Using GIS to Find Hot Spots of Uninsurance for ACA Outreach and Enrollment

Since the passage of the Affordable Care Act, community health centers (CHCs) have received over $200 million in federal grant awards to help uninsured populations gain affordable health insurance.  A variety of Geographic Information Systems (GIS) research techniques were employed to help CHCs target outreach and enrollment.  The objectives were to a) identify areas with many uninsured people newly eligible for Medicaid or subsidies and b) to determine whether these areas were already served by CHCs.  Local estimates of uninsurace by Federal Poverty Level (FPL) were created by imputing American Community Survey (ACS) 2007-2011 county-level data to the ZIP Code Tabulation Area (ZCTA) level.  Interactive maps of these data were uploaded to the CHC online mapping tool (www.UDSMapper.org), enabling each CHC to visualize uninsurance rates within and around their service area.  Additional static maps were created for state-level planning, showing where large populations of uninsured lived in relation to the statewide CHC service area.  Finally, hot-spot analyses were performed to find statistically significant clusters of high uninsurance by state.  Nationally, 25% of all uninsured were below 138% FPL and within a CHC service area, while 15% of all uninsured were below 138% FPL and outside a CHC service area.  Of the unserved, 2.4 million were below 100% FPL and lived in a state not expanding Medicaid, thus remaining ineligible for Medicaid or subsidies.  This use of GIS facilitated health care planning for newly insured populations and those still critically in need of the sliding-fee payment system historically provided by CHCs.