Underinsurance before the implementation of the Affordable Care Act: From the Research Involving Outpatient Settings Network (RIOS Net).
BACKGROUND
As the Affordable Care Act (ACA) is implemented and many uninsured become insured, rates of underinsurance may persist or increase. This study was designed to estimate the rate of underinsurance in primary care safety net clinics serving low income, multiethnic populations in New Mexico.


METHODS
Data were collected from 2 primary care clinics in an urban setting during a 2-week period in 2011 and 2012. Voluntary, anonymous, self-administered surveys were distributed to adult patients waiting to be seen by their doctor. Surveys were available in English and Spanish.


RESULTS
Of those insured, 44% were underinsured. The underinsured comprised higher proportions of patients who were Hispanic, young, and poor; 39% reported fair or poor health, 23% reported that their health suffered from an inability to seek care because of cost, and 53% had either Medicaid or state coverage insurance. Patients with an income of ≤$25,000 were 8 times more likely to be underinsured.


CONCLUSIONS
A high level of underinsurance was found in these safety net clinics. Because millions of Americans gain health care insurance benefits, monitoring whether the current reform provides adequate health care coverage or whether those with new and existing health care insurance are underinsured is critical.
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
Gina
G
Cardinali
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN). RRhyne@salud.unm.edu.
Robert L
RL
Rhyne
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
Anthony
A
Fleg
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
Bernadette N
BN
Corum
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
Dechen
D
Tsewang
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
Angela
A
Jo
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
Josh
J
Leiderman
From the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque (GC, RLR, AF, AJ, JL, CN); the Indian Health Service, Not-tsoo Gah-nee Indian Health Center, Fort Hall, ID (BNC); the Santa Fe Service Unit, Indian Health Service, Santa Fe, NM (DT); Ambulatory Services, University of New Mexico Hospital, Albuquerque (CN).
Charles
C
North
D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D055815:Young Adult
Affordable Care Act; Health Insurance; Practice-based Research; Primary Health Care; Underinsured