WEDNESDAY, March 27, 2013 (HealthDay News) -- Poor people in the southern part of the United States are more likely to delay getting needed health care, mostly because states in that region impose the strictest eligibility requirements for Medicaid, new research says.
The problem is most pronounced in Texas and Florida, according to the report in the March 28 issue of the New England Journal of Medicine.
"There really is a great deal of variability across the country in access [to Medicaid]," said study author Dr. Cheryl Clark, from the Center for Community Health and Health Equity at Brigham and Women's Hospital, in Boston.
Counties in states with really restrictive Medicaid policies tend to have the greatest delays, said Clark, the center's director of health equity research and intervention.
The 2010 Affordable Care Act -- derided by critics as "Obamacare" -- aims to improve access to Medicaid by expanding the program and offering funding to states that adopt the expansion. Medicaid is a government-run program that offers health coverage to lower-income Americans.
States, however, don't have to adopt the expanded program and states that have the most restrictive Medicaid policies -- including Texas, Florida and Arkansas -- have opted out of expanded Medicaid.
"States make different decisions around whether they decide to accept federal support to expand their Medicaid programs," Clark said. "States are going to look very different in terms of their health care infrastructure and we may see a growing gap in health disparities."
Another factor causing delays in care is the number of primary care doctors. Delays in care are less likely in places like New England, where there are a lot of primary care doctors, than in areas in the South, where there are fewer such physicians, Clark's group noted.
Clark said that states that opt out of Medicaid expansion need to come up with another plan to improve access to care for the poor left out of that program.
She said there is a movement across the country to improve access to care for the poor even in places like Texas and Florida that have traditionally been less supportive of medical care for the poor.
Devon Herrick, a senior fellow at the conservative National Center for Policy Analysis, said there are alternatives under the Affordable Care Act to expand Medicaid to cover the poor.
Medicaid won't improve access to care, he said. One problem, which may only get worse, is fewer doctors will treat Medicaid patients.
"A lot doctors don't want to treat Medicaid enrollees because reimbursements tend to be half or even lower, compared to private insurance," he said.
Herrick said he thinks that under the Affordable Care Act, more poor people will be able to get private insurance coverage. "These people would qualify for, really, general subsidies under private coverage," he said. "The reimbursements to providers are nearly double Medicaid."
Each state will have to develop its own program, he said. Some will accept Medicaid expansion and others will find a different path. "There is no one-size-fits-all solution," he said. "There possibly 50 solutions across 50 states, maybe multiple solutions in each state."
One critic said that private insurance under the Affordable Care Act won't solve the access problem for many poor Americans.
"Unfortunately, the Affordable Care Act will leave about 30 million Americans uninsured, most of them U.S. citizens. These uninsured will continue to delay care, even for serious problems like heart attacks," said Dr. Steffie Woolhandler, a professor at CUNY School of Public Health at Hunter College, in New York City.
Some of the newly insured will also delay care because their new coverage is so skimpy that they can't to afford to use it, said Woolhandler, who is also a co-founder of Physicians for a National Health Program.
"For instance, the least expensive private insurance mandated by 'Obamacare' will have deductibles of up to $2,000, meaning that a policyholder who gets sick will need to pay $2,000 out of pocket before their insurance even kicks in," she said.
"A particularly ominous development is that the Obama administration is now allowing states to force even the poorest families to pay out of pocket before they can get medical care -- either by tacking co-payment onto Medicaid or, as in Arkansas, forcing the poor into skimpy private insurance plans. Hence, we can expect medically dangerous delays in care to continue," Woolhandler said.
To learn more about U.S. health care, visit the Kaiser Family Foundation.
SOURCES: Cheryl Clark, M.D., director, health equity research and intervention, Center for Community Health and Health Equity, Brigham and Women's Hospital, Boston; Devon Herrick, Ph.D., senior fellow, National Center for Policy Analysis, Dallas; Steffie Woolhandler, M.D., professor, CUNY School of Public Health,Hunter College, New York City, and co-founder, Physicians for a National Health Program; March 28, 2013, New England Journal of Medicine
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