An early look at rates of uninsured safety net clinic visits after the Affordable Care Act

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The Affordable Care Act (ACA) of 2010 [1]was enacted to expand healthcare coverage (including Medicaid expansion) to the uninsured, which was estimated to be 47 million Americans in 2012. As of January 1, 2014, 25 states and the District of Columbia have expanded their Medicaid programs which studies show will allow 13 to 22 million individuals to gain Medicaid coverage. [2]


The authors did a comparison for the rates of uninsured safety net clinics between states that expanded Medicaid under the ACA and states that did not. The authors used data from adult visits to 156 Community Health Centers with OCHIN practice-based research network and shared electronic health records.


The authors found that Community Health Centers located in states that participated in the Medicaid expansion decreased their rate of uninsured visits by 40% and increased their Medicaid-covered visits by 36%. Community Health Centers that did not participate in the Medicaid expansion showed a 16% decrease in the rate of uninsured visits and no-change in Medicaid-covered visits.


This was the first study that used electronic health record data from Community Health Centers to measure and compare coverage rates. However, the data only was only gathered from nine states and is not necessarily representative of all states that chose to expand or not expand Medicaid.


The study found that states who expanded Medicaid coverage decreased uninsured visits and increased Medicaid-covered visits. The states that chose not to expand Medicaid coverage saw no change in Medicaid-covered visits and only a 16% decrease in uninsured visits suggesting that the ACA expansion of Medicaid coverage may have contributed to the number of uninsured visits.


This was an interesting article about the first use of electronic health records data to compare Community Health Centers in nine states. I’d be interested to see this study conducted on larger scale with more states included and possibly more individuals. The study used data from 333,655 nonpregnant adult patients and their 1,276,298 visits to Community Health Centers. I believe if this study were expanded and more inclusive, we would get a better picture of whether Medicaid expansion was a success. Furthermore, I am interested in why both the states that expanded Medicaid and the states that did not saw decreases in the number of uninsured visits.

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  2. Angier 2015. An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act
[[Category: EHR]