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Insurance Enrollment at a Student-Run Free Clinic After the Patient Protection and Affordable Care Act

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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.

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References

  1. Hadley, J. (2007). Insurance coverage, medical care use, and short-term health changes following an unintentional injury or the onset of a chronic condition. JAMA: The Journal of the American Medical Association, 297(10), 1073–1084.

    Article  CAS  PubMed  Google Scholar 

  2. Burt, C. W., & Arispe, I. E. (2004). Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000. Vital and Health Statistics. Series 13, Data from the National Health Survey (vol. 155, pp. 1–16). Hyattsville: National Center for Health Statistics.

  3. Baker, L. C., & Baker, L. S. (1994). Excess cost of emergency department visits for nonurgent care. Health Affairs (Project Hope), 13(5), 162–171.

    Article  CAS  Google Scholar 

  4. Simonet, D. (2009). Cost reduction strategies for emergency services: Insurance role, practice changes and patients accountability. Health Care Analysis: HCA: Journal of Health Philosophy and Policy, 17(1), 1–19.

    Article  Google Scholar 

  5. New York State of Health. Marketplace: Individual and families. Retrieved June 1, 2016, from https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/search.

  6. McInnes, D. K., Li, A. E., & Hogan, T. P. (2013). Opportunities for engaging low-income, vulnerable populations in health care: A systematic review of homeless persons’ access to and use of information technologies. American Journal of Public Health, 103, e11–24.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fryling, L. R., Mazanec, P., & Rodriguez, R. M. (2015). Barriers to homeless persons acquiring health insurance through the affordable care act. The Journal of Emergency Medicine, 49(5), 755–762.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Desmond, B. S., Laux, M. A., Levin, C. C., Huang, J., & Williams, B. C. (2016). Reasons why individuals remain uninsured under the affordable care act: Experiences of patients at a student-run free clinic in Michigan, a medicaid expansion state. Journal of Community Health, 41(2), 417–423.

    Article  PubMed  Google Scholar 

  9. Kamimura, A., Tabler, J., Chernenko, A., et al. (2016). Why uninsured free clinic patients don’t apply for affordable care act health insurance in a non-expanding medicaid state. Journal of Community Health, 41(1), 119–126.

    Article  PubMed  Google Scholar 

  10. Petrany, S. M., & Christiansen, M. (2014). Knowledge and perceptions of the affordable care act by uninsured patients at a free clinic. Journal of Health Care for the Poor and Underserved, 25(2), 675–682.

    Article  PubMed  Google Scholar 

  11. Rudowitz, R. (2014). Understanding How States Access the ACA Enhanced Medicaid Match Rates. Retrieved June 1, 2016, from http://kff.org/medicaid/issue-brief/understanding-how-states-access-the-aca-enhanced-medicaid-match-rates/.

  12. The Henry J. Kaiser Family Foundation. (2014). Health Insurance Coverage of the Total Population. Retrieved April 5, 2016, from http://kff.org/other/state-indicator/total-population/.

  13. The Henry J. Kaiser Family Foundation. (2016). Key Facts about the Uninsured Population. Retrieved March 13, 2016, from http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/.

  14. Simpson, S. A., & Long, J. A. (2007). Medical student-run health clinics: Important contributors to patient care and medical education. Journal of General Internal Medicine, 22(3), 352–356.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kamimura, A., Christensen, N., Tabler, J., Ashby, J., & Olson, L. M. (2013). Patients utilizing a free clinic: Physical and mental health, health literacy, and social support. Journal of Community Health, 38(4), 716–723.

    Article  PubMed  Google Scholar 

  16. Cadzow, R. B., Servoss, T. J., & Fox, C. H. (2007). The health status of patients of a student-run free medical clinic in inner-city Buffalo, NY. Journal of the American Board of Family Medicine: JABFM, 20(6), 572–580.

    Article  PubMed  Google Scholar 

  17. Niescierenko, M. L., Cadzow, R. B., & Fox, C. H. (2006). Insuring the uninsured: A student-run initiative to improve access to care in an urban community. Journal of the National Medical Association, 98(6), 906–911.

    PubMed  PubMed Central  Google Scholar 

  18. NADAP. (2015). Health Insurance Navigator Service NADAP. Retrieved July 6, 2016, from http://www.nadap.org/services/ipa-navigator/.

  19. Kotagal, M., Carle, A. C., Kessler, L. G., & Flum, D. R. (2014). Limited impact on health and access to care for 19- to 25-year-olds following the patient protection and affordable care act. JAMA Pediatrics, 168(11), 1023–1029.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Courtemanche, C., Marton, J., & Yelowitz, A. (2016). Who gained insurance coverage in 2014, the first year of full ACA implementation? Health Economics, 25(6), 778–784.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wherry, L. R., & Miller, S. (2016). Early coverage, access, utilization, and health effects associated with the affordable care act medicaid expansions. Annals of Internal Medicine, 795–804.

  22. Wallace, J., & Sommers, B. D. (2015). Effect of dependent coverage expansion of the affordable care act on health and access to care for young adults. JAMA Pediatrics, 169(5), 495–497.

    Article  PubMed  Google Scholar 

  23. Park, M. J., Mulye, T. P., Adams, S. H., Brindis, C. D., & Irwin, C. E. (2006). The health status of young adults in the United States. Journal of Adolescent Health, 39(3), 305–317.

    Article  PubMed  Google Scholar 

  24. Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The affordable care act has led to significant gains in health insurance and access to care for young adults. Health Affairs (Project Hope), 32(1), 165–174.

    Article  Google Scholar 

  25. Abramowitz, J., & O’Hara, B. (2015). The financial burden of medical spending: Estimates and implications for evaluating the impact of ACA reforms. Medical Care Research and Review: MCRR, 72(2), 187–199.

    Article  PubMed  Google Scholar 

  26. Wallace, S. P., Torres, J., Sadegh-Nobari, T., & Pourat, N. (2013). Undocumented and uninsured: Barriers to affordable care for immigrant population. The Commonwealth Fund. Retrieved July 6, 2016, from http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Aug/1699_Wallace_undocumented_uninsured_barriers_immigrants_v2.pdf.

  27. Darnell, J. S. (2010). Free clinics in the United States: A nationwide survey. Archives of Internal Medicine, 170(11), 946–953.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to acknowledge the contributions of Lusha Liang, MD, Caroline Pinke, MD, Emily Nash, Shobana Ramasamy, Kristy Krsulich, LCSW, Lisa Noble, and Hannah Huang to this paper. We have not received financial support for this research.

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This study was not funded.

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Authors and Affiliations

  1. Weill Cornell Medical College, 445 E 69th Street, Box 31, New York, NY, 10021, USA

    Megan McGeehan, Rebecca DeMaria, Pamela Charney & Ashita S. Batavia

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  1. Megan McGeehan
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  2. Rebecca DeMaria
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  3. Pamela Charney
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  4. Ashita S. Batavia
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Correspondence to Megan McGeehan.

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McGeehan, M., DeMaria, R., Charney, P. et al. Insurance Enrollment at a Student-Run Free Clinic After the Patient Protection and Affordable Care Act. J Community Health 42, 785–790 (2017). https://doi.org/10.1007/s10900-017-0318-7

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  • DOI: https://doi.org/10.1007/s10900-017-0318-7

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