Why Uninsured Free Clinic Patients Don't Apply for Affordable Care Act Health Insurance in a Non-expanding Medicaid State.
Even after the introduction of the Patient Protection and Affordable Care Act (ACA), uninsured visits remain high, especially in states that opted out of Medicaid expansion. Since the ACA does not provide universal coverage, free clinics serve as safety nets for the un- or under-insured, and will likely continue serving underserved populations. The purpose of this study is to examine factors influencing intentions to not apply for health insurance via the ACA among uninsured free clinic patients in a state not expanding Medicaid. Uninsured primary care patients utilizing a free clinic (N = 551) completed a self-administered survey in May and June 2015. Difficulty obtaining information, lack of instruction to apply, and cost, are major factors influencing intention not to apply for health insurance through the ACA. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of perceived barriers to applying for health insurance through the ACA. Age is an important factor impacting individuals' intentions not to apply for health insurance through the ACA, as older patients in particular need assistance to obtain relevant information about the ACA and other resources. A number of unchangeable factors limit the free clinics' ability to promote enrollment of health insurance through the ACA. Yet free clinics could be able to provide some educational programs or the information of resources to patients. In particular, non-US born English speakers, Spanish speakers, and older adults need specific assistance to better understand health insurance options available to them.
Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT, 84112, USA. akiko.kamimura@utah.edu.
Akiko
A
Kamimura
Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT, 84112, USA.
Jennifer
J
Tabler
Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT, 84112, USA.
Alla
A
Chernenko
Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT, 84112, USA.
Guadalupe
G
Aguilera
School of Medicine, University of Utah, Salt Lake City, UT, USA.
Maziar M
MM
Nourian
Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT, 84112, USA.
Liana
L
Prudencio
Maliheh Free Clinic, Salt Lake City, UT, USA.
Jeanie
J
Ashby
D000328:Adult; D000367:Age Factors; D000554:Ambulatory Care Facilities; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States
Affordable Care Act; Free clinics; Uninsured