Anyone in North America who’s gone to a hospital recently will tell you that medical care is expensive. A visit to the emergency room can easily set you back thousands of dollars in no time – even something as routine as stitches or a broken bone can really put a dent in your finances. When the necessary treatment involves inpatient procedures like major surgery, the prices soar. It’s not uncommon for medical bills to reach the tens of thousands of dollars and sometimes even more.
Health insurance is there to help people deal with these costs, but unfortunately not everyone can afford that either. 47 million Americans were uninsured in 2012 and for many who are are working part-time or who can’t find work, or even for those who do work but still face prohibitively high premiums to cover their families, health insurance is sometimes just not affordable. In fact, not even close to all of the uninsured in America back in ’12 were unemployed. Six in ten of those without insurance have at least one full-time worker in the family, while 16% have a part-time worker in the family.
The uninsured aren’t the only ones suffering from a lack of coverage. When someone without insurance seeks medical care, they may be unable to pay their entire bill. To make up for these uncompensated costs, the providers charge more for their services to those who do have health insurance. In turn, health insurance premiums rise for everyone.
What’s the solution? Well, many disagree about that. Some people think the Affordable Care Act, otherwise known as ObamaCare, may help with this lack of coverage and bring health insurance down. Some states have enabled Medicaid expansion, bridging the coverage gap by covering those previously ineligible. Other states have chosen not to expand the program, and some argue that the ACA does more harm than good.
Several states on this list – which enumerates the states most struggling with health care costs – chose to expand Medicaid but, perhaps surprisingly, some struggling states did not. Considering the implementation of the ACA this year, it should be interesting to see where these states rank at the end of 2014. All data provided here comes from a Gallup poll conducted between January 2nd, 2012 through December 29, 2013. The poll asked Americans if there had ever been times over the past 12 months in which they could not afford health care or medicine for their families. These states had the highest number of residents who responded that they did, indeed, have trouble affording these basic, essential services.
10. Texas and Arizona (tied) – 21.0% Struggle With Health Care Costs
Texas and Arizona both have 21% of their population struggling to afford healthcare and /or medicine. Texas also has the highest percentage of residents who are uninsured (25% of the population). According to ObamaCare projections, 3 million Texans were expected to be insured through the ACA exchanges. Texas isn’t alone in the rankings for those without insurance, though, because Arizona gives them a run for their money. Arizona has the third-highest rate of uninsured children in the nation.
9. Florida – 21.1% Struggle With Health Care Costs
In 2013, Florida had the second highest percentage of uninsured people under the age of 65 years old. In fact, about a quarter of the state (around 3.8 million people) were without insurance, and at least half a million of those were kids under the age of 19 years old. Unfortunately for many, Florida is one of the states who did not opt to expand Medicaid coverage for its citizens, meaning health care costs are still out of reach for many in the state.
8. South Carolina – 21.3% Struggle With Health Care Costs
South Carolina was one of the first states to opt out once the Supreme Court ruled that states were not required to expand their Medicaid programs under the Affordable Care Act. Because of this, about 250,000 people are said to be going without health coverage in the state because they fall into the ‘coverage gap’. That is, they can’t afford to purchase health insurance on the exchange, but they still don’t qualify for Medicaid. So for now, they remain uninsured.
7. Oklahoma – 21.7% Struggle With Health Care Costs
Nearly 1 in 6 Oklahomans are uninsured, and 13% of those are children. Oklahoma is another state that has chosen not to expand Medicaid, and enrollment in the ACA has been low due to the coverage gap that continues to exist in the state. But it’s not just the uninsured who are burdened with the cost of healthcare. The uninsured cost the state $954 million a year in cost shifting, causing Oklahoma to have the 3rd highest “hidden tax” burden in the nation. Uncompensated care such as charity care and bad debt from people who are unable to pay their medical bills cause shortfalls which must be “cost shifted” to insurance companies, self-insured businesses, and others who pay for their health care.
6. Arkansas – 22.3% Struggle With Health Care Costs
For those in Arkansas who are unable to afford health care coverage, there is some good news. Arkansas has chosen to expand Medicaid to those with incomes up to 138% of the federal poverty level. Considering Arkansas is generally a conservative state, many might be surprised to hear that they chose to expand Medicaid. However, one thing to take note of is that they are implementing a slightly different model than other states who chose to go with the expansion. They’re implementing a premium assistance model that allows Medicaid funds to be used to purchase Qualified Health Plans (QHPs) through the ACA marketplace.
5. North Carolina – 22.3% Struggle With Health Care Costs
North Carolina chose to not extend Medicaid coverage, so eligibility for the program will remain quite limited. Medicaid eligibility in North Carolina for non-disabled adults is narrowly limited to parents with incomes below 43% of poverty, or about $10,100 a year for a family of four. Adults without children remain ineligible regardless of income.
4. Kentucky – 22.5% Struggle With Health Care Costs
Kentucky joins Arkansas as a state that’s chosen to expand Medicaid to include those making 138% of the poverty level, which means that more citizens are likely to have help with health costs in the future. In fact, Kentucky may soon fall off this list when next year’s figures roll in thanks to cutting the uninsured population down a full 40% through the ACA.
3. Mississippi – 23.2% Struggle With Health Care Costs
138,000 uninsured adults in Mississippi fall into the coverage gap since the state has chosen not to expand Medicaid. These are people who fall well below the poverty line with limited income, but who do not meet the standard requirements for Medicaid. Families with children who fall below 29% of poverty are eligible, but regardless of income, those without dependent children still remain ineligible. Without any affordable options for health insurance on the exchange, many of them will likely remain uninsured and unable to pay for health care.
2. West Virginia – 23.8% Struggle With Health Care Costs
267,000 West Virginians were uninsured, many of those ineligible for Medicaid before the state decided to expand the program. Now 76% of the non-elderly uninsured are eligible for financial assistance to gain coverage either through the Marketplace or Medicaid. Over half of them are now eligible for Medicaid or CHIP ( Children’s Health Insurance Program, a program for families with higher incomes to insure children who otherwise would not be covered). This is good news for the 23.8% of citizens who have been struggling to afford health care.
1. Alabama – 24.5% Struggle With Health Care Costs
With about 660,000 uninsured non-elderly citizens, Alabama has the highest number of people unable to afford health insurance. 191,000 of these would have been eligible for health care benefits if the state had expanded Medicaid program. However, unlike West Virginia, the state has decided not to expand Medicaid, leaving many of these people without any other affordable options. Thankfully, there are some higher eligibility levels in place for children, but for many adults, they will most likely have to remain uninsured.