Residents of Florida and Texas were more likely to report having difficulty paying their medical bills in 2016 than those who lived in California or New York, according to a survey published Wednesday by the nonprofit Commonwealth Fund, a health policy think tank and advocate for coverage.
Though all four states made gains in the numbers of residents with health insurance since the launch of the Affordable Care Act’s coverage expansions in 2014, the survey found that Florida and Texas residents were more likely to report having a medical bill problem in the prior year or having carried long-term medical debt.
Why the difference?
Sara Collins, a vice president for Commonwealth Fund and co-author of the study, said the biggest factor affecting people’s ability to pay their medical bills was the increased availability of health insurance.
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“More people simply have health insurance coverage,” she said, “so they’re not facing the full cost of their care when they go to the doctor.”
But while nearly 20 million Americans in every state gained coverage under the health law, also known as Obamacare, not all states were equal.
In California and New York, where legislators chose to cover nearly all low-income adults with Medicaid, the gains were greater. Ten percent of Californians lacked health insurance in 2016. In New York, it was about 7 percent.
In Florida and Texas, legislators refused to expand Medicaid, resulting in higher uninsured rates. Texas had the highest uninsured rate in the nation in 2016, with about 25 percent of residents without health insurance. In Florida, the uninsured rate last year was 16 percent.
Most of the Commonwealth Fund’s analysis focused on adults ages 19 to 64 in the four largest states, using the results of a telephone survey of 2,817 people, including 663 in Florida, collected between July and November 2016.
The survey found that 41 percent of Floridians and 44 percent of Texans surveyed reported they had trouble paying their medical bills in the prior year, or were contacted by a collection agency about unpaid medical bills, or were carrying medical debt.
By comparison, about 28 percent of Californians and New Yorkers surveyed reported similar challenges with medical debt.
But state decisions on Medicaid were not the only factor contributing to the differences in medical debt experiences among residents of the different states. Commonwealth Fund researchers said other realities also come into play, including the rate of illegal immigrants living in each state.
Undocumented immigrants are not eligible for Medicaid or ACA coverage, and this likely contributed to Texas’s high rate of uninsured residents.
Collins said she fears that the Republican healthcare proposal known as the American Health Care Act will reverse the health law’s coverage gains and remove its financial protections for consumers.
Because the AHCA proposes ending the federal government’s funding of Medicaid expansion and eliminating the health law’s system of financial aid for eligible low-income consumers, Collins said fewer people are likely to be covered — and those who do have health insurance will have fewer financial protections.
The AHCA would eliminate the health law’s financial aid for low-income Americans to pay their deductibles, co-payments and other out-of-pocket expenses. That financial aid, called cost sharing reduction, is currently available to Americans with ACA coverage who earn less than $30,000 a year for an individual or $50,400 annually for a family of three.
“What one would expect to see over time is a resurgence in the upward trend in financial problems people have related to medical bills,” she said. “It’s hard to see how we wouldn’t see that under this new proposal.”