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FL Health System Fails Poor: Study

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Florida lands near the bottom of the states in a new Commonwealth Fund study that compares 30 performance measures of health-system access, prevention, quality and outcomes.

The study, “Health Care in the Two Americas,” pays particular attention to those with modest incomes, calling them a "vulnerable population."

The authors create a scorecard that divides the states into four sections from best to worst. Along with most Southern states, Florida is ranked in the bottom quartile. A low ranking translates into years of productivity and life lost, said Cathy Schoen, lead author.

 “We are talking about people’s lives, health, and well-being,” said Schoen, Commonwealth Fund Senior Vice President. “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 foundation used Florida and New York as examples of states with close to the same population, around 19 million, and around the  same proportion of the population that is low-income, around 40 percent.

"But when it comes to access to health care, the difference between the two states is dramatic," the authors said in a chart. Among low-income adults under age 65, in New York the percentage of uninsured is 31, and in Florida, it's 48.

Nationwide, Florida has the second-highest percentage of low-income adults who say they went without care in the past year due to cost, the chart said.

Dr. David Blumenthal, Commonwealth Fund's president, wrote in a blog that the results from some Southern states "look more like those in developing countries" of South Asia and Latin America. He said it is crucial that the country move toward a more equitable standard of health care, but added, "Unfortunately, many of the states that lag in health care performance are choosing not to expand eligibility for Medicaid under the Affordable Care Act."

In general, the researchers found that highly paid and educated people fare better than those with less of both, regardless of where they live. But the impact of geography is also pronounced: Low income populations have better access to treatment and quality of care in high-scoring states than their more prosperous counterparts in low-scoring states like Florida.

It has been reported before that Florida has the second-highest rate of uninsured among adults ages 19 to 64, about one in four. The "Two Americas" study added in those who are “underinsured” to the point that they are at high risk of financial stress in case of an illness, and calculated that 60 percent or more of the low-income population of Florida are either uninsured or underinsured.

For the purposes of the study, the authors defined low-income as 200 percent of the federal poverty level or less. In 2013, that would be about $23,000 for a single person or about $47,000 for a family of four.

One solution to Florida’s dismal results would be to expand health-insurance coverage to the poor, the authors said. But Florida turned down Medicaid expansion under the Affordable Care Act, saying no to an estimated $51 billion over a decade in federal funds that would have covered 1 million of the lowest-income uninsured – those who bring in less than 100 percent of the federal poverty level.

Between states at the top of the scorecard and those at the bottom, the study says, there is up to a fourfold difference in performance on such measures as timely access to care, risk of preventable complications, lower-quality health care, and premature death.

The scores for Florida were:
--Access and Affordability: Bottom quartile
--Prevention and Treatment: Bottom quartile
--Potentially Avoidable Hospital Use: Third quartile
--Healthy Lives: Third quartile

The overall scorecard placed Florida in the bottom quartile.