Health Insurance Challenges in the Post-Affordable Care Act (ACA) Era: a Qualitative Study of the Perspective of Low-Income People of Color in Metropolitan Detroit

  • Minal R. Patel
  • Alison Jensen
  • Erminia Ramirez
  • Madiha Tariq
  • Ian Lang
  • Theresa Kowalski-Dobson
  • Joslyn Pettway
  • Michelle Famulare
  • Richard Lichtenstein


Low-income people of color are at risk of remaining uninsured due to a variety of factors. This study examined Affordable Care Act (ACA)-related and other health insurance enrollment experiences, observations, navigation needs, and experiences maintaining health insurance coverage among low-income communities of color in an economically disadvantaged community (Metropolitan Detroit). We conducted nine focus groups (n = 87) between May and June 2015. Participants were recruited through community-based organizations serving our key populations of interest. Using an inductive thematic analysis approach, codes and themes were generated. Findings from six themes demonstrated that although health insurance is perceived as important, confusion and frustration persist around health plan benefits and coverage, eligibility requirements and key provisions of the ACA, and enrollment. Individuals face difficulties justifying the cost of health insurance. More focused insurance outreach efforts are needed to achieve the ultimate goal of improving the health of low-income communities of color.


Health insurance Barriers Affordable Care Act Outreach 


Compliance with Ethical Standards


This study was funded through the National Institute for Health Care Reform (UM#N019071).

Conflict of Interest

All authors declare that they have no conflict of interest.

Statement of Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Michigan Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2017

Authors and Affiliations

  • Minal R. Patel
    • 1
  • Alison Jensen
    • 2
  • Erminia Ramirez
    • 3
  • Madiha Tariq
    • 4
  • Ian Lang
    • 1
  • Theresa Kowalski-Dobson
    • 1
  • Joslyn Pettway
    • 5
  • Michelle Famulare
    • 6
  • Richard Lichtenstein
    • 2
  1. 1.Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborUSA
  2. 2.Department of Health Management and PolicyUniversity of Michigan School of Public HealthAnn ArborUSA
  3. 3.Community Health and Social Services Center Inc.DetroitUSA
  4. 4.Arab Community Center for Economic and Social ServicesDearbornUSA
  5. 5.Covenant Community CareDetroitUSA
  6. 6.Mercy Primary CareDetroitUSA

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