Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act

Nathalie Huguet, Heather Angier, Megan J. Hoopes, Miguel Marino, John Heintzman, Teresa Schmidt, Jennifer E. DeVoe

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


OBJECTIVE: To assess the prevalence of pre-existing conditions for community health center (CHC) patients who gained insurance coverage post-Affordable Care Act (ACA). METHODS: We analyzed electronic health record data from 78,059 patients aged 19 to 64 uninsured at their last visit pre-ACA from 386 CHCs in 19 states. We compared the prevalence and types of pre-existing conditions pre-ACA (2012 to 2013) and post-ACA (2014 to 2015), by insurance status and race/ethnicity. RESULTS: Pre-ACA, >50% of patients in the cohort had ≥1 Pre-existing condition. Post-ACA, >70% of those who gained insurance coverage had ≥1 condition. Post-ACA, all racial/ethnic subgroups showed an increase in the number of pre-existing conditions, with non-Hispanic Black and Hispanic patients experiencing the largest increases (adjusted prevalence difference, 18.9; 95% CI, 18.2 to 19.6 and 18.3; 95% CI, 17.8 to 18.7, respectively). The most common conditions post-ACA were mental health disorders with the highest prevalence among patients who gained Medicaid (45.6%) and lowest among those who gained private coverage (30.5%). CONCLUSIONS: This study emphasizes the high prevalence of pre-existing conditions among CHC patients and the large increase in the proportion of patients with at least 1 of these diagnoses post-ACA. Given how common these conditions are, repealing pre-existing condition protections could be extremely harmful to millions of patients and would likely exacerbate health care and health disparities.

Original languageEnglish (US)
Pages (from-to)883-889
Number of pages7
JournalJournal of the American Board of Family Medicine : JABFM
Issue number6
StatePublished - Nov 1 2019


  • Chronic Disease
  • Cohort Studies
  • Community Health Centers
  • Electronic Health Records
  • Health Care Reform
  • Health Policy
  • Insurance Coverage
  • Medicaid
  • Medically Uninsured
  • Patient Protection and Affordable Care Act
  • pre-existing Condition Coverage

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


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