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Why Uninsured Free Clinic Patients Don’t Apply for Affordable Care Act Health Insurance in a Non-expanding Medicaid State

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Abstract

Even after the introduction of the Patient Protection and Affordable Care Act (ACA), uninsured visits remain high, especially in states that opted out of Medicaid expansion. Since the ACA does not provide universal coverage, free clinics serve as safety nets for the un- or under-insured, and will likely continue serving underserved populations. The purpose of this study is to examine factors influencing intentions to not apply for health insurance via the ACA among uninsured free clinic patients in a state not expanding Medicaid. Uninsured primary care patients utilizing a free clinic (N = 551) completed a self-administered survey in May and June 2015. Difficulty obtaining information, lack of instruction to apply, and cost, are major factors influencing intention not to apply for health insurance through the ACA. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of perceived barriers to applying for health insurance through the ACA. Age is an important factor impacting individuals’ intentions not to apply for health insurance through the ACA, as older patients in particular need assistance to obtain relevant information about the ACA and other resources. A number of unchangeable factors limit the free clinics’ ability to promote enrollment of health insurance through the ACA. Yet free clinics could be able to provide some educational programs or the information of resources to patients. In particular, non-US born English speakers, Spanish speakers, and older adults need specific assistance to better understand health insurance options available to them.

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Acknowledgments

This project was funded by the Public Service Professorship, Lowell Bennion Community Service Center at the University of Utah. The authors want to thank the patients who participated in this study and acknowledge the contribution of the staff and volunteers of the Maliheh Free Clinic. In addition, we thank Nushean Assasnik, Travis Dixon, Anthony Mills, Molly Pace, Naveen Rathi, Monica Scott, Emily Stephens, Tamara Stephens, Ha Trinh, and Lindsey Wright for their help in data collection, data entry or translation related to this study.

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Authors and Affiliations

  1. Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT, 84112, USA

    Akiko Kamimura, Jennifer Tabler, Alla Chernenko, Guadalupe Aguilera & Liana Prudencio

  2. School of Medicine, University of Utah, Salt Lake City, UT, USA

    Maziar M. Nourian

  3. Maliheh Free Clinic, Salt Lake City, UT, USA

    Jeanie Ashby

Authors
  1. Akiko Kamimura
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  2. Jennifer Tabler
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  3. Alla Chernenko
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  4. Guadalupe Aguilera
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  5. Maziar M. Nourian
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  6. Liana Prudencio
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  7. Jeanie Ashby
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Corresponding author

Correspondence to Akiko Kamimura.

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The University of Utah Institutional Review Board (IRB) approved this study.

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Kamimura, A., Tabler, J., Chernenko, A. et al. Why Uninsured Free Clinic Patients Don’t Apply for Affordable Care Act Health Insurance in a Non-expanding Medicaid State. J Community Health 41, 119–126 (2016). https://doi.org/10.1007/s10900-015-0076-3

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  • DOI: https://doi.org/10.1007/s10900-015-0076-3

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