The big three issues in health care are said to be access, cost and quality. A report from the Centers for Disease Control based on 2014 survey data evaluates some core access measures. (CDC Report) The researchers looked first at the number of adults with a usual place of care. Having a regular clinician helps aid in coordination and continuity of care and ensures that basic preventive care is received. People without a usual place of care often use emergency rooms or urgent care centers when they need services. Nationally, 17.3% of citizens have no usual place of care, but this varies from 2.8% in Vermont to 26.7% in Nevada. The states with the highest rates tend to be in the West and Southwest and those with the lowest in the Northeast or Midwest. To some extent this may reflect long travel times in states with a larger area. Only nine states were actually above the national average, but they tended to have large populations. The second measure was the percentage of adults aged 18 to 64 who did not have a visit with a general care physician in the last 12 months. Nationally that rate is 34% and it varies from 15.9% in Vermont to 48.1% in Montana. The Rocky Mountain states tended to have high rates and the Northeast lower ones, but it is a fairly diverse geographic mix. And this statistic may actually reflect the healthiness of a population as well as access difficulties. The reform law’s Medicaid expansion had a very minor effect on either of these rates. 16.6% of adults did not have a usual place of care in states that did the Medicaid expansion versus 18.2% in non expansion states. Similarly, 33.3% of adults in expansion states saw a doctor in the last year and 35% in non expansion states did. So the very expensive Medicaid expansion doesn’t seem to have done much to move these basic measures of access. The type of reform law insurance exchange also did not appear to have an impact on these measures.
