Journal of Community Health

, Volume 41, Issue 2, pp 417–423 | Cite as

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

  • Brian S. Desmond
  • Molly A. Laux
  • Carolyn C. Levin
  • Jiaxin Huang
  • Brent C. Williams
Original Paper


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.


Health insurance Medicaid Tax credits Eligibility Michigan State health plan Healthcare reform Health insurance exchanges Adults Cost of healthcare Disparities 



We are grateful to all of the contributors who made this study possible. We would like to thank the entire 2014–2015 UMSRFC student leadership, who continue to work tirelessly to reach the health care and educational missions of the clinic. This work was also made possible through the help of volunteer University of Michigan undergraduate students—Chelsea Finkbeiner, Michael Mitchell, Caitlin Urban, and Wendy Wismer—who administered surveys to our patients. Finally, a number of University of Michigan faculty provided essential editorial advice in writing this paper: Hari S. Conjeevaram, MD, MS; Joseph C. Kolars, MD; John Z. Ayanian, MD, MPP; and Kara Gavin, MS. Finally, we would like to thank the UMSRFC patients who continually teach us.

Compliance with Ethical Standards

Conflict of interest

Authors have no financial conflicts of interest related to the work described in this manuscript.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Brian S. Desmond
    • 1
  • Molly A. Laux
    • 1
  • Carolyn C. Levin
    • 1
  • Jiaxin Huang
    • 1
  • Brent C. Williams
    • 2
  1. 1.Medical StudentsUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Associate Professor of Internal MedicineMedical Director, Complex Care Management Program, University of Michigan Health SystemAnn ArborUSA

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