People living in Florida and Texas are more likely to have problems paying their medical bills and skip unaffordable doctor visits than those living in California and New York. The reasons are rooted in history, politics and policy, according to new research.
A new Commonwealth Fund study shows large disparities between two states that have embraced the Affordable Care Act and two states that have vehemently opposed it. For example, according to a Commonwealth Fund survey from last year, 43% of those living in the Sunshine State and the Lone Star State said they had not visited their doctor or filled their prescriptions, had skipped treatment or avoided specialist care in the past 12 months. That compares to 31% of Californians and 30% of New Yorkers.
More than 40% of Floridians and Texans also said they had problems paying their medical bills or had concerning amounts of healthcare debt. Only 24% and 29% of Californians and New Yorkers, respectively, said the same.
Texas and Florida, which have two of the highest uninsured rates in the country, are led by Republican governors who have voiced clear opposition to President Barack Obama's healthcare law. Neither state has expanded Medicaid eligibility to people making 138% of the federal poverty level (though some Florida leaders recently tried), and both states have declined to set up their own insurance exchanges.
Meanwhile, California and New York have expanded Medicaid, created their own health insurance exchanges and advocated for legislation to make health insurance more affordable.
One of the Affordable Care Act's primary goals was to give more people affordable access to health coverage. States like California and New York have made progress in reducing their uninsured ranks by embracing the major tenets of the law, the Commonwealth Fund report said.
Although Florida and Texas have reduced their uninsured population through their popular exchanges operated by HHS and relying on HealthCare.gov, many people fall into coverage gaps, such as those who would have qualified for Medicaid under expanded eligibility but can't receive subsidies on the exchanges because their incomes are too low. Undocumented immigrants across the country also have no options under the reform law to obtain low-cost coverage.
But access to health insurance is only the first step, the authors concluded. Bare-bones policies will do little to alleviate people's concerns about their medical bills.
“Expanded coverage is necessary to improve access to care and reduce medical financial burdens among U.S. families,” the report said. “But the quality and comprehensiveness of coverage across all sources of insurance (marketplace plans, individual plans, employer-provided coverage and Medicaid) will ultimately determine the degree to which these problems are lessened for U.S. families.”