- Medicaid expansion increased patient access to care, insurance coverage, and community health clinic (CHC) services, but did not entirely eradicate some racial and ethnic health disparities, according to research published in the Annals of Family Medicine.
Numerous medical studies have looked at the impacts on primary care, CHC access, and insurance coverage for patients following the Affordable Care Act’s (ACA’s) Medicaid expansion. Aside from some outliers, most studies have concluded that Medicaid expansion states saw 40 percent fewer uninsured patients in CHCs, and non-expansion states saw 16 percent fewer uninsured patients in CHCs.
However, none of these studies looked at the CHC and health insurance access disparities among racial and ethnic lines, a phenomenon the Annals of Family Medicine researchers hypothesized still prevails.
This most recent study of over 870,000 patients across the country investigated the rates of patients with and without public and private insurance at 359 CHCs. The researchers stratified the data points by patient racial demographic.
The analysis showed that following the ACA, the number of uninsured visits to CHCs decreased across all racial or ethnic demographics. Those effects were felt more prominently for some races than others, as well as in some states more than others.
Non-Hispanic white and black patients in expansion states, for example, saw larger decreases in uninsured CHC patients thanks to Medicaid expansion. More white and black patients obtained healthcare coverage through Medicaid as a result of the expansion.
This left Hispanic patients experiencing healthcare coverage disparities, the researchers said.
“Although we found improvements across all racial and ethnic groups, important disparities remain,” the team explained. “For example, Hispanic patients maintained the highest uninsured visit rates, and the decline in uninsured visits was significantly less for this group than for non-Hispanic white and non-Hispanic black patients after Medicaid expansion.”
Hispanic patients may experience disproportionate uninsured rates because only US citizens or legal residents are eligible for Medicaid offered via expansion. There are approximately 6 million unauthorized Hispanic individuals living in the US who cannot access Medicaid expansion, the study authors pointed out.
Data also showed that Hispanic patients were not as aware of the Medicaid expansion options as white or black patients.
Limited access to Medicaid coverage under expansion led to a continued health disparity for Hispanic patients, the researchers said. Hispanic patients account for 40 percent of Medicaid eligible patients, but also account for 50 percent of the uninsured population.
The researchers observed a different trend in non-expansion states. The rate of Medicaid-insured patients remained stable, while the rate of privately-insured patients increased. Hispanic patients were 3.6 times more likely to obtain private payer coverage in non-expansion states than their white or black counterparts.
“The sharper increase in privately-covered visits among Hispanic patients may suggest that fewer of these patients were eligible for Medicaid and thus sought private coverage to comply with the individual mandate,” the researchers said.
These results have considerable implications for both patients and the CHCs that help medically underserved patients. Patients insured both privately and publicly increased their odds of receiving optimal care in a CHC, for example.
“Gaining Medicaid coverage was associated with increased receipt of recommended preventive care for CHC patients,” the researchers explained. “Additionally, patients with diabetes and hypertension were significantly more likely to gain control of uncontrolled hemoglobin A1c levels and blood pressure readings when comparing insured with matched uninsured CHC patients.”
Increasing the number of privately and publicly insured patients in CHCs also made it financially feasible for the clinic to offer optimal care. CHCs are low-cost safety-net options for patients with limited financial means or no health insurance. These clinics accrue high costs and need to offset them with patients who do have insurance.
“As CHCs recover more of the costs of care from insurance payments, they may be able to stretch federal grant dollars to conduct quality improvement initiatives,” the research team pointed out. “Improving their ratio of insured to uninsured patients is especially important, because CHC patient populations tend to be sicker and more complex than non-CHC patients and because CHCs continue to care for more patients.”
These results indicate that it is beneficial for both patients and clinics for patients to have affordable access to health payer coverage. Patients with adequate insurance are able to obtain better quality services at their CHCs and help financially support these clinics. The researchers asserted that patients need equitable access to health payer coverage to continue that trend.
“Our findings suggest equitable access, even in CHCs, depends on equality in health insurance coverage,” the research team concluded. “As the future of the ACA is unknown, it is imperative that we understand its impact to date.”