This study uses longitudinal data to examine the consequences of losing and gaining health insurance coverage for access to care and health. For both Medicaid and privately insured persons, compared with those who remained insured, persons losing coverage over a 2-year period were more likely to lack a usual source of care, encounter difficulty in obtaining medical care, be very dissatisfied with ability to obtain needed care, and report no physician visits in the previous 12 months. Uninsured people who gained coverage showed improvement across all indicators of access, in contrast to those who remained without insurance. The effects of changes in coverage on health were in the same direction as those for access, but did not reach statistical significance. This study strengthens the evidence that health insurance coverage has a substantial impact on ability to gain access to medical care and may affect health status.

This article provides a critical review of the literature on the quality and effectiveness of care provided by community health centers (CHCs) compared with other health care delivery models. Since the mid-1960s, CHCs have played a large role in providing comprehensive primary care to our nation's medically underserved. Recent changes in public policy and the health care marketplace have threatened the viability of the CHC delivery model. This review of structure, process, and outcome indicators suggests that CHCs have effectively reduced many barriers to access, promoted high-quality ambulatory care use among underserved populations, and reduced costly hospitalizations. While CHCs have been shown to save money for Medicaid, little research has addressed the health-related outcomes of care. This article recommends specific areas of research essential to understanding the future performance of CHCs.