More than 1 million uninsured patients of community health centers will be left without the protection of health insurance after full implementation of the Affordable Care Act, according to a report.
The report authors estimated more than 5 million health center patients would have gained coverage had all states participated in the expansion of Medicaid eligibility. However, nearly half of all CHCs are located in states that have opted out of the expansion, according to the report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services. (Note: see www.nurse.com/aca for a map of which states are planning to expand Medicaid.)
The nations 1,128 CHCs provide comprehensive care in 8,000 medically underserved urban and rural communities. The new report uses survey data to estimate the number of CHC patients who would gain coverage under the ACAs expansion of Medicaid. Last years Supreme Court ruling upheld the ACA but allowed states to choose whether to participate in the Medicaid expansion. States can opt in or out of Medicaid expansion in any year under the ACA.
Peter Shin, PhD, MPH, and his colleagues analyzed data from both the 2009 Health Center User Survey and the 2011 Uniform Data System to gauge the impact of the ACA on health center patients nationally and in all 50 states and Washington, D.C. Based on conservative assumptions, the analysis showed that more than 1 million health center patients in the opt-out states who would have gained Medicaid coverage under an expansion likely will remain without insurance. These patients are very poor but do not qualify for the traditional Medicaid program and often cannot pay for healthcare even at reduced fees, according to the study.
These patients also are too poor to qualify for subsidies that would allow them to purchase health insurance at reduced rates in the new health insurance exchanges. Language in the ACA restricts subsidy eligibility to those with incomes between 100% and 400% of the federal poverty level. When the law was written, the assumption was that those with incomes lower than 100% of federal poverty would be eligible for Medicaid in all states.
The 518 health centers located in the opt-out states will receive approximately $555 million less in funding than they would have received had their states expanded Medicaid. Yet by law, they still will be treating all community residents, including those who lack health insurance or the means to pay for care, the authors noted.
The report paints a disparate picture for the 582 health centers in states that participate in the Medicaid expansion. Approximately 2.8 million patients at these health centers will gain coverage as a result of that decision. This added coverage will translate into a potential revenue increase of over $2 billion, which will support expanded staff and services.
States that have rejected the Medicaid expansion might reconsider and decide to expand coverage. Ohios just-announced Medicaid expansion is estimated to translate to coverage for more than 63,000 additional residents and an additional $29 million in revenue gains in 2014 across 33 health centers, according to the report.
But in the near term, the report warns that many poor people living in the 25 opt-out states will continue to lack coverage and might find long wait times at clinics, long distances to find care and other barriers that could translate to delays in treatment or no care at all. CHCs in those states will be unable to add much-needed services such as mental health or dental care, according to the report, or to expand into remote or other seriously underserved areas where people might have to travel for hours to find a doctor.