Kansas and Missouri Consumer Health Access Survey

Understanding insurance status, health care access, and medical debt in a regional population

The states of Kansas and Missouri share a border, Midwestern character, and the major metropolitan area of Kansas City. They also share a key similarity in the field of health care policy: both are among the 18 states that have opted not to expand Medicaid under the Affordable Care Act. Income requirements for people to enroll in Medicaid remain low.

Kansas and Missouri are home to several foundations that promote a culture of health, help enroll people in health insurance, and support safety-net health care providers. Based on a firsthand perspective of their constituents’ needs, these foundations shared a sense that people in Kansas and Missouri were struggling with untreated health conditions and burdensome medical bills.

To understand the magnitude of the problem, these foundations needed details on these and other topics—more data than the federal or state governments currently make available. In 2017, they chose RTI to conduct a comprehensive survey about consumer health access among residents of the two states.

Collecting and Analyzing Complex Health Data

The foundations were drawn to our nonprofit status and portfolio of state-level studies of access to health care. We worked closely with them to identify the survey objectives and priority content, then created a customized telephone survey to answer their questions.

For this survey, our Research Operations Center used the latest software and most effective techniques to call 4,200 Kansas and Missouri consumers, adjusting the balance of land lines and mobile lines to maintain our clients’ desired focus on working-age adults, and using cost-effective methods that enabled us to gather clear and meaningful results. We then analyzed the data to gain insights into insurance status and the use of safety-net health services among the target population.

Among the key findings were:

• Roughly one-quarter of adults ages 19 to 64 in both Kansas and Missouri, and one-third of children in both states, live in households carrying medical debt. Those percentages represent almost half a million people in Kansas and more than a million in Missouri.
• Twenty percent of adults ages 19 to 64 are uninsured.
• Almost 40 percent of adults lacked dental coverage, and one in five did not get needed dental care.
• Among the 60 percent of adults with a chronic condition, such as heart disease or diabetes, 19 percent in Kansas and 28 percent in Missouri did not receive care.
• Among the 30 percent of adults with mental health, substance abuse, or addiction issues, 22 percent in Kansas and 35 percent in Missouri did not receive care.

These findings add up to widespread hardships among Kansas and Missouri residents, especially low-income people, a category that includes one in four adults ages 19 to 64. The numbers confirm that many people in Kansas and Missouri are dealing with a vicious cycle. A lack of coverage means they delay important treatments for medical and dental issues that worsen or lead to other problems. When they do get care, they often end up struggling to pay the bills.

Evidence to Improve Public Health

In June 2018, we announced the results of the Kansas-Missouri survey to an eager audience of media and stakeholders in Kansas City. The findings on the pervasiveness of medical debt, the inaccessibility of dental care, and the lack of care for chronic conditions could prove relevant for policymakers in Kansas, Missouri, and other states. This is especially true as states consider whether to expand Medicaid under the Affordable Care Act.

We have further context on Medicaid expansion due to our prior work in Ohio. We studied the expansion of Medicaid and found that the experience of low-income Ohioans contrasts sharply with that of people with similar incomes in Kansas and Missouri. Ohio expanded Medicaid and saw its uninsured rate among low-income adults plummet to 14 percent, the lowest ever reported. After enrolling, 27 percent of new Medicaid recipients were diagnosed with a chronic condition, 32 percent were diagnosed with substance abuse or dependence, and nearly one-third were positively screened for depression and anxiety disorders.

Based on the results of the Kansas-Missouri study, our clients will be able to focus their outreach and advocacy efforts on specific community needs. The foundations are committed to exceeding their state governments’ efforts to measure access to health care and to gathering scientifically sound evidence to support their future investments. For other states and organizations dedicated to promoting public health, the Kansas and Missouri survey can serve as a model.