As states fight health law, coverage gaps slowly grow
Study finds access, medical issues vary based on stance
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-based 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 more poor adults.
Some states have expanded Medicaid with federal aid made available by the law; others — 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 between 2013 and 2014, according to a recent Gallup poll. That was nearly twice the rate of states that have not fully implemented the law.
The coverage increases also are improving access, other research shows.
The Commonwealth Fund looked at patients’ own descriptions of their health care experiences in a 2014 national survey on insurance coverage.
The problems in Texas and Florida, which have among the highest rates of uninsured in the country, were widespread.
More than 40 percent of residents of the two states said they did not go to the doctor when they were sick, fill a prescription, see a needed specialist or take a recommended test or treatment in the previous year.
The same proportion said they had been unable to pay a medical bill, had been contacted by a collection agency over a medical bill or had medical debt.
By contrast, just 31 per- cent of Californians and 30 percent 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. And insured Californians and New Yorkers were half as likely as Texans and Floridians to report having health plans with deductibles of at least 5 percent of their income, another survey found. People with higher deductibles said they’re less likely to get needed care.
But the large differences in insurance coverage between the states probably explains much of the disparities in access, said Commonwealth Fund Vice President Sara Collins.
Thirty percent of working-age Texans and 21 percent of working-age Floridians were uninsured in 2014, the study found. By contrast, 17 percent of working-age Californians and 12 percent of New Yorkers lacked coverage.
“Increasing coverage improves people’s ability to get access to medical coverage,” Collins said.