Wednesday, April 15, 2015
The Commonwealth Fund
April 10, 2015
Health Care Coverage and Access in the Nation's Four Largest States
By Petra W. Rasmussen, Sara R. Collins, Michelle M. Doty, Sophie Beutel
In this brief we use data from the Biennial Survey to examine
differences in health insurance coverage, cost-related problems getting
needed care, and medical bill problems and debt among adults ages 19 to
64 in the nation's four largest states.
The four largest states in the U.S.—California, Florida, New York, and
Texas—fall into two distinct categories. The first group is represented
by California and New York, both of which are operating their own health
insurance marketplaces and have expanded eligibility for Medicaid to
adults who earn at or below 138 percent of the federal poverty
level—about $16,000 for an individual or $32,000 for a family of four.3
Florida and Texas, the second group, are using the federal marketplace
to enroll residents in health plans and have declined to expand Medicaid
eligibility. In this new analysis of data from the Commonwealth Fund
Biennial Health Insurance Survey, we find that, in 2014, there were
larger shares of uninsured adults in Florida and Texas compared with
California and New York. In addition, adults in Florida and Texas were
more likely to report not getting needed care because of cost and to
report having problems paying medical bills.
Percent of adults ages 19-64 who are uninsured
12% - New York
17% - California
21% - Florida
30% - Texas
Percent of adults ages 19-64 who experienced cost-related access problems
30% - New York
31% - California
43% - Florida
43% - Texas
Percent of adults 19-64 reporting medical bill problems or medical debt
29% - New York
24% - California
42% - Florida
41% - Texas
The analysis suggests that the health policy decisions made by state
leaders matter. Of the four states studied, New York has had the longest
history of legislation aimed at enhancing the availability of affordable
coverage. California also implemented an early expansion of Medicaid
eligibility and, based on federal survey data, both states began
achieving declines in their adult uninsured rate earlier than other
states. Both have taken advantage of opportunities granted by the
Affordable Care Act to further expand the reach of coverage and access.
Alternatively, Florida and Texas, while experiencing robust enrollment
in private plans through the federal health insurance marketplace, have
not expanded Medicaid eligibility and have made less headway in reducing
their uninsured populations.
While there have been significant declines in the number and share of
uninsured adults since the major provisions of the Affordable Care Act
went into effect in 2014, coverage gaps are leaving millions uninsured
and without access to affordable coverage. An estimated 3.7 million
people have fallen into the Medicaid coverage gap in states that have
not yet expanded eligibility for Medicaid.
In addition, the law does not provide access to any new coverage options
for unauthorized immigrants. They are ineligible for Medicaid coverage
and cannot purchase private plans through the marketplace, either
subsidized or unsubsidized. The Congressional Budget Office estimates
that by 2020, 30 percent of the remaining uninsured will be unauthorized
immigrants, or about 9 million people. Another part of the law that is
leaving people uninsured is the so-called "family coverage glitch,"
which defines affordability—and eligibility for subsidies—based on the
cost of individual, rather than family, coverage. Currently, an
estimated 2 million to 4 million people are uninsured because of this issue.
The analysis also indicates that expanded coverage is necessary to
improve access to care and reduce medical financial burdens among U.S.
families. 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.
Comment by Don McCanne
New York and California have fully implemented the provisions of the
Affordable Care Act whereas Florida and Texas have not. As a result,
Florida and Texas have more people who are uninsured, more people who
experience cost-related access problems, and more people with medical
bill problems or medical debt.
Although the leaderships of Florida and Texas should be ashamed for
failing to implement the programs that would ensure that more residents
receive the health care that they need, the leaderships of New York and
California should be ashamed as well for not demanding changes in our
health care financing system that would ensure health care for everyone.
The numbers in the tables above for these two "exemplary" states are
disgraceful and would not be tolerated by any other wealthy nation.
Incremental patches are grossly inadequate. We need a single payer
national health program.
at 8:11 AM