A recent article in Health Affairs finds that
access to care for adults has deteriorated in the last decade. The likelihood
of having a usual source of care, an office visit, or seeing a dentist all
declined. At the same time, the likelihood of visiting an emergency room rose
slightly. Adults were also more likely to have unmet medical and dental needs.
In fact, adults were 66% more likely to report an unmet medical need and 79%
more likely to report an unmet dental need in 2010 than in 2000. They were also
more likely to have delayed care.
Why these declines in access to care? Coverage changes
(i.e., an increase in the number of uninsured and a decrease in the number of
adults with private coverage), contributed to these declines, but they do fully
explain the change, as declines in access were seen across coverage groups. For
example, both privately- and publicly-insured adults were more likely to have
unmet medical and dental needs, and to have delayed care. The decline, however,
was most pronounced among the uninsured. By 2010, they were much less likely
than their insured counterparts to have a usual source of care or a
medical/dental visit, and were far more likely to have an unmet need or delayed
care due to cost.
It was not all bad news from our friends at the Urban
Institute. There’s some good news as well, as these trends did not extend to
children. In contrast to what was seen for adults, children were more likely to
have a usual source of care, an office visit, and a dental visit when compared
to 2000. There were no significant changes for children in terms of unmet
medical or dental needs, although children did experience increases in the
likelihood of having an emergency room visit and delaying care for non-cost
reasons. (For more on access to care for children, check out the most recent
MACPAC report .)
There’s also optimism that improved access could be just
over the horizon for adults. While we know coverage doesn’t necessarily equal
access, the findings on children provide hope that the ACA may improve adults’
access to care. Over the last decade, as coverage and access for adults
deteriorated, Medicaid and CHIP have given children the opportunity to maintain
or improve their access to care. Maybe the ACA coverage expansions will have
the same positive impact for adults.