Abstract
Purpose: Millions of people gained health care coverage in Los Angeles after the Affordable Care Act (ACA); however, challenges with obtaining and utilizing primary care still persist, particularly in the safety net. In this study, we explore barriers to accessing primary care services among safety-net patients in Los Angeles after Medicaid expansion and implementation of other programs for safety-net patients after the ACA.Methods: We conducted qualitative interviews, in Spanish and English, with 34 nonelderly adult patients in 1 of 3 insurance groups: Medicaid, MyHealthLA (a health care program for low-income undocumented individuals), or uninsured. We recruited participants from three sites in Los Angeles in 2017. We analyzed our interviews using a framework approach and included emerging concepts from participant responses.Results: We identified seven themes regarding barriers to accessing primary care: understanding the concept of primary care, finding a primary care provider (PCP), switching PCPs, getting timely appointments, geography and transportation, perceived cost or coverage barriers, and preferring emergency or urgent care over primary care. Patients with Medicaid were more likely to report barriers compared with other groups. Uninsured patients were less likely to understand the concept of primary care. Patients with MyHealthLA noted getting timely appointments and cost of care to be significant barriers.Conclusion: Despite Medicaid and other coverage expansions for safety-net patients after the ACA, substantial barriers to accessing primary care persist. Addressing such barriers through the development of targeted interventions or broader policy solutions could improve access to primary care for safety-net patients in Los Angeles.
Highlights
The Affordable Care Act (ACA) expanded health insurance to millions of Americans in 2014, including *1.7 million people in Los Angeles County.[1]
In the most recent and comprehensive study of access to care for Los Angeles County residents conducted after the ACA, nearly a quarter of those surveyed reported at least some difficulty obtaining care when they needed it; this proportion was >40% in the poorest income group.[6]
We asked participants if they could identify a regular primary care clinic (PCC) where they could go for nonemergency care and a single individual who served as their primary care provider (PCP)
Summary
The Affordable Care Act (ACA) expanded health insurance to millions of Americans in 2014, including *1.7 million people in Los Angeles County.[1]. Despite major gains in insurance coverage across the country following implementation of the ACA, barriers to accessing primary care services persist, in the safety net.[3] Nationally, gains in the percentage of people with primary care providers (PCPs) after the ACA were observed in the privately insured but not among those with Medicaid.[4] In California, patients with Medi-Cal had a harder time accessing primary compared with those with employer-sponsored coverage, and these disparities did not improve after the ACA; low-income people with Medi-Cal were twice as likely to be refused new patient appointments in primary care 1 year after the ACA.[5] In the most recent and comprehensive study of access to care for Los Angeles County residents conducted after the ACA, nearly a quarter of those surveyed reported at least some difficulty obtaining care when they needed it; this proportion was >40% in the poorest income group (those making
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