THE BLOG
06/05/2012 01:51 pm ET Updated Aug 05, 2012

Pay No Attention to That Patient Behind the Curtain

When you consider the sheer volume of hostile energy that has been directed against health care reform (aka the ACA), you could be forgiven for assuming that America's health care system is just fine, thank you very much -- or that if it has its weak spots, those are merely blips due to the recession.

Two new studies paint a far different picture.

If you listened to National Public Radio last week, you've probably already heard about one study. Along with the Robert Wood Johnson Foundation and the Harvard School of Public Health, NPR polled Americans about their perceptions of health care cost and quality and -- here's the twist -- compared answers of "average" respondents with those who had had a serious illness or hospitalization in the last year.

As reported by NPR, researchers "found that people who have a serious medical condition or who've been in the hospital in the past year tended to have more concerns about costs and quality than people who aren't sick. No big surprise there. But what was notable: 3 of 4 people who were sick said cost is a very serious problem, and half said quality is a very serious problem."

When NPR asked listeners to provide their own stories of recent encounters with the health care system, it got more than 1,000 responses in 24 hours.

For a slightly wonkier read, find someone with a subscription to this month's issue of Health Affairs, or check out the Urban Institute's public summary of their researchers' findings. The study's title says it all: "Virtually Every State Experienced Deteriorating Access to Care for Adults over the Past Decade."

What does this mean? For starters:

• More people -- both insured and uninsured -- had unmet medical needs in 2010 than in 2000.
• More people -- again, both insured and uninsured -- reported going without routine care because it was too expensive.
• More people -- you guessed it, insured and uninsured -- hadn't seen a dentist in the past year than in 2000.

Not surprisingly, the numbers were especially dramatic for those without health insurance. According to the report, in 2010 uninsured adults were far more likely than their insured counterparts to have unmet health needs due to cost (48.1 and 11.2 percent, respectively) and far less likely to have received a routine checkup (37.9 and 69.7 percent) or dental visit (37.5 and 72.3 percent).

Kids fared better, probably because children, unlike adults, can access health insurance through CHIP or Medicaid -- until the ACA kicks in, Medicaid enrollment is restricted to adults in certain categories (those with disabilities, caregivers, etc.).

This bleak news comes as health care costs soar -- one out of every six dollars in our economy today is a health care dollar -- and a combination of high unemployment rates and reduced benefits packages have placed roughly 50 million people in the expanding group of the uninsured.

If you think these grim statistics don't impact all of us, consider how much those with insurance are paying -- in the form of higher premiums -- to cover emergency room visits for the un- and under-insured (hint: it's a lot).

Or if that's too attenuated, how about the possibility that the driver on the road next to you has an undiagnosed (and untreated) heart disease, that your waitress could really use some antibiotics, or that the guy operating heavy machinery is stressed and distracted by the bills mounting from his daughter-in-law's recent catastrophic accident?

Is there anything to be done? Yes, and we've done it! The Urban Institute researchers found that the potential benefits from the ACA's expansion of health insurance coverage "are large and exist in every state." The Medicaid expansion alone is estimated to reach 16 million adults.

That's good news for all of us -- unless, of course, you are opposed to the ACA (see the aforementioned "we're fine, thank you very much" crowd). Then the report's findings are mixed.

On one hand, the Urban Institute report warns that "states that intentionally delay ACA implementation or are less aggressive in seeking to enroll people on Medicaid or subsidized exchange plans will not see the potential benefits of the ACA as soon as states that move more aggressively to expand coverage." That's bad news for governors like Chris Christie who have vowed to delay implementation.

On the other hand, researchers found that the only state where the ACA may not substantially improve access to health care is -- you guessed it -- Massachusetts. Why? Because the Bay State already has health care reform thanks to its former governor.

The bad news for all of us, of course, is that the fate of the ACA currently hangs in the Supreme Court. And without health reform, researchers do not see a way to stop the steady reduction in access to health care in our country.

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