Certified Registered Nurse Anesthetists (CRNAs) are the main providers of anesthesia in lower-income areas where populations are more likely to be uninsured, unemployed, and/or eligible for Medicaid, according to research published in Nursing Economic$.

Researchers from the American Association of Nurse Anesthetists (AANA) conducted the study to determine if there is a relationship between the distribution of CRNAs or physician anesthesiologists and socioeconomic factors related to geography and insurance type.

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Examining data from the 2012 US Health Resources and Services Administration Area Resource File (ARF) data file, the researchers found that there are more CRNAs in counties with lower-income populations, as well as in states with less restrictive practice regulations and more rural counties. They also learned from their analysis that anesthesiologists are more common in counties with higher-income populations.

“These findings point to the significance CRNAs have in providing access to anesthesia care to low-income and vulnerable populations,” said lead researcher Lorraine M. Jordan, PhD, CRNA, FAAN, senior director of research for the American Association of Nurse Anesthetists (AANA) in a press release. “As the Affordable Care Act (ACA) places increased demands on the healthcare system due to the newly insured or Medicaid-eligible, including demands for surgical and pain management services, the role of CRNAs will become even more critical in providing access to quality healthcare to these populations.”

According to the Kaiser Commission on Medicaid and the Uninsured (2013), nearly 47 million nonelderly Americans were uninsured in 2012. Since the ACA marketplaces opened in late 2013, 15.8 million people have gained insurance coverage, according to a 2014 census data report. Based on an Urban Institute analysis, approximately 22.3 million uninsured individuals will qualify for Medicaid under the new provisions of the ACA.