The Consequences of Insufficient Household Income

of need being met. There is a wide range of coverage across the country: Connecticut has the largest PCP
shortage, with only 13 percent of need being met, while Delaware has the smallest shortage, with 94 percent
of need being met. Across the country, on average, only 48 percent of mental health care need is being met,
and 39 percent of dental care need (Kaiser Family Foundation, 2016).
The availability of primary care is especially important for prevention and cost-effective treatment. People
without a usual source of care are more likely to rely on ERs for care, which results in lower quality of
health in the short term and more complicated health issues and increased costs over the long term (Liaw,
Petterson, Rabin, & Bazemore, 2014).
The primary care shortage is a particular problem for low-income Americans, especially in rural areas, for two
reasons:
1. Many PCPs are unwilling to accept Medicaid patients due to low reimbursement rates, though that
has lessened to some degree since 2014, when Medicaid reimbursement rates were increased to equal
Medicare rates. However, even Medicare patients, especially new patients, have challenges finding
doctors. This trend will likely increase in the future as many of the physicians with the largest caseloads
of Medicare patients retire; one-third of PCPs have at least half of their patients on Medicare, and these
doctors are disproportionately older (Polsky, et al., 2015; Decker, 2013; Boccuti, Fields, Casillas, &
Hamel, 2015).
2. Rural areas have far fewer doctors per patient than urban areas, and rural residents already often
have difficulty reaching providers because of long distances to medical facilities (National Rural Health
Association, 2017).
Demand for unpaid family caregivers is increasing as seniors age and as the U.S. health care system
increasingly relies on family members or other caregivers to perform medical and nursing tasks that were
once provided only in hospitals. However, the number of caregivers available is decreasing due to a variety
of trends including more women in the workforce, fewer children and delayed childbearing, and an increase
in divorce rates. Traditional caregivers – spouses and children – have competing demands that make it
harder for them to provide care, especially the demands of work and child care. There is already evidence
that the number of caregiving hours is increasing, but the number of caregivers has remained flat (AARP
Public Policy Institute, 2015; Scommegna, 2016; Reinhard, Levine, & Samis, 2012). Without caregivers,
many seniors in poor health will not receive adequate care, which will lead to deterioration of their health
status and a reduction in their quality of life.
Having basic needs met is the strongest predictor of better health for ALICE and poverty-level
families. The interconnectedness of health and basic needs highlights the importance not only of basic
health services and broad insurance coverage, but also of healthy communities and lifestyles. This includes
affordable access to fresh produce and other healthy foods; neighborhoods planned to include parks,
playgrounds, and other activity spaces; quality education options from pre-K through college; and safe,
affordable housing. Initiatives like these require work both within and beyond the health care sector, and this
work is time-consuming, expensive, and often slow to happen (Lavizzo-Mourey, 2015; Alonzo L. Plough,
2014; Solomon, 2016). Factors including state and federal budgets, political will, awareness of return on
investment, and the willingness of various sectors to collaborate will affect whether or not these types of
initiatives move forward.
74 UNITED WAY ALICE REPORT – THE CONSEQUENCES OF INSUFFICIENT HOUSEHOLD INCOME