Health Insurance Challenges in the Post-Affordable Care Act (ACA) Era: a Qualitative Study of the Perspective of Low-Income People of Color in Metropolitan Detroit.
Low-income people of color are at risk of remaining uninsured due to a variety of factors. This study examined Affordable Care Act (ACA)-related and other health insurance enrollment experiences, observations, navigation needs, and experiences maintaining health insurance coverage among low-income communities of color in an economically disadvantaged community (Metropolitan Detroit). We conducted nine focus groups (n = 87) between May and June 2015. Participants were recruited through community-based organizations serving our key populations of interest. Using an inductive thematic analysis approach, codes and themes were generated. Findings from six themes demonstrated that although health insurance is perceived as important, confusion and frustration persist around health plan benefits and coverage, eligibility requirements and key provisions of the ACA, and enrollment. Individuals face difficulties justifying the cost of health insurance. More focused insurance outreach efforts are needed to achieve the ultimate goal of improving the health of low-income communities of color.
Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Ann Arbor, MI, 48109-2029, USA. minalrp@umich.edu.
Minal R
MR
Patel
Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, SPH 2, Ann Arbor, MI, 48109-2029, USA.
Alison
A
Jensen
Community Health and Social Services Center Inc., 5635 W Fort St, Detroit, MI, 48209, USA.
Erminia
E
Ramirez
Arab Community Center for Economic and Social Services, 2651 Saulino Court, Dearborn, MI, 48120, USA.
Madiha
M
Tariq
Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Ann Arbor, MI, 48109-2029, USA.
Ian
I
Lang
Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Ann Arbor, MI, 48109-2029, USA.
Theresa
T
Kowalski-Dobson
Covenant Community Care, 5716 Michigan Ave, Detroit, MI, 48210, USA.
Joslyn
J
Pettway
Mercy Primary Care, 5555 Conner Ln #2691, Detroit, MI, 48215, USA.
Michelle
M
Famulare
Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, SPH 2, Ann Arbor, MI, 48109-2029, USA.
Richard
R
Lichtenstein
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D018912:Arabs / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D036301:Qualitative Research; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
Affordable Care Act; Barriers; Health insurance; Outreach