Credit: Rhoda Baer
As implementation of the Affordable Care Act (ACA) continues, a new report indicates that most community health centers across the US are attempting to help uninsured individuals obtain health insurance.
But health centers in certain states are hampered in their outreach and enrollment efforts and are significantly less optimistic about the impact of health reform in their communities.
“These findings show the effects of state policies that are designed to stand in the way of health reform,” said study author Sara Rosenbaum, of the George Washington University School of Public Health and Health Services in Washington, DC.
“These restrictive policies are measurably impairing community-level efforts to cover the uninsured. Without the Medicaid expansion or comprehensive enrollment assistance, millions of people in medically underserved communities could go without the benefits provided under the Affordable Care Act.”
Using data from a nationwide survey, Rosenbaum and her colleagues examined the early outreach and enrollment efforts of 606 community health centers across the US.
The data showed that, by early October 2013, virtually all of the responding health centers had received enhanced outreach funding.
And three quarters of them had already instituted expanded outreach and enrollment assistance efforts, such as one-on-one assistance with online and paper applications for health insurance, and enrollment help in multiple languages.
The researchers also compared health center outreach and enrollment in the 21 states (and Washington DC) that have embraced health reform to health centers in 9 states that have resisted or rejected key parts of the ACA.
The 9 “restrictive” states were those that had rejected an expansion of Medicaid and adopted policies or Navigator laws that make it harder to provide assistance to the uninsured.
The comparison showed that community health centers in the restrictive states had significantly more limited outreach and enrollment resources and had significantly fewer enrollment staff. Restrictive states had an average of 3 full-time enrollment staff members, compared to 6 staff members in full-implementation states.
Furthermore, health centers in restrictive states were significantly less likely than those in full-implementation states to be assessing patient eligibility for insurance coverage—59% and 79%, respectively.
And health centers in the 9 restrictive states were significantly less optimistic about the potential impact of the ACA on their patients.
In restrictive states, nearly 1 in 6 health center leaders expected at least half of their patients to remain uninsured. In full-implementation states, only 2% of leaders said the same.
For more details, see the full report, “Assessing the Potential Impact of State Policies on Community Health Centers’ Outreach and Enrollment Activities.”
