title: Reasons Why Individuals Remain Uninsured Under the Affordable Care Act: Experiences of Patients at a Student-Run Free Clinic in Michigan, a Medicaid Expansion State.
abstract: Since the enactment of the Affordable Care Act (ACA), many people remain uninsured. While studies have examined this population, few have explored patients' experiences seeking insurance. To elucidate these individuals' perspectives, we surveyed patients (n = 80) at the University of Michigan Student-Run Free Clinic concerning their activity accessing insurance. Over half of respondents had sought insurance in the past 6 months; 57 % of respondents qualified for Medicaid by self-reported income (≤138 % FPL) and all but one were eligible for tax credits on the Health Insurance Marketplace. However, only 35 % of apparently Medicaid-eligible respondents had recently applied. There was no significant difference in the rate of applying for those above the income cutoff (p = 0.901). Perceived expense of plans and belief of ineligibility for Medicaid discouraged respondents from actively seeking insurance. Personalized outreach emphasizing new Medicaid eligibility requirements and tax credits may be needed to facilitate Medicaid enrollment for some uninsured persons under the ACA.
authors.affiliation: Medical Students, University of Michigan Medical School, Ann Arbor, MI, 48109-2800, USA. bdesmond@med.umich.edu.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Desmond
authors.affiliation: Medical Students, University of Michigan Medical School, Ann Arbor, MI, 48109-2800, USA.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Laux
authors.affiliation: Medical Students, University of Michigan Medical School, Ann Arbor, MI, 48109-2800, USA.
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Levin
authors.affiliation: Medical Students, University of Michigan Medical School, Ann Arbor, MI, 48109-2800, USA.
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Huang
authors.affiliation: Associate Professor of Internal Medicine, Medical Director, Complex Care Management Program, University of Michigan Health System, Ann Arbor, MI, 48109-2800, USA.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence; D017057:Medically Uninsured; D008824:Michigan; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D000070319:Student Run Clinic; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: Adults; Cost of healthcare; Disparities; Eligibility; Health insurance; Health insurance exchanges; Healthcare reform; Medicaid; Michigan; State health plan; Tax credits