An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act

Abstract

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.

Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013–2014

“…(Morgan, 2012; The White House, 2012) Studies have shown that previous Medicaid expansions significantly impacted CHCs’ payer mix, but these analyses assessed changes in single states only, had limited follow-up periods, did not assess impact on type of CHC visits, or were based on survey data subject to recall bias. (Baicker et al; McCormick, Sayah, Lokko, Woolhandler, & Nardin; Sommers, Baicker, & Epstein) Angier et al (2015) describe CHC visit coverage rates in the first six months after implementation of the ACA’s insurance opportunities in a sample of states that expanded Medicaid versus states that did not. They found a 36% increase in Medicaid visit rates and a corresponding 40% decrease in uninsured visits in expansion states the first six months of 2014.…”

Surgeon Reimbursements in Maxillofacial Trauma Surgery

“…However, given the almost equal increase in the proportion of patients on Medicaid, it seems plausible that most of the reduction in the number of uninsured at our institution was attributable to the expansion of Medicaid in our state, which is one of 25 states, in addition to the District of Columbia, that have expanded their Medicaid programs to all those earning less than 138 percent of the federal poverty level. 13 In addition to the changes in payor distribution, there were significant increases in reimbursement rates across several payor types, namely, workers' compensation, private insurance, Medicaid, and Tricare. It is easy to understand why the Medicaid reimbursement rate increased, because the Affordable Care Act mandated temporary increases in Medicaid reimbursement, paid for by the federal government.…”

Reasons Why Individuals Remain Uninsured Under the Affordable Care Act: Experiences of Patients at a Student-Run Free Clinic in Michigan, a Medicaid Expansion State

“…The clinic is the sole provider of free primary health care in Livingston County. Since the enactment of the ACA, states with expanded Medicaid have seen a decline in free clinic usage [13]; Livingston County saw the other free clinic provider close its doors in early 2015 due to decreased patient volume. However, UMSRFC still experiences health care demand from the uninsured in southeastern Michigan, providing care to approximately 400 unique patients each year.…”