Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal Research

An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act

Heather Angier, Megan Hoopes, Rachel Gold, Steffani R. Bailey, Erika K. Cottrell, John Heintzman, Miguel Marino and Jennifer E. DeVoe
The Annals of Family Medicine January 2015, 13 (1) 10-16; DOI: https://doi.org/10.1370/afm.1741
Heather Angier
1Oregon Health & Science University, Portland, Oregon
MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: angierh@ohsu.edu
Megan Hoopes
2OCHIN, Inc, Portland, Oregon
MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rachel Gold
2OCHIN, Inc, Portland, Oregon
3Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
PhD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Steffani R. Bailey
1Oregon Health & Science University, Portland, Oregon
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Erika K. Cottrell
1Oregon Health & Science University, Portland, Oregon
2OCHIN, Inc, Portland, Oregon
PhD, MPP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
John Heintzman
1Oregon Health & Science University, Portland, Oregon
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Miguel Marino
1Oregon Health & Science University, Portland, Oregon
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jennifer E. DeVoe
1Oregon Health & Science University, Portland, Oregon
2OCHIN, Inc, Portland, Oregon
MD, DPhil
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Abstract

PURPOSE The Affordable Care Act of 2010 supports marked expansions in Medicaid coverage in the United States. As of January 1, 2014, a total of 25 states and the District of Columbia expanded their Medicaid programs. We tested the hypothesis that rates of uninsured safety net clinic visits would significantly decrease in states that implemented Medicaid expansion, compared with states that did not.

METHODS We undertook a longitudinal observational study of coverage status for adult visits in community health centers, from 12 months before Medicaid expansion (January 1, 2013 to December 31, 2013) through 6 months after expansion (January 1, 2014 to June 30, 2014). We analyzed data from 156 clinics in the OCHIN practice-based research network, with a shared electronic health record, located in 9 states (5 expanded Medicaid coverage and 4 did not).

RESULTS Analyses were based on 333,655 nonpregnant adult patients and their 1,276,298 in-person billed encounters. Overall, clinics in the expansion states had a 40% decrease in the rate of uninsured visits in the postexpansion period and a 36% increase in the rate of Medicaid-covered visits. In contrast, clinics in the nonexpansion states had a significant 16% decline in the rate of uninsured visits but no change in the rate of Medicaid-covered visits.

CONCLUSIONS There was a substantial decrease in uninsured community health center visits and a significant increase in Medicaid-covered visits in study clinics in states that expanded Medicaid in 2014, whereas study clinics in states opting out of the expansion continued to have a high rate of uninsured visits. These findings suggest that Affordable Care Act–related Medicaid expansions have successfully decreased the number of uninsured safety net patients in the United States.

  • safety net clinics
  • uninsured
  • Affordable Care Act
  • practice-based research
  • primary care
  • Received for publication September 26, 2014.
  • Revision received November 13, 2014.
  • Accepted for publication November 19, 2014.
  • © 2015 Annals of Family Medicine, Inc.
View Full Text
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 13 (1)
The Annals of Family Medicine: 13 (1)
Vol. 13, Issue 1
January/February 2015
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
5 + 10 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act
Heather Angier, Megan Hoopes, Rachel Gold, Steffani R. Bailey, Erika K. Cottrell, John Heintzman, Miguel Marino, Jennifer E. DeVoe
The Annals of Family Medicine Jan 2015, 13 (1) 10-16; DOI: 10.1370/afm.1741

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act
Heather Angier, Megan Hoopes, Rachel Gold, Steffani R. Bailey, Erika K. Cottrell, John Heintzman, Miguel Marino, Jennifer E. DeVoe
The Annals of Family Medicine Jan 2015, 13 (1) 10-16; DOI: 10.1370/afm.1741
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Health Care Expenditures Among Adults With Diabetes After Oregons Medicaid Expansion
  • Following Uninsured Patients Through Medicaid Expansion: Ambulatory Care Use and Diagnosed Conditions
  • Impact of Alternative Payment Methodology on Primary Care Visits and Scheduling
  • The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Visit Rates for Diabetes in Safety Net Health Centers
  • Implementation of Health Insurance Support Tools in Community Health Centers
  • Uninsured Primary Care Visit Disparities Under the Affordable Care Act
  • At Federally Funded Health Centers, Medicaid Expansion Was Associated With Improved Quality Of Care
  • Medicaid Expansion And Grant Funding Increases Helped Improve Community Health Center Capacity
  • After Medicaid Expansion In Kentucky, Use Of Hospital Emergency Departments For Dental Conditions Increased
  • Community Health Center Use After Oregon's Randomized Medicaid Experiment
  • In This Issue: Policy and Practice
  • Google Scholar

More in this TOC Section

  • Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients
  • Shared Decision Making Among Racially and/or Ethnically Diverse Populations in Primary Care: A Scoping Review of Barriers and Facilitators
  • Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?
Show more Original Research

Similar Articles

Subjects

  • Person groups:
    • Vulnerable populations
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health policy
    • Health services
  • Core values of primary care:
    • Access

Keywords

  • safety net clinics
  • uninsured
  • Affordable Care Act
  • practice-based research
  • primary care

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine