Barriers to health insurance persist under Affordable Care Act

The second marketplace enrollment period under the Affordable Care Act (ACA) has now ended, and enrollment in Iowa's expanded Medicaid, Health and Wellness continues. At the Iowa City Free Medical and Dental Clinic, it is clear that while some of our former patients have successfully obtained insurance, barriers to obtaining insurance continue to exist.

In the early months of 2014 and again in July through October 2014, clinic staff administered anonymous voluntary surveys to patients to ascertain how many of them were aware of and taking advantage of the new opportunities under the law. Although the same patients were not surveyed both times, there were clear trends in the answers to the questions. Most importantly, the results clearly indicated a continuing need for the Free Clinic's services.

In early 2014, common barriers included a limited awareness of the ACA and difficulties encountered on the ACA enrollment website, but with time these issues appeared to improve. Our surveys during the period from July to October 2014 indicated that more patients were aware of the law and website difficulties lessened.

However, surveys identified continuing and substantive barriers to ACA enrollment.

The most common barrier was the inability to afford the ACA premiums, despite subsidization by the government. Other barriers included not qualifying for an ACA program or not understanding the application process. Some patients were dissuaded by the complexities of applying. Fortunately, the Johnson County ACA Federal Navigator has been working at the Free Clinic to assist patients with enrollment, as her schedule allows.

Because some patients' employers offered insurance, they were disqualified from the marketplace even though employment-related premiums were more than they could afford. For clinic patients between jobs, where it was difficult to afford COBRA payments (continuation of prior employment-related insurance), the application time for new insurance and probation periods at work left them uninsured for months at a time.

Immigrants face additional barriers. To be eligible for ACA programs, qualified immigrants must reside in the United States for at least five years - leaving many with lengthy gaps in coverage. Visitors to our country on a visa may reside in the U.S. for months or years, but will not qualify for an ACA program.

Clearly, the need for the Iowa City Free Clinic in our community still is great. For example, the waiting period for new patients diagnosed with chronic medical issues has not decreased over the past year. Clinic dental services continue to be in high demand.

In fact, in the post-ACA era, our challenges may be more complex. A greater percentage of clinic patients have language barriers, mental health issues or other social obstacles to overcome, necessitating longer appointments to provide appropriate medical care.

With the next ACA enrollment cycle, we hope to see more people qualify for the opportunities offered through the ACA. But until all people are able to access and afford health care, the Free Medical Clinic will continue to serve our community.

' Dr. Cecilia Norris is Medical Director of the Iowa City Free Medical and Dental Clinic. Comments: Iowa City Free Medical and Dental Clinic, 2440 Towncrest Drive, Iowa City, 52240; (319) 337-4459.