Following Uninsured Patients Through Medicaid Expansion

Ambulatory Care Use and Diagnosed Conditions

Nathalie Huguet, Steele Valenzuela, Miguel Marino, Heather Angier, Brigit Hatch, Megan Hoopes, Jennifer Devoe

Research output: Contribution to journalArticle

Abstract

PURPOSE: The Patient Protection and Affordable Care Act (ACA) has improved access to health insurance, yet millions remain uninsured. Many patients who remain uninsured access care at community health centers (CHCs); however, little is known about their health conditions and health care use. We assessed ambulatory care use and diagnosed health conditions among a cohort of CHC patients uninsured before enactment of the ACA (pre-ACA: January 1, 2012 to December 31, 2013) and followed them after enactment (post-ACA: January 1, 2014 to December 31, 2015). METHODS: This retrospective cohort analysis used electronic health record data from CHCs in 11 US states that expanded Medicaid eligibility. We assessed ambulatory care visits and documented health conditions among a cohort of 138,246 patients (aged 19 to 64 years) who were uninsured pre-ACA and either remained uninsured, gained Medicaid, gained other health insurance, or did not have a visit post-ACA. We estimated adjusted predicted probabilities of ambulatory care use using an ordinal logistic mixed-effects regression model. RESULTS: Post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The majority of patients had ≥1 diagnosed health condition. The adjusted proportion of patients with high use (≥6 visits over 2 years) increased from pre-ACA to post-ACA among those who gained Medicaid (pre-ACA: 23%, post-ACA: 34%, P <.001) or gained other insurance (pre-ACA: 29%, post-ACA: 48%, P <.001), whereas the percentage fell slightly for those continuously uninsured. CONCLUSIONS: A significant percentage of CHC patients remained uninsured; many who remained uninsured had diagnosed health conditions, and one-half continued to have ≥3 visits to CHCs. CHCs continue to be essential providers for uninsured patients.

Original languageEnglish (US)
Pages (from-to)336-344
Number of pages9
JournalAnnals of family medicine
Volume17
Issue number4
DOIs
StatePublished - Jul 1 2019

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Patient Protection and Affordable Care Act
Medicaid
Ambulatory Care
Community Health Centers
Health
Health Insurance
Insurance
Electronic Health Records

Keywords

  • access to health care
  • health care delivery
  • Medicaid
  • medically uninsured
  • Patient Protection and Affordable Care Act
  • preexisting condition
  • primary health care

ASJC Scopus subject areas

  • Family Practice

Cite this

Following Uninsured Patients Through Medicaid Expansion : Ambulatory Care Use and Diagnosed Conditions. / Huguet, Nathalie; Valenzuela, Steele; Marino, Miguel; Angier, Heather; Hatch, Brigit; Hoopes, Megan; Devoe, Jennifer.

In: Annals of family medicine, Vol. 17, No. 4, 01.07.2019, p. 336-344.

Research output: Contribution to journalArticle

Huguet, Nathalie ; Valenzuela, Steele ; Marino, Miguel ; Angier, Heather ; Hatch, Brigit ; Hoopes, Megan ; Devoe, Jennifer. / Following Uninsured Patients Through Medicaid Expansion : Ambulatory Care Use and Diagnosed Conditions. In: Annals of family medicine. 2019 ; Vol. 17, No. 4. pp. 336-344.
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abstract = "PURPOSE: The Patient Protection and Affordable Care Act (ACA) has improved access to health insurance, yet millions remain uninsured. Many patients who remain uninsured access care at community health centers (CHCs); however, little is known about their health conditions and health care use. We assessed ambulatory care use and diagnosed health conditions among a cohort of CHC patients uninsured before enactment of the ACA (pre-ACA: January 1, 2012 to December 31, 2013) and followed them after enactment (post-ACA: January 1, 2014 to December 31, 2015). METHODS: This retrospective cohort analysis used electronic health record data from CHCs in 11 US states that expanded Medicaid eligibility. We assessed ambulatory care visits and documented health conditions among a cohort of 138,246 patients (aged 19 to 64 years) who were uninsured pre-ACA and either remained uninsured, gained Medicaid, gained other health insurance, or did not have a visit post-ACA. We estimated adjusted predicted probabilities of ambulatory care use using an ordinal logistic mixed-effects regression model. RESULTS: Post-ACA, 20.9{\%} of patients remained uninsured, 15.0{\%} gained Medicaid, 12.4{\%} gained other insurance, and 51.7{\%} did not have a visit. The majority of patients had ≥1 diagnosed health condition. The adjusted proportion of patients with high use (≥6 visits over 2 years) increased from pre-ACA to post-ACA among those who gained Medicaid (pre-ACA: 23{\%}, post-ACA: 34{\%}, P <.001) or gained other insurance (pre-ACA: 29{\%}, post-ACA: 48{\%}, P <.001), whereas the percentage fell slightly for those continuously uninsured. CONCLUSIONS: A significant percentage of CHC patients remained uninsured; many who remained uninsured had diagnosed health conditions, and one-half continued to have ≥3 visits to CHCs. CHCs continue to be essential providers for uninsured patients.",
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