Why don't more uninsured people seek health coverage? U-M study suggests knowledge gap

http://www.eurekalert.org/pub_releases/2015-11/uomh-wdm110515.php

Public Release: 5-Nov-2015
Why don't more uninsured people seek health coverage? U-M study suggests knowledge gap
Findings from free clinic run by U-M medical students could help other safety net providers
University of Michigan Health System

If you need health care in rural Michigan, and you don't have insurance or money, you can turn to a free clinic -- like the one University of Michigan medical students run each Saturday in the tiny town of Pinckney.

Fewer people need this kind of help these days, because of new insurance options made possible by the Affordable Care Act.

But hundreds of people still rely on free primary care from the students and the U-M doctors who volunteer with them, because they still lack health insurance.

Why so many? The students decided to find out. In a new paper, they report that the main barriers to coverage lie in perceived cost, and a knowledge gap about who is eligible for low-cost plans or programs to help pay for coverage.

The findings have already prompted several of the students to get certified to counsel patients about their insurance options under the ACA, in hope that personalized attention will help. They hope their research will prompt other safety net clinics to do the same, and overcome barriers to insurance so more people can get the coverage, tax credits and subsidies they're eligible for.

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"Almost everyone we see in our clinic should have an option for low- or reduced-cost insurance under the ACA," says Brian Desmond, the first author of the paper and a second-year medical student. "In all, 57 percent of the patients we surveyed were eligible for the Healthy Michigan Plan or Medicaid based on income, but only 35 percent of those eligible had actively applied in the last six months."

Most of those who hadn't applied said they thought they weren't eligible, or that it would cost too much. Though the Healthy Michigan Plan does include modest cost-sharing for participants above the poverty level, the program is free for most residents - including those who previously couldn't qualify for Medicaid.

Of the patients in the study whose incomes were too high for Medicaid or the Healthy Michigan Plan -- above 138 percent of the poverty level -- most said that the cost of private insurance was what kept them from getting insured. Many had actually shopped for such coverage on the Healthcare.gov marketplace, but had not bought it because of premium or deductible costs.

When the students looked at these patients' situations further, they found that all but one would have qualified for tax credits to help cut their monthly premium costs. This finding parallels a national survey by the Robert Wood Johnson Foundation that showed that many uninsured people are confused about, or have not heard of, federal tax credits to reduce premiums.

Eighty percent of the patients had jobs, and most were in their 40s and 50s. Only 18 percent had had health insurance within the last two years, and 40 percent had been uninsured for over 10 years. A quarter of respondents hadn't seen a doctor in more than a year before coming to the clinic for care, and 8 percent hadn't seen one in more than five years.

Most of those who said they were not actively seeking health insurance qualified for the Healthy Michigan Plan - suggesting that they had assumed no program was open to them. The students didn't ask about immigration status; some undocumented immigrants aren't eligible for ACA plans.

Starting this Saturday, the U-M Student Run Free Clinic will offer insurance counseling appointments every week, by students trained as Certified Application Counselors and fully versed in ACA insurance options and supports. Medical students Katherine He and Emily Arntson have led the clinic's drive to provide this service.

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