Location, Location, Location: The Affordable Care Act's Impact on Free Clinics Depends on What State They're In

Little is known about how nonprofit volunteer-led free and charitable clinics, which deliver free or low-cost health services to approximately two million uninsured annually, have fared following the Affordable Care Act's (ACA's) Medicaid coverage expansions. In late 2014 we surveyed 156 clinics that are partners of Americares, a key stakeholder, about the impact of the ACA. We used clinics' responses to create outcome measures reflecting 1) how well clinics fared in terms of fundraising, staffing levels, volunteer hours, scope of services, and trends in patients and visits; and 2) their tendency to modify clinic operations, such as integrating new technology, changing the clinic flow, adding new services, or billing patients. In multivariable negative binomial regression models we examined associations between location in a Medicaid expansion state and the two outcomes. Location in an expansion state was significantly and positively associated with experiencing negative impacts and making major operational changes.