Impact of the Affordable Care Act on Insurance Coverage and Billing at a Publicly-Funded STD Clinic

Background: In Rhode Island, the Patient Protection and Affordable Care Act (ACA) has led to over 97% of the state’s population being insured. The ACA offers new opportunities for provision and payment of STD services. We explore the impact of the ACA and potential barriers to using insurance at the Rhode Island STD Clinic.

Methods: We reviewed insurance information and barriers to using insurance among patients presenting for STD services between July, 2015 and December, 2015 at the Rhode Island STD Clinic. Chi-square and t-tests were used to evaluate differences across groups. Significance was defined as p<0.05.

Results: A total of 692 patients had complete insurance information available; 60% were insured. Individuals without insurance were more likely than those with insurance to be non-white (50% versus 40%; p=0.014) and non-MSM (39% versus 27%; p=0.001). Among those with health insurance, 26% obtained coverage as a result of the ACA and 56% of those were previously uninsured. Among uninsured individuals, the most common reported barriers to obtaining health insurance was inability to afford insurance (34%) and being unemployed (26%). Among those with insurance, 44% reported willingness to use insurance for STD services. The most common reasons why individuals were unwilling to use their insurance included preserving anonymity (46%), preventing parents/partners from receiving statements in the mail (35%) and/or co-pays/deductibles (31%). Among those with insurance, 50% actually used insurance to pay for STD services.

Conclusions: Despite expanded insurance access, many individuals presenting to the Rhode Island STD Clinic were still uninsured. Even among those who were insured, significant barriers still existed to using insurance. STD clinics may continue to play an important role in providing safety-net STD services even in states with low uninsured rates. STD clinics must work with both public and private insurers to address financial barriers and optimize payment structures for services.