States with restrictions show hampered ACA enrollment efforts

One of the first studies to investigate the impact of state policies on the implementation of the Affordable Care Act found more limited health center outreach in states that both rejected Medicaid expansion and passed health care navigator laws.

“These findings show the effects of state policies that are designed to stand in the way of health reform. These restrictive policies are measurably impairing community-level efforts to cover the uninsured,” Sara Rosenbaum, JD, a coauthor of the study and Harold and Jane Hirsh Professor of Health Law and Policy at the George Washington University School of Public Health and Health Services, stated in a press release from the institution. “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 [ACA],”

Rosenbaum and colleagues examined the early outreach and enrollment efforts of 606 community health centers in the United States. According to the press release, the investigators compared centers in 21 states and the District of Columbia that have fully embraced the ACA with nine “restrictive” states that both rejected Medicaid expansion and adopted regulations that made it harder to provide assistance to the uninsured or had laws concerning federally certified health care navigators.
Rosenbaum and colleagues found states that embraced health care reform had significantly more outreach and enrollment resources than the restrictive states. States that embraced the ACA also had an average of six full-time enrollment staff members compared to an average of three in the restrictive states.
According to the release, nearly 80% of health centers in states that fully implemented the ACA were assessing patient eligibility for insurance coverage compared to 59% of centers in the restrictive group.
The survey also revealed that nearly one in six health center leaders in restrictive states expected at least half of their patients to remain uninsured compared to 2% of leaders in the comparison group.

Disclosure: Orthopedics Today was unable to determine whether the authors had any relevant financial disclosures.