Uninsured Primary Care Visit Disparities Under the Affordable Care Act

Heather Angier; Megan Hoopes; Miguel Marino; Nathalie Huguet; Elizabeth A. Jacobs; John Heintzman; Heather Holderness; Carlyn M. Hood; Jennifer E. DeVoe

doi:10.1370/afm.2125

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Author response Re:Fear Hurts Equitable Access for Latino-Americans
Heather Angier

Published on: 02 October 2017
Fear Hurts Equitable Access for Latino-Americans
Joseph W. Gravel

Published on: 25 September 2017

Published on: (2 October 2017)
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Author response Re:Fear Hurts Equitable Access for Latino-Americans
Heather Angier, Research Associate
Other Contributors:
We appreciate this comment on the interaction of our findings with larger and recent societal phenomena. Indeed, in our network, which serves significant Latino populations, these issues are salient. Previous policy research found that after Oregon Medicaid required citizenship documentation insurance gaps and unmet healthcare needs increased for children. (1) Conversely, other regional research demonstrated significant i...
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We appreciate this comment on the interaction of our findings with larger and recent societal phenomena. Indeed, in our network, which serves significant Latino populations, these issues are salient. Previous policy research found that after Oregon Medicaid required citizenship documentation insurance gaps and unmet healthcare needs increased for children. (1) Conversely, other regional research demonstrated significant insurance gains in Latino populations after the Affordable Care Act, especially Spanish-speaking ones, which is encouraging. (2) We hope findings - from our network and others - that community health centers continue to be viewed as a "safe" place for Latino patients to seek care and disclose information (3, 4) will mitigate, at least somewhat, the fear brought about by recent policy changes and public rhetoric. We do, however, share Dr. Gravel's concern, and agree that more/expanded research is needed to fully appreciate the impact of immigration reform on Latino patients' access to health insurance and receipt of healthcare.
(1) Hatch BA, DeVoe JE, Lapidus JA, et al. Citizenship documentation requirement for Medicaid eligibility: effects on Oregon children. Fam Med. 2014 Apr;46(4):267-75.
(2) Heintzman J, Bailey SR, DeVoe JE, et al. In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon. J Racial Ethn Health Disparities. 2016.
(3) Lopez-Cevallos DF, Lee J, Donlan W. Fear of deportation is not associated with medical or dental care use among Mexican-origin farmworkers served by a federally-qualified health center--faith-based partnership: an exploratory study. Journal of immigrant and minority health / Center for Minority Public Health. 2014;16(4):706-11.
(4) DeVoe JE, Angier H, Likumahuwa S, et al. Use of Qualitative Methods and User-Centered Design to Develop Customized Health Information Technology Tools Within Federally Qualified Health Centers to Keep Children Insured. Journal of Ambulatory Care Management April/June. 2014;37(2):148-54.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (25 September 2017)
Page navigation anchor for Fear Hurts Equitable Access for Latino-Americans
Fear Hurts Equitable Access for Latino-Americans
Joseph W. Gravel, Chair & Chief Medical Officer
As Chief Medical Officer at a Community Health Center in a Medicaid- expansion state (Massachusetts) that serves a predominately Latino patient population, I appreciate this well-done article by Angier and colleagues. It is particularly important to look at health policy's variable effects on different subpopulations as a means to create better policy in the future and improve implementation of that policy to achieve its i...
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As Chief Medical Officer at a Community Health Center in a Medicaid- expansion state (Massachusetts) that serves a predominately Latino patient population, I appreciate this well-done article by Angier and colleagues. It is particularly important to look at health policy's variable effects on different subpopulations as a means to create better policy in the future and improve implementation of that policy to achieve its intent, which may require different strategies for different ethnic minority subgroups. The study's conclusions ring true based on our own experiences trying to engage everyone in our community, and the study's discussion is thoughtful and insightful particularly in hypothesizing on the reasons for the discrepancies between subgroups.
To build further on this study, it would be interesting to analyze the effect of what is clearly increasing fear in communities with large numbers of immigrants, related to DACA and other potential changes affecting immigrants and their families. During the past year our Health Center's physicians have witnessed an increasing fear of applying for health insurance or providing any administrative information that patients fear can be used against them in the future. This occurs even with those with full citizenship and eligibility for Medicaid; providing reassurance has proven to be difficult. I suspect the access and insurance discrepancy with Hispanic subgroups will continue to widen. This will be caused by the tenor of political discourse regardless of any reductions in healthcare insurance access resulting from repeal of the ACA or failing repeal, intentional sabotaging of the ACA through regulatory or legislative means.
Competing interests: None declared
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Competing Interests: None declared.