OR 0.59, 95%CI 0.44–0.80), and women with depression were less likely to be up-to-date (OR 0.71, 95%CI 0.56–0.91) compared to men and women without chronic conditions. Conclusion Specific chronic conditions were found to be associated with up-to-date status for cancer screening. This finding may help practices to identify patients who need to receive cancer screening.