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Free Clinic Patients’ Perceptions and Barriers to Applying for Health Insurance After Implementation of the Affordable Care Act

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Abstract

Despite implementation of the Affordable Care Act (ACA), many Americans remain uninsured and receive care in free clinics. It is unknown what free clinic attendees in Pennsylvania know about health insurance expansion or what they perceive as barriers in enrolling in health insurance. The objective of this study was to assess the perceptions and experiences of free clinic patients from southwestern Pennsylvania when applying for health insurance after implementation of the ACA. We designed and implemented a survey of patients at three free clinics within Allegheny County, Pennsylvania from September 2016 to February 2017. Our survey included 22-items, 7 sociodemographic questions and 15 questions regarding the patient’s health status and their perspectives related to obtaining health insurance. Data was obtained from 203 patient surveys; 110 (55.3%) of the respondents were men and 99 (48.8%) were African American. There were 48 respondents (24.1%) who did not report any income at the time of the study, and of those that did report an income, 92 (46.2%) respondents reported an income below 133% of the federal poverty level. The main barriers patients faced when applying for health insurance were: (1) lack of knowledge about health insurance (n = 127, 58.1%), (2) cost of health coverage (n = 85, 41.9%), (3) lack of resources (n = 83, 40.4%), and (4) lack of enrollment documentation (n = 43, 23.8%). Significant work is needed to better educate patients about their eligibility and options for health insurance. Free clinics can play a key role in eliminating barriers to health insurance enrollment.

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Acknowledgements

Would like to thank Dr. Steven Shapiro and Dr. William Markle for guidance and mentorship during this project. We would like to show appreciation to Dr. Jalil Azmat, the CEO of the Braddock Free Clinic and Mary Herbert, the Director of the Birmingham Free Clinic, for their collaboration on this project. Finally, thank you to all the free clinic volunteers who helped make this work possible.

Funding

There was no funding for this project.

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Authors and Affiliations

  1. Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Amy J. Kennedy, Caroline Kensler, Thuy Bui & Thomas R. Radomski

  2. Department of Internal Medicine, Allegheny Heath Network, Pittsburgh, PA, 15212, USA

    Veli Bakalov

  3. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Laura Reyes-Uribe

  4. University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15261, USA

    Sharon E. Connor

  5. Division of General Internal Medicine, UPMC Hamot, Erie, PA, 16550, USA

    Maggie Benson

  6. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, 15213, USA

    Thomas R. Radomski

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  1. Amy J. Kennedy
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  2. Veli Bakalov
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  3. Laura Reyes-Uribe
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  4. Caroline Kensler
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  6. Maggie Benson
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  7. Thuy Bui
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  8. Thomas R. Radomski
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Correspondence to Amy J. Kennedy.

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Appendix 1: Survey Instrument

Appendix 1: Survey Instrument

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Kennedy, A.J., Bakalov, V., Reyes-Uribe, L. et al. Free Clinic Patients’ Perceptions and Barriers to Applying for Health Insurance After Implementation of the Affordable Care Act. J Community Health 45, 492–500 (2020). https://doi.org/10.1007/s10900-019-00766-y

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