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. 2020 Dec:141:106271.
doi: 10.1016/j.ypmed.2020.106271. Epub 2020 Oct 9.

Private/marketplace insurance in community health centers 5 years post-affordable care act in medicaid expansion and non-expansion states

Anne E Larson  1 , Megan Hoopes  2 , Heather Angier  3 , Miguel Marino  4 , Nathalie Huguet  3
Affiliations

Private/marketplace insurance in community health centers 5 years post-affordable care act in medicaid expansion and non-expansion states

Anne E Larson et al. Prev Med. 2020 Dec.

Abstract

Community health centers (CHCs) play an important role in providing care for the safety net population. After implementation of the Affordable Care Act, many patients gained insurance through state and federal marketplaces. Using electronic health record data from 702,663 patients in 257 clinics across 20 states, we sought to explore the following differences between Medicaid expansion and non-expansion state CHCs: (1) trends in private/marketplace insurance post-expansion, and (2) whether CHC patients retain private/marketplace insurance. We found that patients in non-expansion state CHCs relied more heavily on private/marketplace insurance than patients in expansion states and had increases in private/marketplace-insured visits from 2014 through 2018. Additionally, there appeared to be seasonal variation in private/marketplace-insured visits that were more pronounced in non-expansion states. While a greater percentage of patients in non-expansion states retained private/marketplace insurance than in expansion states, a greater percentage of those who did not retain it became uninsured. In comparison, a greater percentage of patients in expansion states who lost private/marketplace insurance gained other types of health insurance. CHCs' ability to provide adequate care for vulnerable populations relies, in part, on federal grants as well as reimbursement from insurers: decreases in either could result in reduced capacity or quality of care for patients seen in CHCs.

Keywords: Affordable Care Act (ACA); Community health centers (CHCs); Health insurance.

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Figures

APPENDIX:
APPENDIX:
Percent of Total CHC Patients with ≥1 Private/Marketplace Insured Visit by Patient Characteristic and Expansion Status: 2014 – 2018
FIGURE 1:
FIGURE 1:
Percent of CHC visits covered by private/marketplace insurance in Medicaid expansion and non-expansion states: 2014 – 2018
FIGURE 2:
FIGURE 2:
Retention and disenrollment from private/marketplace insurance in CHCs in Medicaid expansion and non-expansion states: 2014–2018
See this image and copyright information in PMC

References

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