Ready or Not? The Affordable Care Act and Safety-Net Primary Care Clinic Capacity in Iowa

With the full implementation of the Affordable Care Act (ACA), as many as 25 million individuals are expected to gain insurance coverage over the next five years, creating an increase in demand for health care services. At the same time, as many as 31 million individuals will remain uninsured. Safety-net primary care clinics, including community health centers (CHCs) and rural health clinics (RHCs), are being counted upon to meet the anticipated increase in demand while also continuing to serve the remaining uninsured. While these clinics are afforded new opportunities under the ACA, they also face significant potential challenges. The research described in this issue brief aimed to determine the current capacity of CHCs and RHCs in Iowa and their expected capacity to respond to the opportunities and challenges of the ACA. We utlilized an online survey to gather data on current and future needs related to safety-net workforce, service provision, integrated care delivery, and organizational change. We found that both CHCs and RHCs have current staff vacancies that they report difficulty filling and that both report difficulties referring patients for specialty care. We also found that both groups anticipate the demand for their services to increase in the wake of the ACA, and that both CHCs and RHCs face resource constraints that may limit their ability to respond to the opportunities and challenges of the ACA.