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

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.

The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 that began in 2013. This issue brief is a summary of data extracted from the HRMS surveys in Texas administered between September 2013 and March 2015, with responses from 1,544 Texans.

The HRMS is designed to provide timely information on implementation issues under the ACA and to document changes in health-insurance coverage and related health outcomes. Rice University's 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 (HRMS-Texas).

The HRMS was developed by the Urban Institute, conducted by GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute. The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the view of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation.

Full survey report: http://bakerinstitute.org/research/hmrs-issue-brief-14