The Affordable Care Act (ACA) enacted on March 23, 2010, aimed to enhance health insurance coverage and access to care across the United States. One of its significant objectives was to extend coverage to uninsured individuals through Medicaid expansion and the Health Insurance Marketplace.
Key Provisions of the ACA
Medicaid Expansion – Expanded Medicaid to cover low-income adults up to 138% of the federal poverty level.
Health Insurance Marketplace – Allowed individuals and small businesses to purchase private health Insurance (PHI).
Individual Mandate – Required eligible individuals to have federally approved health Insurance coverage.
Impact on Federally Qualified Health Centers (FQHCs)
Increased Coverage – ACA’s implementation led to millions gaining Insurance coverage, especially in states that expanded Medicaid.
Views from Administrators – FQHC administrators in Medicaid-expanded states (like Arizona and California) were positive about Medicaid expansion, noting a surge in patients gaining Medicaid coverage.
Challenges in Non-Expanded States – FQHCs in non-expanded states (like Texas) faced hurdles in coverage expansion, leaving many low-income patients uninsured.
Challenges for Newly Insured Patients
Access to Primary Care – Despite gaining Insurance, some patients struggled to find primary care providers (PCPs) accepting Medicaid, limiting their options, and leading them to rely heavily on FQHCs.
Limited Network for Secondary Care – Accessing specialist care for Medicaid patients remained challenging due to restricted networks and few providers accepting Medicaid.
Struggles Faced by FQHCs
Capacity Challenges – FQHCs struggled to meet increased demands due to limited resources and workforce shortages, impacting their ability to provide timely care.
Impact on Patient Care – Longer wait times for appointments and difficulties in referring patients to specialists were common issues.
Policy Implications
Need for Expanded Coverage – There’s a need to widen covered services for Medicaid and affordable private Insurance plans to ensure comprehensive access to care.
Capacity Expansion – Policies should focus on supporting FQHCs to enhance their capacity, recruit more healthcare professionals, and manage increased demand effectively.
The ACA’s coverage expansion facilitated millions in gaining Insurance coverage, particularly in Medicaid-expanded states. However, challenges persisted for newly Insured patients in accessing care, emphasizing the need for broader coverage and increased FQHC capacity.
While the ACA made strides in extending coverage, further efforts are necessary to bridge gaps and ensure comprehensive access to healthcare for all.
The healthcare industry has complex challenges and evolving trends that necessitate strategic navigation. Inszone Insurance remains committed to staying abreast of these developments to better serve our healthcare clients.
Source: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06961-9
Amy Hieatt
