Pre- and Post-ACA Diagnosed Health Conditions and Clinical Complexity of Community Health Center Patients Who Were Uninsured in the Pre-ACA Period, Stratified by Insurance Group (N = 138,246)
| Continuously Uninsureda (n = 28,834) | Gained Medicaidb (n = 20,766) | Gained Other Insurancec (n = 17,171) | No Post-ACA Period Ambulatory Care Visitsd (n = 71,475) | |
|---|---|---|---|---|
| Diagnosed health conditions | ||||
| Pre-ACA period ≥1 condition, % of patients | 55.5 | 64.2 | 61.9 | 39.9 |
| No. of preperiod diagnoses, mean (SD) | 1.4 (1.1) | 1.5 (1.2) | 1.4 (1.2) | 1.5 (1.0) |
| No. of postperiod new diagnoses, mean (SD) | 2.0 (1.2) | 2.6 (1.6) | 2.5 (1.5) | … |
| Pre/post change, mean | +0.6Ref | +1.1e | +1.1e | … |
| Charlson Comorbidity Index score | ||||
| Pre-ACA period ≥1 score, % of patients | 47.3 | 59.1 | 58.9 | 34.3 |
| Pre-ACA period, mean (SD) | 1.3 (1.9) | 2.1 (2.3) | 1.8 (2.2) | 1.1 (1.8) |
| Post-ACA period, mean (SD) | 1.6 (2.1) | 2.9 (2.6) | 2.5 (2.6) | … |
| Pre/post change, mean | +0.3Ref | +0.8e | +0.7e | … |
ACA = Patient Protection and Affordable Care Act; Ref = reference group.
Notes: Pre-ACA = January 1, 2012 to December 31, 2013; Post-ACA = January 1, 2014 to December 31, 2015. Visits refer to ambulatory care only. Preexisting conditions were identified by International Classification of Diseases, Ninth or Tenth Revision codes on patients’ problem lists or encounter diagnoses. Preexisting conditions included human immunodeficiency virus infection/acquired immune deficiency syndrome; systemic lupus erythematosus; alcohol or drug abuse; mental disorders; Alzheimer’s disease/dementia; multiple sclerosis; rheumatoid arthritis, fibromyalgia, or other inflammatory joint disease; muscular dystrophy; cancer other than skin; severe obesity; cerebral palsy; congestive heart failure; paraplegia or paralysis; coronary artery disease; Crohn’s disease or ulcerative colitis; Parkinson’s disease; chronic obstructive pulmonary disease, emphysema, or asthma; diabetes mellitus; Pneumocystis pneumonia; epilepsy; hemophilia; sleep apnea; hepatitis; stroke; and kidney disease/renal failure. Pairwise insurance-group differences between Continuously Uninsured vs Gained Medicaid, Continuously Uninsured vs Gained Other Insurance, and Continuously Uninsured vs No Post-ACA Period Ambulatory Care Visits were statistically significant (P <.05) for pre-ACA period ≥1 condition/score.
↵a All preperiod visits were uninsured, and all postperiod visits were uninsured.
↵b All preperiod visits were uninsured, and all postperiod visits were covered by Medicaid with the following exception: to allow for time to enroll in Medicaid, the first visit post-ACA could be uninsured.
↵c All preperiod visits were uninsured, and during the post-ACA period, visits were covered by other insurance types or insurance patterns (churning).
↵d All preperiod visits were uninsured, and there were no visits during the post-ACA period.
↵e Statistically significant (P <.05) interaction terms between insurance groups by time period using a Poisson regression model.