title: Barriers to Health Insurance Pre- and Post-Affordable Care Act Implementation in Providence, RI.
abstract: The impact of healthcare reform under the Affordable Care Act (ACA) on individuals living in cities has not yet been quantified by local Departments of Health. This makes it difficult for safety net sources of healthcare, such as free clinics, to plan for the future. Therefore, members of Clinica Esperanza/Hope Clinic conducted a survey in predominantly Latino communities of South and West Providence, RI, using a convenience sample method (N = 206). Survey results were compared to a prior survey conducted in the same communities prior to ACA implementation. Despite gains due to Obamacare, a much higher level of uninsurance was reported in this survey than has been reported statewide. In 2014, as compared to 2010, 48% vs. 95% of respondents reported being uninsured, and more held private (20% vs. 5%) or government-subsidized health insurance (32% vs. 1%). Undocumented immigration status and cost were the two most commonly reported reasons for remaining uninsured under the ACA. First-generation immigrants living in urban centers are still reporting significantly higher rates of uninsurance (48%) than the general population in RI (7.4%).
authors.affiliation: University of Rhode Island, student volunteer at Clinica Esperanza/Hope Clinic.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pigoga
authors.affiliation: Smith College, volunteer at Clinica Esperanza/Hope Clinic and research assistant at EpiVax, Inc.
authors.forename: Farzana
authors.initials: F
authors.lastname: Kibria
authors.affiliation: Brown University, student volunteer at Clinica Esperanza/Hope Clinic.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pinilla
authors.affiliation: volunteer Research Consultant for Clinica Esperanza/Hope Clinic and is currently enrolled as a medical student at the University of Miami Medical School.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bicki
authors.affiliation: Nurse Director at Clinica Esperanza/Hope Clinic.
authors.forename: Valerie
authors.initials: V
authors.lastname: Joseph
authors.affiliation: volunteer Medical Director at Clinica Esperanza/Hope Clinic, Director of the Institute for Immunology and Informatics at University of Rhode Island, and Chief Executive and Scientific Officer at EpiVax, Inc.
authors.forename: Anne S
authors.initials: AS
authors.lastname: De Groot
mesh_terms: D000328:Adult; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D012237:Rhode Island / Q000453:epidemiology
keywords: Affordable Care Act; free clinic; health disparities; immigrant; uninsured