Affordable Care Act

Texas Health Survey Shows Both Insured And Uninsured Skip Needed Care

One in three people without health insurance reported forgoing primary care, while one in six insured people did. The data come from a survey conducted by researchers at Rice University and the Episcopal Health Foundation in Houston.

Almost two years after the Affordable Care Act went fully into effect, there’s some good news: there are fewer uninsured adults in Texas, down from 25 percent (in September 2013) to 17 percent in March.

But a new survey reveals those still without insurance are more than twice as likely as insured people to forgo getting primary care treatment. One of the primary researchers, Elena Marks, is president of the Episcopal Health Foundation in Houston.

“Because they’re uninsured they’re delaying all kinds of care compared to their insured counterparts – who also delay care, because even if you have insurance, there are also copays and deductibles.”

Marks and health economist Vivian Ho of Rice University analyzed data from a statewide survey to reveal many gaps in access to care for the uninsured, including access to mental health providers and medical specialists. But the biggest gap occurred in primary care.

“That is concerning because primary care is the gateway to preventive services, and to low-cost services in a community based setting,” Marks said.

About 32 percent of the uninsured Texans reported skipping primary care. But so did 16 percent of respondents who did have insurance. Marks explained that high deductibles may have played a role.

“Accessing care, in many cases, is not free even if you do have insurance,” she said.

Under the Affordable Care Act, uninsured people must shop among insurance plans through an online marketplace. Marks says many people bought plans that had attractively low monthly premiums. But when it was time to go to the doctor, they may have decided against it because the deductible was high: up to $2,000, $3,000 or even $4,000.

Other reasons that insured people may not seek care include the difficulty of finding an in-network primary care doctor nearby, or issues with transportation.

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