title: Improving Health Care for the Future Uninsured in Los Angeles County: A Community-Partnered Dialogue.
abstract: OBJECTIVE
  To understand the health care access issues faced by Los Angeles (LA) County's uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue.
  
  
  METHODS
  Qualitative study using a community-partnered participatory research framework.
  
  
  METHODS
  Community forum breakout discussion.
  
  
  CONCLUSIONS
  Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district.
  
  
  METHODS
  Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes.
  
  
  RESULTS
  Five overarching value themes were identified - knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in "outsider" community-based providers not related to quality.
  
  
  CONCLUSIONS
  Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations.
authors.affiliation: 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 2. VISN3 Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY ; 3. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
authors.forename: Sharat P
authors.initials: SP
authors.lastname: Iyer
authors.affiliation: 4. Charles R. Drew University of Medicine and Science, Los Angeles ; 5. Healthy African American Families, Los Angeles.
authors.forename: Andrea
authors.initials: A
authors.lastname: Jones
authors.affiliation: 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 6. National Research Service Award GIM Fellowship in Primary Care & Health Services Research, University of California, Los Angeles.
authors.forename: Efrain
authors.initials: E
authors.lastname: Talamantes
authors.affiliation: 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Barnert
authors.affiliation: 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 7. Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles ; 8. VA Greater Los Angeles Healthcare System.
authors.forename: Hemal K
authors.initials: HK
authors.lastname: Kanzaria
authors.affiliation: 6. National Research Service Award GIM Fellowship in Primary Care & Health Services Research, University of California, Los Angeles.
authors.forename: Alissa
authors.initials: A
authors.lastname: Detz
authors.affiliation: 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Daskivich
authors.affiliation: 4. Charles R. Drew University of Medicine and Science, Los Angeles ; 5. Healthy African American Families, Los Angeles.
authors.forename: Loretta
authors.initials: L
authors.lastname: Jones
authors.affiliation: 10. Los Angeles County Department of Health Services.
authors.forename: Gery W
authors.initials: GW
authors.lastname: Ryan
authors.affiliation: 10. Los Angeles County Department of Health Services ; 11. Division of General Internal Medicine and Health Service Research, University of California, Los Angeles.
authors.forename: Anish P
authors.initials: AP
authors.lastname: Mahajan
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act; D055818:Public-Private Sector Partnerships / Q000458:organization & administration*
keywords: Community Health Services; Health Services Accessibility; Medically Uninsured; Patient Protection and Affordable Care Act