title: The Perceived Impact of the Patient Protection and Affordable Care Act on North Carolina's Free Clinics.
abstract: BACKGROUND
  The Patient Protection and Affordable Care Act of 2010 (ACA) may dramatically affect the demographics of the uninsured population and the funding prospects for free health clinics.
  
  
  METHODS
  We conducted a cross-sectional survey of 64 of 80 free clinics (80.0% response rate) in North Carolina to assess free clinic directors' knowledge of the ACA and their perceptions of how the ACA would affect clinic operations.
  
  
  RESULTS
  Free clinic directors were knowledgeable about well publicized aspects of the ACA (eg, lack of Medicaid expansion in North Carolina), but they were less knowledgeable about provisions such as the Federal Tort Claims Act and high-risk pools, which may have direct and indirect effects on free clinics. Directors expressed concern over the unintended consequences of the ACA, such as reduced funding and reduced volunteerism. Anticipated clinic changes as a result of the ACA include initiation of electronic medical records and, to a lesser extent, a move to become "hybrid" clinics (federally qualified health center look-alikes).
  
  
  CONCLUSIONS
  This study is focused on North Carolina free clinics that are members of the North Carolina Association of Free Clinics (NCAFC). Findings cannot be generalized to non-NCAFC free clinics or to free clinic networks outside the state.
  
  
  CONCLUSIONS
  Despite its effort to expand health insurance coverage, the ACA may have unintended consequences to low-cost free clinics that serve uninsured populations.
authors.affiliation: graduate student, Department of Immunology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Swan
authors.affiliation: professor, Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina kfoley@wakehealth.edu.
authors.forename: Kristie L
authors.initials: KL
authors.lastname: Foley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009657:North Carolina; D058991:Patient Protection and Affordable Care Act; D008486:Physician Executives; D055815:Young Adult