Dis­par­i­ties in ac­cess to care

Cal­i­for­ni­ans and New York­ers have bet­ter ac­cess to care than Florid­i­ans and Tex­ans.

Los Angeles Times - - BUSINESS - By Noam N. Levey noam.levey@la­times.com

Cal­i­for­ni­ans and New York­ers have bet­ter ac­cess to health­care than Florid­i­ans and Tex­ans, a study f inds.

WASH­ING­TON — The na­tional divide over the Af­ford­able Care Act is be­gin­ning to af­fect Amer­i­cans’ ac­cess to med­i­cal care and per­haps even their abil­ity to pay med­i­cal bills, a new study of the coun­try’s four largest states sug­gests.

Res­i­dents of Florida and Texas, which have re­sisted ex­pand­ing in­sur­ance cov­er­age through the health law, re­ported more prob­lems get­ting needed care than res­i­dents of Cal­i­for­nia and New York, which both guar­an­tee cov­er­age to their res­i­dents.

Florid­i­ans and Tex­ans were also sig­nif­i­cantly more likely to strug­gle with med­i­cal bills and to re­port that they had med­i­cal debt, ac­cord­ing to the study from the Com­mon­wealth Fund, a New York foun­da­tion that stud­ies health sys­tems do­mes­ti­cally and around the world.

“Health pol­icy de­ci­sions made by state lead­ers mat­ter,” the study’s au­thors con­clude, warn­ing: “Cov­er­age gaps are leav­ing mil­lions unin­sured and with­out ac­cess to af­ford­able cov­er­age.”

The new re­search adds to grow­ing ev­i­dence that the 2010 health law may be widen­ing geo­graphic health dis­par­i­ties in the United States, an in­crease driven in large part by state de­ci­sions about whether to open their gov­ern­ment Med­i­caid pro­grams to poor adults.

Some states have ex­panded Med­i­caid with fed­eral aid made avail­able by the law; other states — all led by ei­ther Repub­li­can gov­er­nors or leg­is­la­tures, or both — have turned down the as­sis­tance, cit­ing con­cerns about Med­i­caid’s ef­fec­tive­ness and cost.

Na­tional sur­veys have al­ready shown that has dramatically af­fected rates of cov­er­age.

States that fully im­ple­mented the law saw a 4.8 per­cent­age-point im­prove­ment in the share of adults with in­sur­ance from 2013 to 2014, ac­cord­ing to a re­cent Gallup poll. That was nearly twice the rate of states that have not fully im­ple­mented the law.

The in­creases in cov­er­age also are im­prov­ing ac­cess, other re­search in­di­cates.

A study of billing data pub­lished last month by re­searchers at Quest Di­ag­nos­tics found that the num­ber of Med­i­caid pa­tients with newly iden­ti­fied di­a­betes surged 23% from 2013 to 2014 in states that ex­panded their pro­grams, while there was vir­tu­ally no in­crease in states that de­clined to ex­pand cov­er­age.

Com­mon­wealth Fund re­searchers looked at pa­tients’ own de­scrip­tions of their health­care ex­pe­ri­ences in a 2014 na­tional sur­vey that the fund con­ducted on health in­sur­ance cov­er­age.

The prob­lems in Texas and Florida, which have among the high­est rates of unin­sured in the coun­try, were wide­spread.

More than 40% of res­i­dents of the two states re­ported that they did not go to the doc­tor when they were sick, didn’t fill a pre­scrip­tion, didn’t see a needed spe­cial­ist or skipped a rec­om­mended test or treat­ment in the pre­vi­ous year.

The same pro­por­tion re­ported they had been un­able to pay a med­i­cal bill, had been con­tacted by a col­lec­tion agency over a med­i­cal bill, had had to change their way of life to pay bills or had med­i­cal debt.

By con­trast, just 31% of Cal­i­for­ni­ans and 30% of New York­ers re­ported the same ac­cess prob­lems.

Even fewer said they had the same strug­gles with med­i­cal bills.

Re­searchers noted that a va­ri­ety of fac­tors may help ex­plain th­ese dif­fer­ences.

In­sur­ance poli­cies in Florida and Texas tend to have higher cost-shar­ing re­quire­ments, for ex­am­ple, which prob­a­bly feed con­sumers’ billing chal­lenges in those states.

In­sured Cal­i­for­ni­ans and New York­ers were half as likely as in­sured Tex­ans and Florid­i­ans to re­port hav­ing health plans with de­ductibles that were at least 5% of their in­come, ac­cord­ing to an­other sur­vey. Peo­ple with higher de­ductibles are more likely to re­port not get­ting needed care.

But the large dif­fer­ences in in­sur­ance cov­er­age be­tween the states prob­a­bly ex­plains much of the dis­par­i­ties in ac­cess, said Sara Collins, a Com­mon­wealth Fund vice pres­i­dent and one of the study’s au­thors.

Thirty per­cent of work­ing-age Tex­ans and 21% of work­ing-age Florid­i­ans were unin­sured in 2014, ac­cord­ing to the study. By con­trast, 17% of work­ing-age Cal­i­for­ni­ans and 12% of work­ing-age New York­ers were with­out cov­er­age last year.

“We know that in­creas­ing cov­er­age im­proves peo­ple’s abil­ity to get ac­cess to med­i­cal cov­er­age,” Collins said.

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