Health Care Access Sharply Divided by Geography and Income

When it comes to health care, a study from the Commonwealth Fund found that there are two Americas, divided by geography and income. The report, titled “Health Care in the Two Americas,” analyzed 30 indicators of access, prevention and quality, potentially avoidable hospital use and health outcomes, finding sharp health care disparities among states. There are also wide differences within states by income, but many benchmarks for low-income populations in the top states were better than those for higher-income or more-educated individuals in the lagging states.

Report Findings

Overall, states in the Northeast and Upper Midwest performed best for low-income populations, while Southern and South-Central states often lagged. In the highest-performing states, low-income and less educated residents are more likely to be covered by health insurance, have a regular source of medical care, and get recommended preventive care. In contrast, the lowest-performing states have high uninsured rates, low rates of preventive care, high rates of potentially-avoidable hospital use from disease complications, and significantly worse health outcomes. Even the highest-performing states have room for improvement. In all states, premature death rates were markedly higher for people with a high school education or less than for college-educated individuals.

Possibilities for Improvement

If vulnerable populations in all states were to make the same benchmarks as higher-privileged populations, overall American health would improve drastically. Fewer people would die prematurely, resulting in 86,000 fewer deaths each year. Among low-income Medicare beneficiaries, there would be over 300,000 fewer readmissions within 30 days of hospital discharge, and 750,000 fewer beneficiaries would receive an unsafe prescription drug. Not just Medicare beneficiaries would benefit: 33,000 more infants born to mothers with a high school diploma or less would survive to see their first birthday. The Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), which expands health insurance and provides an array of new resources and tools, presents a historic opportunity for all states to greatly improve health and health care for vulnerable populations. Many of the lowest-performing states, however, have chosen not to expand their Medicaid programs under PPACA, which could increase the existing disparities between high- and low-performing areas of the country.