Poor Americans’ Access To Health Care Varies Hugely Between States, And Those Gaps Are Getting Wider

The huge disparities in health care across the country have contributed to a dynamic in which low-income Americans’ access to high quality care is largely dependent on the state they live in, according to a new report from the Commonwealth Fund.

Commonwealth’s new scorecard attempts to investigate whether states are successfully providing health care to economically disadvantaged populations. The nonprofit finds a dramatic range between the highest-ranked states and the lowest-ranked states on its list. While the poor residents of states that rank higher on Commonwealth’s scale of health care quality are more likely to be covered under some type of insurance and receive some kind of regular medical treatment, the poor residents living in states with lower rankings are much less likely to have access to the same care.

For instance, when Commonwealth looked at how many low-income adults over the age of 50 are receiving their recommended preventive care — like cancer screenings and vaccines — researchers found that states like Idaho, Oklahoma, and California have rates of 26 percent or less. But in Massachusetts, 42 percent of that population receives that care. Commonwealth found that the average national rate for this health indicator was somewhat in the middle of those two figures, at 32 percent.

Low-income adults are also much more likely to have dental issues in lower-ranked states. In West Virginia, Tennessee, Alabama, Mississippi, and Kentucky, about 25 percent of poor residents under the age of 65 have lost six or more teeth due to decay or disease — compared to less than 10 percent of those people in Connecticut, Hawaii, and Utah.

“There are often two Americas when it comes to healthcare, divided by geography and income,” the study’s authors concluded.

Ultimately, the stark differences in health care access and quality are leading to thousands of preventable deaths among poor Americans. The researchers point out that if the lowest-ranked states brought their health care delivery up to the standards that already exist for wealthier people in the highest-ranked states, an estimated 86,000 fewer people would die prematurely each year:

CREDIT: Commonwealth Fund
CREDIT: Commonwealth Fund

Previous research has found that the health disparities between rich and poor areas of the United States are only getting increasingly worse. Ironically, those gaps will likely widen once the health reform law is fully implemented.

Obamacare seeks to expand the Medicaid program to extend health coverage to additional low-income Americans, but the expansion is optional — and the states that are resisting it tend to be the same ones with disproportionately large uninsured populations and poor health care outcomes. Poor Americans in the South have the most to gain from Medicaid expansion, but their lawmakers are the ones refusing to cooperate with it. If stubborn Obamacare opponents keep digging in their heels against reform, the political fight over Medicaid is expected to widen the gulf between what are already the healthiest and sickest states in the country.

The Commonwealth Fund’s report didn’t specifically examine the impacts of the Affordable Care Act, but the researchers do note that the health reform law represents a “historic opportunity for states to provide better health care to economically vulnerable people by providing resources to overcome the geographic and income divide.” Of course, that’s only if states accept it.

“The lack of Medicaid will only exacerbate the disparities our scorecard highlights,” the Commonwealth Fund’s president, David Blumenthal, told USA Today.