Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers

Nathalie Huguet, Megan J Hoopes, Heather Angier, Miguel Marino, Heather Holderness, Jennifer E DeVoe, Nathalie Huguet, Megan J Hoopes, Heather Angier, Miguel Marino, Heather Holderness, Jennifer E DeVoe

Abstract

Background: It is crucial to understand the impact of the Affordable Care Act (ACA). This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not.

Methods: Electronic health record data on 875,571 patients aged 19 to 64 years with ≥ 1 visit between 2012 and 2015 in 412 primary care CHCs in 9 expansion and 4 nonexpansion states. We assessed changes in rates of total, uninsured, Medicaid-insured, and privately insured primary care and preventive care visits; immunizations administered, and medications ordered.

Results: Rates of uninsured visits decreased pre- to post-ACA, with greater drops in expansion (-57%) versus nonexpansion (-20%) states. Medicaid-insured visits increased 60% in expansion states while remaining unchanged in nonexpansion states. Privately insured visits were 2.7 times higher post-ACA in nonexpansion states with no increase in expansion states. Comparing 2015 with 2014: Uninsured visit rates continued to decrease in expansion (-28%) and nonexpansion states (-19%), Medicaid-insured rates did not significantly increase, and privately insured visits increased in nonexpansion states but did not change in expansion states.

Conclusions: Medicaid expansion and subsidies to purchase private coverage likely increased the accessibility of health insurance for patients who had previously not been able to access coverage.

Keywords: Affordable Care Act; United States; community health centers; health policy.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Distribution (%) of visit payer mix by expansion status and study year. Yearly totals do not sum to 100%; Medicare and other/miscellaneous coverage types comprise the remaining proportion of visits.

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Source: PubMed

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