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Barriers to Enrollment in Health Insurance for Patients at Free Clinics: A Review of the Literature

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Abstract

The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 has expanded health care access in the United States by subsidizing insurance premiums, establishing marketplaces for private insurance plans, and expanding Medicaid eligibility. 1 Since the passage of the ACA, more than 20 million previously uninsured people have been able to enroll in health insurance programs. Despite these gains, more than 32 million Americans remain uninsured. 2 Uninsured patients rely heavily on safety-net services such as free clinics for medical care. There are over 1,000 student-run clinics (SRCs) and other free clinics in in the United States, serving over 1.8 million patients annually. 3 These clinics primarily provide primary care services, although some clinics offer a broader scope of care. Nevertheless, these clinics do not offer the full range of services available in other care settings to patients with insurance. 3,4 Despite the increased availability of health insurance, there are still barriers that prevent uninsured patients of free clinics from enrolling in health insurance. Several studies have examined these barriers and a few studies have examined the protocols used by clinics to enroll patients in health insurance and effectiveness of these protocols. The purpose of this review is to synthesize the findings of studies that have assessed these topics.

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