The overall share of 21 percent was about the same as in 2014, the last year the poll asked the question. That was also the first year that Kentucky expanded Medicaid to households with incomes up to 138 percent of the federal poverty level.
Interestingly, the poll found more difference between people with incomes above and below 200 percent of the poverty line, about $50,000 for a family of four. Among those with higher incomes, the share delaying or forgoing care rose to 20 percent, from 14 percent in 2014. Among those with lower incomes, the delay-or-forgo share declined to 25 percent, from 29 percent in 2014.
Why would people with higher incomes report more trouble paying for medical care, while those with lower incomes were reporting less trouble? Perhaps because co-payments and deductibles in private insurance plans have increased, while those in Medicaid and other government insurance plans have remained stable or nonexistent, said Ben Chandler, CEO of the Foundation for a Healthy Kentucky, co-sponsor of the poll.
"The Affordable Care Act and Medicaid expansion in Kentucky significantly reduced the percentage of uninsured Kentuckians, but many still struggle with other cost barriers," Chandler said in a foundation news release. "We need to find a way to bridge those gaps to improve health and to reduce the higher health-care costs that result when we delay or forgo essential and preventive care."
The poll also found that more Kentucky adults do not use a regular doctor, health clinic or other appropriate source of health care than they reported in 2009, the first time the poll asked such questions, "but that hasn't necessarily translated into more visits to inappropriate sources such as emergency room or urgent-care-clinic visits," the foundation said.
In the poll, 24 percent of Kentucky adults said they do not have a usual place to go for health care, compared to 18 percent in 2009. "About 8 percent of Kentucky adults said they go to the emergency room or an urgent-care center when they need care, a figure that has remained steady since 2009," the foundation said.
Kentucky adults without health insurance were nearly twice as likely to lack a usual source of health care as those with coverage, the poll found.
"Going to the same place for medical care, a place that knows you and your medical history, is key to maintaining good health and preventing chronic disease," Chandler said. "You're more likely to have regular wellness visits, immunizations and health screenings and to avoid dangerous medication interactions and preventable hospital admissions when you have both health insurance and a regular care provider. The fact that those living on low incomes are less likely to have either of these is another example of how poverty often leads to poorer health."
The telephone poll of Kentucky adults is also funded by Interact for Health, a Cincinnati-area foundation. Its margin of error is plus or minus 2.5 percentage points.