By Flora M. Castillo, APTA Immediate Past Chair
The Affordable Care Act’s new health insurance exchanges have just opened for business. Some 16 million people are projected to gain insurance coverage next year through these new marketplaces — as well as through Medicaid, the publicly financed health program for low-income Americans.
But that coverage won’t do them any good if they can’t get to the doctor. For millions of Americans — including many who already have health insurance — that’s a real concern.
Lawmakers may differ on the best way forward for health care reform. But they should all be able to agree that problems with transportation should not keep their fellow citizens from securing the care they need.
According to the Federal Transit Administration, about 3.6 million Americans skip or delay nonemergency medical care every year because of issues with transportation. Their doctor’s office may not be conveniently reachable by public transit, or they might have trouble transporting their entire family when child care is unavailable.
Prevention is key to a successful health care system. These missed appointments can lead to the deterioration of a person’s medical condition — and even greater health costs.
More than half of these 3.6 million folks have limited financial resources, with household incomes of less than $20,000 a year. A number of them may be eligible for Medicaid but have trouble putting their coverage to use because they struggle to get to the doctor.
Their limited mobility doesn’t just jeopardize their health — it also exacerbates America’s health cost crisis.
The FTA found that, compared with the general population, these 3.6 million Americans are more likely to suffer from chronic conditions such as high blood pressure or diabetes. Chronic diseases are responsible for 75 percent of U.S. health expenditures, according to the Centers for Disease Control and Prevention.
And if the folks missing those appointments are on Medicaid, taxpayers shoulder the additional costs that come about when patients forgo treatment and allow health problems to grow serious.
Improving health care will therefore require improving Americans’ access to transportation. Investing more in public transit and coordinating existing transportation service providers are both critical.
But money alone isn’t the answer.
Policymakers should also take advantage of the services that local public transit agencies already offer. Examples for how to do so abound and should serve as models for the rest of the country.
Consider Cleveland’s HealthLine service, which delivers patients and riders to the Cleveland Clinic and University Hospitals, among other destinations, every five minutes during the morning and afternoon rush hours. Such a system provides patients with convenient, direct access to their health care providers, and increases the likelihood that they’ll make their appointments.
North Carolina’s Department of Health and Human Services has adopted an integrated approach, calling on state policymakers to coordinate nonemergency medical transportation with local public transportation agencies already providing public transit in their communities.
Since July 2009, New Jersey has contracted with a broker to provide nonemergency transportation to Medicaid beneficiaries. The broker receives an annual fee for each eligible patient. By working with county community transit systems and purchasing NJ Transit bus and rail tickets when appropriate, the broker has reduced costs per passenger trip. Over 15 percent of the 5.2 million Medicaid nonemergency trips in 2012 were provided by public or county community transit.
Collaborative efforts like these can go a long way toward helping Americans make their doctor’s appointments — and thus stay healthy.
Over the next few years, millions of Americans are set to secure health insurance, but many will not be able to put that coverage to use and receive care without improved access to transportation. Policymakers must eliminate that roadblock.