"Without health insurance, people are less likely to have a regular health care provider and more likely to skip routine health care. This puts them at increased risk for serious health problems. Evidence has shown that strategies to reduce financial and other barriers to health insurance access can help increase coverage rates." Increase the proportion of people with health insurance — AHS‑01 - Healthy People 2030 | health.gov

Access to Care

Potential barriers to care include lack of health insurance coverage, inability to afford out of pocket costs, lack of transportation, language barriers and being uncomfortable in the medical environment and distrust of providers. Nebraska state report card: Access to Health Services (clearimpact.com) 

Insurance and Out-of-pocket

Lack of insurance, or even the ability to cover out of pocket costs, is going to mean that medical treatment is likely to be delayed.  This can be especially significant when it comes to more advanced stages of cancer.  It is estimated that age-specific mortality is 25% higher in the uninsured than in the privately insured population (King, Jr. , et al., 2016).                   Figure 46: US Census, American Community Survey 2015-19 via SparkMap May 10, 2022

The Uninsured Population Under Age 18 has been trending in the right direction, although it did show an increase from 2018 to 2019.No health care coverage, Adults 18-64 years old  has not been as high in this health district as it has been in the state as a whole (13.7% versus 17.1% in 2019).  Both rates were trending up as of 2019.  Medicaid safety net in Nebraska may not be as broad in Nebraska as in other states.  While expansion was approved in 2018, there was a two year delay in implementation. System was overhauled in late 2020 into a program called Heritage Health. (Norris).The table below reports information about the Medicare population, including the number of beneficiaries enrolled in parts A & B (the fee-for-service population) and the number enrolled in Medicare Advantage. 

Figure 47: Centers for Medicare and Medicaid Services, CMS - Geographic Variation Public Use File , 2020 via SparkMap

The percent of adults from the NNRHN region who could not see a doctor in the past 12 months because of cost was quickly climbing as of 2019, coming close to the state rate.

No doctor

The indicator regarding area adult residents having no personal doctor or health care provider was going in the right direction, dropping from 20.6% to 15.9%.  This is important because “Patients who have a usual source of care report greater trust and satisfaction with their providers, are more likely to receive treatment for chronic health conditions, and report fewer unmet service needs. Having a usual place and usual provider are associated with an increased likelihood of receiving preventive services and recommended screenings compared with having no usual source of care.” “However, people without insurance are less likely to have a usual source of care, often due to out-of-pocket costs related to receiving care.” P A-22. (Agency for Healthcare Research and Quality, 2021)

The 2019 figures indicate that men and minorities have higher rates of lacking a primary care provider(PCP) in both this health district and the state.  The disparity between men and women is not as significant in the report region as it is in the state. In the NNRHN area it was 19.1% for males versus 12.7% for females while it was 26.2% to 14.7% on the state level. The disparity between white/non-Hispanic and minorities is even greater.   On the state level the difference was almost 20% (37.2% versus 17.3%) while in our health district in 2019 the difference was 23 percentage points (34.4% to 11.4%).  Respondents to the community health surveys and participants at our listening sessions point to some key reasons for this difference, including not only language barriers and costs, but also trust issues. See Appendix 5 and Appendix 4.