Feb. 15, 2000 (Washington) -- When it comes to health care, all Americans are not created equal, at least according to a disturbing new report from the American Association of Retired Persons (AARP). The 273-page document, called "Reforming the Health Care System: State Profiles 1999," is a snapshot of public and private health insurance programs. Comparing 100 key indicators, it points out some glaring discrepancies, particularly along financial lines.
In fact, some of the differences could make a life or death difference. "I think it's an awesome thought to conclude that where you live might so powerfully affect not only your lifestyle, your health, but also how many years you have left," says John Rother, AARP's director of legislation and public policy.
Among the findings: The death rate from heart disease is more than twice as high in Mississippi as it is in Minnesota. While the average employee health insurance contribution was just $757 in Michigan, a person in Florida might have to kick in $2,165 to get coverage. Where you live also determines how likely you are to go to the doctor, says the report. In Wisconsin, just 6% deferred a doctor visit because of cost, but in Arizona a whopping 25% postponed medical care because they couldn't afford it.
"Low income among older persons is often associated with unmet medical needs because of the burden of out-of-pocket expenses," says Jo Ann Lamphere, DrPH, who is lead author of the AARP report. Even though Medicaid is designed to helpthe poor, the analysis says that low-income people are often short-changed by the Medicaid program. In Nevada, for instance, just 26% of the poor have Medicaid coverage, while the number rises to 61% in the District of Columbia, the highest in the nation.
Because each state creates its own Medicaid program in partnership with the federal government, there are bound to be differences -- but some of them are glaring. Only in 11 states do disabled and very poor elderly get full Medicaid benefits.
There are also some striking state-by-state differences in Medicare payments. While the U.S. average is $5,416, in North Dakota the amount is only $3,650. In Los Angeles, the typical Medicare payment is nearly $7,000.
AARP will be pushing hard for broader insurance coverage as well as a prescription drug benefit for Medicare during this election year. One possible mechanism, says Rother, would be to take money from the national tobacco settlement and pump that into health care on a state-by-state basis.
"It's wrong that people are dying unnecessarily as these health status indicators suggest. It's wrong that millions of Americans do not have health coverage," says Rother. According to the report, in 12 states, fewer than 60% have employer sponsored insurance.
The report is an overview, and, as such, doesn't name states that are best or worst. But some of the differences are impressive. Hawaii, which mandates that employers cover their workers, has an uninsured rate of less than 10% among those younger than age 65. However, in West Virginia, nearly 20% are uninsured.
"If anyone thought that we have a unitary health care system in the United States, these data should put that thought to rest," says Rother. He says he believes that if we could somehow reproduce the best practices while eliminating the worst, our health care problems could be cut in half.