Moving Past Insurers and Cost Barriers: The Next Hurdles to Access to Care In a Monday afternoon session, “Moving Past Insurance and Cost Barriers: The Next Hurdles to Access to Care,” chaired by Vicki Fung of Kaiser Permanente, panelists addressed the multiple barriers beyond basic affordability that impede access to health care. Jeffrey Kullgren, Department of Veterans Affairs and University of Pennsylvania, presented findings from his work documenting and classifying non-affordability barriers (e.g. travel distance) and found these barriers to be more common than those related to affordability. Failure to address these barriers may limit the efforts of the ACA to make care more accessible. Renee Hsia, University of California San Francisco, and Yu-Chu Shen, Naval Postgraduate School, both presented work on barriers to emergency department (ED) access. Hsia examined risk factors for ED closure and found that for-profit status, a profit margin in the lowest quartile, location in a competitive market, a high percentage of patients in poverty, and safety net status were all risk factors for ED closure. Shen, in her analysis of the effects of ED ambulance diversion on mortality for heart attack patients, found that patients who had a heart attack on a day when an ED was on diversion for 12 more hours had a mortality rate that was 2.8 percent higher than patients whose nearest ED was not diversion. Finally, Yan Xing, of the University of Texas MD Anderson Cancer Center, found that long travel distance to a health center was associated with a diagnosis of advanced colon cancer at presentation, greatly decreasing odds of cancer survival.