An estimated 1.1 million people who use community health centers for their medical needs will go without health insurance because they live in 1 of the 24 states without current plans to expand their Medicaid programs under the Affordable Care Act (ACA), according to a new report.
The analysis is based on information from the 2012 Uniform Data System, which tracks patient demographics, services provided, clinical indicators, utilization rates, revenue, costs, and quality performance in community health centers supported by the US Health Resources and Services Administration and other public and nonprofit organizations.
In 2012, community health centers served 20.7 million patients in 8000 medically underserved areas, according to the report from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at George Washington University in Washington, DC. Of the 7.5 million patients who were uninsured, 3.2 million lived in states that have opted out of the Medicaid expansion.
The new report indicates that about 5.2 million uninsured community health center patients would have been eligible for Medicaid or subsidized coverage if the Medicaid expansion was available nationwide. But 2.3 million of the patients live in opt-out states. Among them, 1.2 million would qualify for subsidies and 1.1 million would be eligible for Medicaid.
But because they live in opt-out states, those 1.1 million patients fall into the coverage gap between traditional Medicaid eligibility and the lower income eligibility limit for premium subsidies in the state exchanges. Traditional Medicaid eligibility covers very low-income residents and usually excludes childless adults without disabilities; the lower eligibility limit for premium subsidies is 100% of the federal poverty level.
What’s more, the report also shows that community health centers in opt-out states likely will forgo $569 million in revenues they would have collected under expanded Medicaid programs. In contrast, community health centers in opt-in states are expected to generate about $2.1 billion in revenue from increased Medicaid payments.
Of the 1.1 million patients likely to remain uninsured, 71% live in 11 Southern opt-out states; 35% of the total are concentrated in 5 states: Alabama, Florida, Georgia, Louisiana, and Mississippi.
“Health center patients living in the South remain disproportionately affected by the failure to expand Medicaid,” Sara Rosenbaum, JD, of the Milken Institute School of Public Health at George Washington University, said in a statement. Poor, minority patients in opt-out states already face troubling health disparities, and the decision to reject the Medicaid expansion threatens to worsen those disparities, according to the report.