title: Insurance Enrollment at a Student-Run Free Clinic After the Patient Protection and Affordable Care Act.
abstract: The Patient Protection and Affordable Care Act (ACA) aims to increase insurance coverage through government subsidies. Medical student-run free clinics (SRFC) are an important entry point into the healthcare system for the uninsured. SRFCs do not have a standardized approach for navigating the complexities of enrollment. The Weill Cornell Community Clinic (WCCC) developed a unique enrollment model that may inform other SRFCs. Our objective is to describe enrollment processes at SRFCs throughout New York City, and to evaluate enrollment outcomes and persistent barriers to coverage at WCCC. We surveyed SRFC leadership throughout NYC to understand enrollment processes. We evaluated enrollment outcomes at WCCC through chart review and structured phone interviews. Subjects included WCCC patients seen in clinic between October 1, 2013 and September 30, 2015 (N = 140). Demographic information, method of insurance enrollment, and qualitative description of enrollment barriers were collected. SRFCs in New York City have diverse enrollment processes. 48% (N = 42) of WCCC patients obtained health insurance. Immigration status was a barrier to coverage in 21% of patients. Failure to gain coverage was predicted by larger household size (p = 0.02). Gender and employment status were not associated with remaining uninsured. The main barriers to enrollment were inability to afford premiums and lack of interest. Insurance enrollment processes at SRFCs in New York City are mostly ad hoc and outcomes are rarely tracked. Following implementation of the ACA, WCCC stands out for its structured approach, with approximately half of eligible WCCC patients gaining coverage during the study period.
authors.affiliation: Weill Cornell Medical College, 445 E 69th Street, Box 31, New York, NY, 10021, USA. mam2167@med.cornell.edu.
authors.forename: Megan
authors.identifier: http://orcid.org/0000-0003-1097-6480
authors.initials: M
authors.lastname: McGeehan
authors.affiliation: Weill Cornell Medical College, 445 E 69th Street, Box 31, New York, NY, 10021, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: DeMaria
authors.affiliation: Weill Cornell Medical College, 445 E 69th Street, Box 31, New York, NY, 10021, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Charney
authors.affiliation: Weill Cornell Medical College, 445 E 69th Street, Box 31, New York, NY, 10021, USA.
authors.forename: Ashita S
authors.initials: AS
authors.lastname: Batavia
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009519:New York City; D058991:Patient Protection and Affordable Care Act; D012737:Sex Factors; D012959:Socioeconomic Factors; D000070319:Student Run Clinic / Q000458:organization & administration*; D000069756:Undocumented Immigrants; D014481:United States
keywords: Affordable Care Act; Insurance enrollment; Underserved populations