Health Insurance Coverage Changes in Community Health Centers after the Affordable Care Act

Health Insurance Coverage Changes in Community Health Centers after the Affordable Care Act

By Heather Angier & Megan Hoopes

In the US, racial and ethnic minorities have been significantly less likely to have health insurance than non-Hispanic whites. OHSU and OCHIN conducted a new research study to find out if these disparities in health insurance coverage were reduced after the Affordable Care Act (ACA) expanded Medicaid coverage eligibility.

Using electronic health record (EHR) data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) clinical data research network, we compared differences in Medicaid, private, or uninsured visits before and after the ACA in 10 states that expanded Medicaid and 6 states that did not. The dataset included 359 CHCs, and 870,319 patients with >4 million visits.

The study found uninsured visit rates decreased for all racial/ethnic groups after the ACA. Yet, there were differences in expansion compared to non-expansion states: there were greater decreases in uninsured visit rates and greater increases in Medicaid-insured visit rates in expansion states than in non-expansion states. Also, Hispanic patients had the highest uninsured visit rates before and after the ACA compared to non-Hispanics.

Overall, this study suggests the ACA is having its intended impact. The progress; however, was not uniform in expansion versus non-expansion states or among all racial/ethnic minority subgroups. Thus, equity in health insurance coverage has not yet been achieved. As the future of the ACA is unknown, so are health insurance disparities.