By Flora M. Castillo, October 29, 2013
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
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.
may differ about the best way forward for health 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.
to the Federal Transit Administration, about 3.6 million Americans skip
or delay non-emergency medical care every year because of issues with
transportation. Their doctor’s office may not be conveniently reachable
by public transit — or they may have trouble transporting their entire
family when child care is unavailable.
Prevention is the 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
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.
FTA found that, compared to the general population, these 3.6 million
Americans are more likely to suffer from chronic conditions like 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 forego treatment — and allow health
problems to grow serious.
Improving our healthcare system 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.
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.
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 healthcare
providers — and increases the likelihood that they’ll make their
North Carolina’s Department of Health and Human
Services has adopted an integrated approach — by calling on state
policymakers to coordinate non-emergency medical transportation with
local public transportation agencies already providing public transit in
Since July 2009, New Jersey has contracted
with a broker to provide NEMT 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 NEMT trips in 2012
were provided by public or county community transit.
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.
eliminate that roadblock.