Improving Health Care for the Future Uninsured in Los Angeles County: A Community-Partnered Dialogue

Objectives: To understand the health care access issues faced by Los Angeles (LA) County’s uninsured and residually unin­sured after implementation of the Afford­able Care Act (ACA) and to identify poten­tial solutions using a community-partnered dialogue.Design: Qualitative study using a com­munity-partnered participatory research framework.Setting: Community forum breakout discus­sion.Discussants: Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organiza­tions including uninsured individuals, and the county school district.Main Outcome Measures: Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes.Results: Five overarching value themes were identified – knowledge, trust, quality, partnership, and solutions. Lack of knowl­edge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of tra­ditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in “outsider” community-based providers not related to quality.Conclusions: Improving health care for the residually uninsured after ACA implementa­tion will require addressing dissatisfaction in safety-net providers, disseminating knowl­edge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic part­nerships can be a trusted conduit to discuss issues related to the health care of vulner­able populations. Ethn Dis. 2015; 25(4)487- 494; doi:10.18865/ed.25.4.487