States opting out of Medicaid leave 1.1 million community health center patients without health insurance

May 9, 2014, George Washington University
An estimated 1.1 million community health center patients will remain without health insurance because they live in one of 24 states that have rejected the Medicaid expansion. Credit: The George Washington University/RCHN Community Health Foundation

An estimated 1.1 million community health center patients are left without the benefits of health coverage simply because they live in one of 24 states that have opted out of the Medicaid expansion, a key part of the Affordable Care Act (ACA), according to a new report.

The research, by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University also shows that the vast majority (71 percent) of the 1.1 million patients left behind live in just 11 southern (AL, FL, GA, LA, MS, NC, OK, SC, TN, TX, VA).

"These low-income patients, many of them living in the South, already face significant challenges to obtaining care," says lead author Peter Shin, PhD, MPH, director of the Geiger Gibson Program in Community Health Policy and an associate professor of health policy at Milken Institute SPH. "Our analysis suggests these patients will remain without access to affordable insurance, which will almost certainly lead to delays in care and the risk of more serious health conditions."

The new report updates earlier estimates to reflect health center growth between 2011 and 2012 as reported in the Uniform Data System. This latest analysis, like the previous one which was published in 2013, examines what happens to centers and their patients in both the Medicaid expansion states, including New Hampshire, which recently decided to expand Medicaid—as well as the 24 states that have continued to reject the Medicaid expansion.

In 2012, community served 20.7 million patients in 8,000 medically underserved communities throughout the United States. Community health center patients tend to be uninsured or underinsured and they are typically much poorer than uninsured patients generally.

Shin and his colleagues estimate that the ACA would have helped 5.2 million out of a total of 7.5 million uninsured community health center patients to gain health coverage either by buying affordable policies or qualifying for Medicaid under the expansion programs. However, 1.1 million of the 5.2 million who could have gained coverage will remain uninsured due to states' decisions to opt out of the Medicaid expansion.

This report also shows that of the 1.1 million community health center patients left struggling without insurance, 35 percent live in just five opt-out states (AL, FL, GA, LA, MS).

"Health center patients living in the South remain disproportionately affected by the failure to expand Medicaid," says Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH. "Of the community health center patients denied coverage by virtue of their zip code, most live in the south and more than one third lives in the Deep South." Poor, minority patients in these states already face troubling disparities in health and health care. The decision to reject the Medicaid expansion threatens to make those disparities even worse, the report says.

The analysis also shows that health centers in the opt-out states will likely forgo over half a billion dollars ($569 million) in revenues they would have received under a Medicaid expansion. The loss of potential revenues presents significant challenges to these health centers, which already struggle to care for rising numbers of uninsured patients. In addition, the loss of federal revenues associated with an expansion also means these health centers will not be able to expand into areas that lack access to health care, the report says.

"While the number of uninsured Americans is going down across the nation thanks to the Affordable Care Act, the number of uninsured or underinsured patients seeking care at community health centers continues to grow," says Feygele Jacobs, president and CEO of the RCHN Community Health Foundation. "By rejecting Medicaid expansion, these states are leaving our safety net health care system and the patients it serves in jeopardy."

Community health centers in states that have expanded Medicaid face a very different future with 2.9 million in the expansion states gaining in 2014, according to the researchers. The increase in insurance payments will generate potential revenues of $2.1 billion in 2014, which help to pay for physicians, nurses, care for —and to further expand into isolated communities without access to crucial services.

Explore further: Over one million community health center patients will remain uninsured and left out of health reform

Related Stories

Over one million community health center patients will remain uninsured and left out of health reform

October 16, 2013
A new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services (SPHHS) examines the impact of health reform on community ...

State medicaid expansions did not erode perceived access to care or increase emergency services

April 8, 2014
Previous expansions in Medicaid eligibility by states were not associated with an erosion of perceived access to care or an increase in emergency department (ED) use.

New report looks at how states' restrictions on ACA implementation are affecting access

January 14, 2014
The first study to gauge the impact of state restrictions on the roll-out of the Affordable Care Act (ACA) indicates that community health centers across the country are engaged in an intensive effort to find and enroll eligible ...

Without sufficient support, community health centers will drop one million patients

November 18, 2013
A new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services (SPHHS) examines the impact of federal and state policy ...

Many uninsured vets will be eligible for Medicaid under ACA

March 29, 2013
(HealthDay)—A large proportion of uninsured veterans and their spouses will be eligible for Medicaid or new subsidies for coverage under the Affordable Care Act (ACA), according to a report published by the Robert Wood ...

'Coverage gap' likely to affect 5.2 million uninsured adults

October 18, 2013
(HealthDay)—About 5.2 million uninsured adults are expected to fall into the Affordable Care Act (ACA) 'coverage gap,' with incomes too high to qualify for Medicaid programs but below the level eligible for federal subsidies ...

Recommended for you

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.