An early look at rates of uninsured safety net clinic visits after the affordable care act

Heather Angier, Megan Hoopes, Rachel Gold, Steffani Bailey, Erika Cottrell, John Heintzman, Miguel Marino, Jennifer Devoe

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

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.

METHODS We 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).

RESULTS Analyses 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.

PURPOSE The Affordable Care Act of 2010 supports marked expansions in Med-icaid 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.

Original languageEnglish (US)
Pages (from-to)10-16
Number of pages7
JournalAnnals of Family Medicine
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Safety-net Providers
Patient Protection and Affordable Care Act
Medicaid
Ambulatory Care
Community Health Centers
Electronic Health Records
Patient Safety
Observational Studies
Longitudinal Studies

Keywords

  • Affordable care act
  • Practice-based research
  • Primary care
  • Safety net clinics
  • Uninsured

ASJC Scopus subject areas

  • Family Practice

Cite this

An early look at rates of uninsured safety net clinic visits after the affordable care act. / Angier, Heather; Hoopes, Megan; Gold, Rachel; Bailey, Steffani; Cottrell, Erika; Heintzman, John; Marino, Miguel; Devoe, Jennifer.

In: Annals of Family Medicine, Vol. 13, No. 1, 01.01.2015, p. 10-16.

Research output: Contribution to journalArticle

@article{1645886361154df7a34a85f92dad314e,
title = "An early look at rates of uninsured safety net clinic visits after the affordable care act",
abstract = "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.METHODS We 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).RESULTS Analyses 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.PURPOSE The Affordable Care Act of 2010 supports marked expansions in Med-icaid 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.",
keywords = "Affordable care act, Practice-based research, Primary care, Safety net clinics, Uninsured",
author = "Heather Angier and Megan Hoopes and Rachel Gold and Steffani Bailey and Erika Cottrell and John Heintzman and Miguel Marino and Jennifer Devoe",
year = "2015",
month = "1",
day = "1",
doi = "10.1370/afm.1741",
language = "English (US)",
volume = "13",
pages = "10--16",
journal = "Annals of Family Medicine",
issn = "1544-1709",
publisher = "Annals of Family Medicine, Inc",
number = "1",

}

TY - JOUR

T1 - An early look at rates of uninsured safety net clinic visits after the affordable care act

AU - Angier, Heather

AU - Hoopes, Megan

AU - Gold, Rachel

AU - Bailey, Steffani

AU - Cottrell, Erika

AU - Heintzman, John

AU - Marino, Miguel

AU - Devoe, Jennifer

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.METHODS We 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).RESULTS Analyses 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.PURPOSE The Affordable Care Act of 2010 supports marked expansions in Med-icaid 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.

AB - 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.METHODS We 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).RESULTS Analyses 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.PURPOSE The Affordable Care Act of 2010 supports marked expansions in Med-icaid 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.

KW - Affordable care act

KW - Practice-based research

KW - Primary care

KW - Safety net clinics

KW - Uninsured

UR - http://www.scopus.com/inward/record.url?scp=84920946632&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920946632&partnerID=8YFLogxK

U2 - 10.1370/afm.1741

DO - 10.1370/afm.1741

M3 - Article

VL - 13

SP - 10

EP - 16

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1709

IS - 1

ER -