HRMS Issue Brief 14

Concerned about high medical bills, uninsured Texans are twice as likely as the insured to delay or forgo health care. That’s one of the findings of a new survey released Aug. 20, 2015, by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation. Scroll down for a Rice University/Episcopal Health Foundation news release on the findings or to download a PDF of the report. 

The Health Reform Monitoring Survey (HRMS)-Texas report is based on the HRMS, a national project that provides timely information on implementation issues under the Affordable Care Act (ACA) and changes in Health Insurance Coverage and Related Health Outcomes. The Baker Institute and the Episcopal Health Foundation are partnering to fund and report on key factors about Texans obtained from an expanded representative sample of Texas residents. They have published 14 reports in the series:   

• "Comparison of Affordability and Utilization of Health Care Services by Insured and Uninsured Adult Texans" (released Aug. 20, 2015)
• "Characteristics of Uninsured Texans as of March 2015" (released July 30, 2015)
• "Change in Insurance Status of Adult Texans By Demographic Group as of March 2015" (released June 2, 2015)
• "Effects of the Affordable Care Act on Health Insurance Coverage in Texas as of March 2015" (released April 30, 2015)
• "Marketplace Plans: Premiums, Network Size and Market Competition" (released Nov. 10, 2014)
• "Preparing for the Second Marketplace Open Enrollment Period in Texas" (released Oct. 16, 2014)
• "Affordability of Marketplace Plans in the Largest Metropolitan Areas of Texas" (released Sept. 23, 2014)
• "Insurance status of adult Texans and characteristics of the uninsured as of June 2014" (released Sept. 3, 2014)
• "Affordability of Marketplace Plans for the Marketplace Target Population" (released July 8, 2014)
• "The Experience of Texans with healthcare.gov" (released June 11, 2014)
• "The Affordable Care Act and Hispanics in Texas" (released May 9, 2014)
• "Early Effects of the Affordable Care Act on Health Insurance Coverage in Texas for 2014" (released April 14, 2014)
• "The Affordable Care Act and Texas' 'Young Invincibles'" (released March 31, 2014)
• "Were Texans Satisfied with the Cost of Health Care and Health Insurance Prior to the Affordable Care Act?" (released Feb. 10, 2014)

New report shows uninsured Texans are twice as likely to delay seeking primary care, mental health care

Texans without health insurance are twice as likely to skip seeking primary and mental health care because of cost. That’s one of the findings of a new survey released today by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

The report found that in the past year 32 percent of uninsured adult Texans said they had skipped primary care due to costs, compared with 16 percent of adults who have health insurance. When it comes to mental health care or counseling, 12 percent of uninsured Texans said they had delayed care, compared with 6 percent of adults with insurance.

“Lack of access to affordable primary and mental health care services are well-documented problems for all Texans, especially the uninsured,” said Elena Marks, president and CEO of the Episcopal Health Foundation and a nonresident health policy fellow at the Baker Institute. “In the case of primary care, the uninsured may be waiting to seek care when they’re sicker and need more intensive and expensive care. That’s concerning because basic health care services are usually less expensive and can help prevent more serious health problems. Untreated mental illness is also associated with a number of adverse outcomes, including physical illness.”

Researchers found both insured and uninsured Texans were the most likely to forgo dental care — 34 percent of the uninsured and 23 percent of those with insurance said they skipped dental care due to costs.

“This isn’t surprising because most insurance plans don’t include coverage for dental care,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute and director of the institute's Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “The Affordable Care Act does not require dental care coverage in Marketplace plans. As with other services, lack of insurance coverage is associated with skipping care.”

It’s also no surprise that uninsured Texans said they had more trouble paying the bill when they do seek medical care. The survey found that 28 percent of uninsured adults said they had trouble paying medical bills in the past year, compared with 18 percent of insured Texans who said they had the same difficulties.

Researchers also compared the health status of the insured and uninsured. When it comes to physical health, both groups reported similar rates of poor physical health days. However, when asked about poor mental health, a greater percentage of uninsured Texans said they had 11 or more days of poor mental health in the past year.

The report is the 14th in a series on the implementation of the Affordable Care Act (ACA) in Texas co-authored by Marks and Ho.