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Access to Health Care Services Varies Widely from State to State

In fact, the authors speculated that the availability of health care services might be directly related to wealth. Wealthy regions with small pockets of poverty, the study found, have a higher-than-average supply of health care professionals. In addition, the authors wrote, doctors in those areas "may not feel as threatened financially by the uninsured, and may be more willing to treat them for free or reduced cost."

However, the investigators predicted that even in wealthy communities, impoverished individuals' access to health care services will diminish as the federal government increasingly shifts the burden of caring for uninsured individuals to state and local governments. "As a result, variation across communities in access to care for the uninsured is likely to persist or grow even larger," they observed.

This is especially bad news for Florida residents. A survey of Florida's health care providers by the Florida Hospital Association recently revealed that the cost of treating the state's uninsured population has increased more than 24% since 1990 to an estimated $940 million in 1996 alone. The report goes on to predict that those costs will continue to grow as health maintenance organizations (HMOs) raise their premiums to account for their dropping profit margins, "which will bump more Floridians into the ranks of the uninsured."

But Florida is not alone: Another survey in Nevada found that nearly 20% of the state's residents are uninsured and that a number of other residents have temporary lapses in their health insurance coverage. In total, a 1998 Health Care Financing Administration (HCFA) survey estimated that there are 31.8 million uninsured Americans, with about 17% falling into high-risk categories such as seniors over the age of 65.

The good news is that a number of corporations are picking up where the federal and state governments have now left off. These corporations are issuing grants to help extend insurance programs into impoverished areas that have been largely ignored. In California, for example, WellPoint Health Networks Inc., the for-profit manager of the state's Blue Cross health plan, recently awarded the state $1.8 million to establish a telemedicine program designed to increase rural communities' access to health care providers. The grant included about $250,000 in rate enhancements to establish a statewide network that will serve migrant farm workers and Native Americans. These two state populations are often uninsured or generally have only temporary coverage.

Despite the emergence of these grants, which are now also available from universities and other public institutions, some states are finding that reaching those individuals who qualify for subsidized health care coverage prior to the collapse in their health represents another complication. This problem is now evident in Wisconsin, whose welfare reform program was once hailed by health care analysts as a possible model for national welfare reform. The state is now struggling to make sure that residents who have moved off welfare can still access their Medicaid benefits because many eligible clients either don't realize that they still qualify for the Medicaid program or are discouraged by the state's recertification process.

In response, Wisconsin is now launching an extensive outreach program aimed at informing former welfare recipients that they still have access to essential health care services. However, state-based health care advocacy groups say that there are a number of people who are no longer receiving these critical services, which is a situation that may lead to higher health care costs as these Medicaid-qualifying recipients enter acute-care facilities. The uninsured, HCFA's study confirms, rely disproportionately on hospital emergency departments. And that reliance on emergency care is putting the nation's health care system in a very untenable position, the HCFA analyst concluded.

In terms of the elderly uninsured, HCFA estimates that the Medicaid program spent an average of $8,973 per individual in 1996. This figure includes the cost of Medicaid's long-term care services, but HCFA analysts say that the average cost could be signifiantly reduced by increasing third-party insurance options for the elderly individuals. However, HCFA analysts add, their present focus is on uninsured children, who account for over 30% of the nations uninsured ranks.

Ori Twersky
Associate Editor