SCORECARD EVALUATES HOW WELL STATES’ HEALTH CARE SYSTEMS ARE WORKING FOR
LOW-INCOME AMERICANS, FINDS WIDE DISPARITIES IN ACCESS TO CARE AND HEALTH
Finds Lower-Income People in Top Performing States Often Better Off Than
Higher-Income People in Lagging States; Millions Would Have Better Care and
Healthier Lives If All States Could Do As Well As The Top Performers
New York, NY, September 18, 2013 - Access to affordable health care and quality
of care vary greatly for low-income people based on where they live,
according to a new Commonwealth Fund scorecard. The Scorecard provides the
first state-by-state comparison of the health care experiences of the 39
percent of Americans with incomes less than 200 percent of the federal
poverty level, or $47,000 a year for a family of four and $23,000 for an
individual. Low-income people account for at least 25 percent of total state
populations, and as much as nearly half (47%) in some states - including
Arkansas, Louisiana, Mississippi, and New Mexico.
The report also compares the health care experiences of those with low
incomes to those with higher incomes - over 400 percent of poverty, or $94,000
a family of four - and finds striking disparities by income within each
state. Yet, the wide differences by geography often put higher-income as well
as low-income families at risk. The report finds that higher-income people
living in states that lag far behind are often worse off than low-income
people in states that rank at the very top of the scorecard. For example,
low-income elderly Medicare beneficiaries in Connecticut and Wisconsin are
less likely to receive
high-risk medications than are higher-income elderly
in Mississippi, Louisiana, and Alabama.
The stark differences in health care access, quality, and outcomes detailed
in the report add up to substantial loss of lives and missed opportunities to
improve health and quality of care. According to the Scorecard, if all
states could reach benchmarks set by the leading states for their more
estimated 86,000 fewer people would die prematurely each year,
fewer low-income Medicare beneficiaries would be prescribed potentially
of millions of adults and children would receive needed preventive care
like vaccines, check-ups, and cancer screenings,
9 million fewer low-income adults under age 65 would lose six or more
teeth because of tooth decay, infection, or gum disease, and
million more low-income adults and children would have health insurance
coverage, reducing the number of uninsured by half.
repeated evidence that we are often two Americas, divided by income and
geography when it comes to opportunities to lead long and healthy lives.
These are more than numbers,” said Cathy Schoen, Commonwealth Fund Senior
Vice President and lead author of the report. “We are talking about people’s
lives, health, and well-being. Our hope is that state policymakers and health
care leaders use these data to target resources to improve access, care, and
the health of residents with below-average incomes.”
The report, Health Care
in the Two Americas: Findings from the Scorecard on State Health System
Performance for Low-Income Populations, and online interactive
map rank states on 30 indicators covering issues such as access to affordable
health care, preventive care and quality, potentially avoidable hospital use,
and health outcomes. The report also examines how well the top-performing
state in each category does for its high-income residents and sets that as a
benchmark in order to assess the potential if all states could do as well.
Health Disparities Exist Within and Among States
The report finds substantial variation in health care and health outcomes for
low-income people - a two- to five-fold difference. While there was room for
every state to improve, states in the Upper Midwest, Northeast, and Hawaii
performed best, while Southern and South Central states often lagged.
Some findings of wide geographic disparities and gaps in care include:
percentage of uninsured low-income adults ranged from a low of 12
percent in Massachusetts to a high of 55 percent in Texas.
32 percent of low-income adults ages 50 or older received recommended
preventive care, such as cancer screenings and vaccines, ranging from 26
percent or less in Idaho, Oklahoma, and California, to 42 percent in
Massachusetts, the top-ranked state for this indicator.
eight states, 40 percent or more of Medicare beneficiaries received
medications considered high-risk for the elderly - rates more than double
of states with safer prescribing.
hospitalizations among children from low-income communities in New York
were eight times higher than in Oregon, the state with
the lowest rate.
(477 per 100,000 in New York compared to 56 per 100,000 in Oregon.)
least one of four low-income adults under 65 in West Virginia,
Tennessee, Alabama, Mississippi, and Kentucky lost six or more teeth due
or disease, compared to less than 10 percent in Connecticut,
Hawaii, and Utah, the states with the lowest rates.
Demonstrating the potential to improve, the report finds that in
top-performing states, low-income people often fared better than the national
average, and even better than higher-income people in the worst-performing
states. On nearly half of the indicators, including potentially preventable
hospitalizations, infant mortality, smoking, and obesity, lower-income or
less-advantaged people in high-performing states did better than
more-advantaged people in low-performing states.
Suffer from Lack of Access to Affordable, Timely Health Care
The report finds that low-income people were more likely to be uninsured or
underinsured than those with higher incomes. In 2010-2011 nearly 56 million
low-income people were uninsured or underinsured, ranging from a low of 36
percent in Massachusetts to a high of more than 60 percent in Alaska,
Colorado, Florida, Idaho, Montana, Nevada, New Mexico, Texas, Utah, and
Insurance and access to health care are closely linked: the report finds that
insured low-income people have similar rates of having a usual source of care
and receiving recommended care as insured high-income people. However,
insurance alone doesn’t guarantee receipt of high-quality, safe care, as
demonstrated by the varied experience of low- and higher-income Medicare
beneficiaries, all of whom are insured.
The report findings point to the need to strengthen primary care to ensure
timely access, reduce reliance on emergency rooms, and improve care for those
with chronic disease. The Scorecard finding that those living in low-income
communities often fare worse points to the need for targeted efforts focused
on “hot spots,” or communities with very high rates of hospital or emergency
room use, to act early, prevent complications and improve population health.
According to the report, the Affordable Care Act represents a historic
opportunity for states to provide better health care to economically
vulnerable people by providing resources to overcome the geographic and
income divide - especially for states with high rates of poverty. The authors
note that investing those resources well has the potential to improve the
health and productivity of the entire state. The scorecard offers targets to
improve as well as a way of tracking progress by state over time.
“The Scorecard’s startling findings show us where our bright and weak spots
are when it comes to providing health care to millions of Americans living on
modest or low incomes,” said Commonwealth Fund President David Blumenthal,
M.D. “And the timing is important. We are at an unprecedented moment in the
history of our nation. We have the potential to raise the bar, unite the
country, and realize the promise of a more equal opportunity to thrive by
expanding health care coverage and innovating to find the most effective ways
to deliver high-quality, safe care for everyone.”
Data and Resources
The report and additional resources, including an interactive map, state
profiles, an infographic, and a slide show explainer, “A Tale of Two States:
The Health Care Income Divide Visualized,” will be available at: www.commonwealthfund.org/Publications/Fund-Reports/2013/Sep/Low-Income-Scorecard.aspx.
Methodology: The low-income scorecard compares
states on 30 indicators spanning access and affordability,
prevention/quality, potentially avoidable hospital use, and health
outcomes. It draws from the most current data available, generally
2010-2011. Where possible the indicators compare experiences by income.
Where person-specific income information was not available, the analysis
uses low-income communities or education to assess income-related
differences. States were ranked on each indicator and dimension. For selected
indicators the analysis assesses potential gains if the state improved to
the top rate set by leading states for low- income or high-income
residents. The website provides state-specific profiles.