Despite coverage expansions following enactment of the Affordable Care Act (ACA), barriers to primary care coverage and access still exist for a significant number of people, according to a study published in Health Equity.

The purpose of the study was to identify barriers to obtaining or utilizing primary care services in East Los Angeles after Medicaid expansion and targeted insurance coverage options following ACA implementation. Individuals who were likely to experience difficulties accessing primary care were recruited from urgent care centers or emergency department (ED) waiting rooms using a convenience sampling approach. Qualitative interviews in both Spanish and English were conducted with 34 patients aged 18 to 64 who were either uninsured or covered by Medicaid (Medi-Cal) or MyHealthLA. Of the 34 participants, 20.6% (n=7) were uninsured, 58.8% (n=20) were on Medi-Cal insurance, and 20.6% (n=7) were on MyHealthLA; 41.2% (n=14) of participants spoke only Spanish. Mean income among study participants was $12,873. Qualitative data were analyzed using both deductive and inductive means, and results were organized using a framework approach. Descriptive statistics were generated using quantitative analysis of discrete variables.

The researchers identified 7 primary barriers to obtaining and/or utilizing needed primary care in the study population:

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• Failure to understand the concept of primary care or what type of care is rendered by a primary care clinic or primary care provider (PCP);

• Finding a PCP;

• Switching PCPs;

• Difficulty obtaining an appointment or extended wait times for appointments;

• Geography and transportation;

• Perceived cost of coverage and cost of additional testing or imaging services required for diagnosis and/or treatment;

• Preference for emergency or urgent care.

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Out of the groups of study participants, those with Medicaid were more likely to report barriers, those without insurance were less likely understand the concept of primary care, and those with MyHealthLA were more likely to consider the timeliness of appointments and cost of care as significant barriers.

Limitations of the study included reduced generalizability due to the fact that only English and Spanish speakers from East Los Angeles were recruited. As well, the use of convenience sampling may have induced biases by recruiting participants with very negative or very positive experiences with healthcare access and primary care in particular.

Although the ACA has expanded healthcare coverage to millions of residents receiving care in Los Angeles, the study researchers concluded that “additional steps are needed to ensure meaningful health care access for all,” and that “targeted interventions and comprehensive policy solutions could lead to improved primary care access and utilization.”


Saluja S, McCormick D, Cousineau MR, et al. Barriers to primary care after the Affordable Care Act: a qualitative study of Los Angeles safety-net patients’ experiences [published online August 23, 2019]. Health Equity. doi: 10.1089/heq.2019.0056