title: An early look at rates of uninsured safety net clinic visits after the Affordable Care Act.
abstract: OBJECTIVE
  The Affordable Care Act of 2010 supports marked expansions in Medicaid coverage in the United States. As of January 1, 2014, a total of 25 states and the District of Columbia expanded their Medicaid programs. We tested the hypothesis that rates of uninsured safety net clinic visits would significantly decrease in states that implemented Medicaid expansion, compared with states that did not.
  
  
  METHODS
  We undertook a longitudinal observational study of coverage status for adult visits in community health centers, from 12 months before Medicaid expansion (January 1, 2013 to December 31, 2013) through 6 months after expansion (January 1, 2014 to June 30, 2014). We analyzed data from 156 clinics in the OCHIN practice-based research network, with a shared electronic health record, located in 9 states (5 expanded Medicaid coverage and 4 did not).
  
  
  RESULTS
  Analyses were based on 333,655 nonpregnant adult patients and their 1,276,298 in-person billed encounters. Overall, clinics in the expansion states had a 40% decrease in the rate of uninsured visits in the postexpansion period and a 36% increase in the rate of Medicaid-covered visits. In contrast, clinics in the nonexpansion states had a significant 16% decline in the rate of uninsured visits but no change in the rate of Medicaid-covered visits.
  
  
  CONCLUSIONS
  There was a substantial decrease in uninsured community health center visits and a significant increase in Medicaid-covered visits in study clinics in states that expanded Medicaid in 2014, whereas study clinics in states opting out of the expansion continued to have a high rate of uninsured visits. These findings suggest that Affordable Care Act-related Medicaid expansions have successfully decreased the number of uninsured safety net patients in the United States.
authors.affiliation: Oregon Health & Science University, Portland, Oregon angierh@ohsu.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.affiliation: OCHIN, Inc, Portland, Oregon.
authors.forename: Megan
authors.initials: M
authors.lastname: Hoopes
authors.affiliation: OCHIN, Inc, Portland, Oregon Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.affiliation: Oregon Health & Science University, Portland, Oregon.
authors.forename: Steffani R
authors.initials: SR
authors.lastname: Bailey
authors.affiliation: Oregon Health & Science University, Portland, Oregon OCHIN, Inc, Portland, Oregon.
authors.forename: Erika K
authors.initials: EK
authors.lastname: Cottrell
authors.affiliation: Oregon Health & Science University, Portland, Oregon.
authors.forename: John
authors.initials: J
authors.lastname: Heintzman
authors.affiliation: Oregon Health & Science University, Portland, Oregon.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: Oregon Health & Science University, Portland, Oregon OCHIN, Inc, Portland, Oregon.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
mesh_terms: D000328:Adult; D003151:Community Health Centers / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data* / Q000639:trends; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011320:Primary Health Care / Q000706:statistics & numerical data* / Q000639:trends; D064876:Safety-net Providers / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D055815:Young Adult
keywords: Affordable Care Act; practice-based research; primary care; safety net clinics; uninsured