Understanding How ACA’s Coverage Expansion Impacted Federally Qualified Health Centers

23 January 2024

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

Executive VP – North American Health Care Practice Leader

Amy Hieatt is an Executive VP – North American Health Care Practice Leader at Inszone Insurance Services, joining Inszone in September 2023. In her role, Amy is responsible for overseeing the strategic direction and day-to-day operations of Inszone’s national healthcare liability vertical, with a strong emphasis on maintaining a customer-centric approach.

Over the past 20+ years, Amy has dedicated her career to the property and casualty insurance sector, focusing extensively on the Medical Professional Liability and Professional Liability sectors. Prior to her role at Inszone, she served as the Managing Director at Connected Risk Solutions (formerly ABRisk Solutions), a national wholesale brokerage. Before that, Amy led Business Development efforts for NORCAL Group’s Admitted and E&S business lines, managing teams across four regional offices nationwide. She initially entered the insurance field on the retail side, holding the position of Executive Vice President at a regional retail agency that specialized in healthcare liability insurance.


Amy’s remarkable journey in insurance, spanning over two decades, is marked by her commitment to servant leadership, her impressive track record of achieving growth and retention, and her dedication to mentoring high-performing collaborative teams. Her expertise in the medical professional liability sector has earned her the admiration of her peers, recognizing her as a visionary leader and expert in the field.


In her time off, Amy is passionate about outdoor activities, advocating for animal rights, and finds joy in traveling and reading.

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