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
Since the enactment of the Affordable Care Act (ACA), many people remain uninsured. While studies have examined this population, few have explored patients’ experiences seeking insurance. To elucidate these individuals’ perspectives, we surveyed patients (n = 80) at the University of Michigan Student-Run Free Clinic concerning their activity accessing insurance. Over half of respondents had sought insurance in the past 6 months; 57 % of respondents qualified for Medicaid by self-reported income (≤138 % FPL) and all but one were eligible for tax credits on the Health Insurance Marketplace. However, only 35 % of apparently Medicaid-eligible respondents had recently applied. There was no significant difference in the rate of applying for those above the income cutoff (p = 0.901). Perceived expense of plans and belief of ineligibility for Medicaid discouraged respondents from actively seeking insurance. Personalized outreach emphasizing new Medicaid eligibility requirements and tax credits may be needed to facilitate Medicaid enrollment for some uninsured persons under the ACA.
KeywordsHealth insurance Medicaid Tax credits Eligibility Michigan State health plan Healthcare reform Health insurance exchanges Adults Cost of healthcare Disparities
- 1.Henry, J. (2013). Kaiser Family Foundation. Summary of the Affordable Care Act. CA, USA. Fact sheet [#8061-02]. http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/.
- 2.Institute of Medicine. (2009). America’s uninsured crisis: consequences for health and health care. Washington, DC. Report brief. http://iom.nationalacademies.org/Reports/2009/Americas-Uninsured-Crisis-Consequences-for-Health-and-Health-Care.aspx.
- 3.Cohen, R. A., & Martinez, M. E. (2015). Health insurance coverage: Early release of estimates from National Health Interview Survey, 2014. National Center for Health Statistics.Google Scholar
- 4.Witters, D. (2015). In U.S., uninsured rates continue to drop in most states. Washington, D.C.: Gallup. http://www.gallup.com/poll/184514/uninsured-rates-continue-drop-states.aspx.
- 5.Robert Wood Johnson Foundation. (2015, June). Understanding the uninsured now. Conducted by PerryUndem Research/Communication. http://www.rwjf.org/en/library/research/2015/06/understanding-the-uninsured-now.html.
- 6.Kamimura, A., et al. (2015). Why uninsured free clinic patients don’t apply for Affordable Care Act Health Insurance in a Non-expanding Medicaid State. Journal of Community Health. doi:10.1007/s10900-015-0076-3.
- 8.Henry, J. (2014, January). Kaiser Family Foundation. How will the uninsured in Michigan fare under the Affordable Care Act? CA, USA. Fact sheet. https://kaiserfamilyfoundation.files.wordpress.com/2014/01/8531-mi.pdf.
- 9.Michigan Department of Health and Human Services. (2015). Adult benefits waiver. Lansing, MI. http://www.michigan.gov/mdhhs/0,5885,7-339-71547_2943_4853-66333--,00.html.
- 10.Centers for Medicare and Medicaid Services. (2015, June). Medicaid and CHIP: April 2015 monthly applications, eligibility determinations, and enrollment report. Baltimore, MD: U.S. Department of Health and Human Services. http://www.medicaid.gov/medicaid-chip-program-information/program-information/downloads/april-2015-enrollment-report.pdf.
- 11.Angelotti, S. (2013, March). Fiscal analysis of Governor Snyder’s Medicaid expansion proposal. MI, USA. Issue paper. http://www.senate.michigan.gov/sfa/Publications/Issues/MedicaidExpansion/MedicaidExpansionProposal.pdf.
- 12.Henry J. (2013, October). Kaiser Family Foundation. Medicaid eligibility for adults as of January 1, 2014. CA, USA. Fact sheet. http://kff.org/medicaid/fact-sheet/medicaid-eligibility-for-adults-as-of-january-1-2014/#footnote-EN8497.