A national poll is gauging how health care has changed since the Affordable Care Act took effect. lt is conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard Chan School.

It shows that health care costs can still cause serious financial problems. This is especially true in states that didn't expand Medicaid, like in North Carolina.

One likely reason? The coverage gap, which includes those who do not qualify for Medicaid and don't make enough to be eligible for discounts on a Marketplace insurance plan.

Health economist and Wake Forest University professor Christina Dalton says North Carolina ranks high in terms of the number of individuals who fall into this category. She notes, “Eight percent of the U.S. population that's in the coverage gap is actually in North Carolina. It's in the top four highest [states]. There's Texas, Georgia, Florida and North Carolina.” 

The Kaiser Family Foundation reports that 89% of those in the coverage gap are from the South.

The poll also shows a rise in the use of urgent care centers and mini-clinics. People are choosing these locations for cost and efficiency, and Dalton says that's not necessarily a bad thing. 

“I think overall, in terms of the bigger question of health care costs increasing rapidly, that the first thing to worry about is treating all these people in a lower cost environment compared to the ER.”

But this could have implications for emergency rooms. If more money is going to urgent care centers, less money is going to the ER, and that means the subsidy to help treat uninsured patients could get smaller over time.

There are 247 urgent care clinics and 433 walk-in clinics in North Carolina.   

  

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