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Suburban poor, uninsured turn to emergency rooms for care

Increased poverty in the suburbs has led to emergency departments in those areas becoming the primary source of care for poor and uninsured.

Susan Morse, Senior Editor

A demographic shift of poverty to the suburbs has not been met by federal policies for healthcare access and safety net hospitals in those areas, resulting in the poor and uninsured using emergency rooms for care, according to a new Health Affairs study.

Despite the perception of the suburbs as affluent, close to 17 million people live in poverty in these neighborhoods, more than in cities or rural areas, the Health Affairs study said.

The suburbs are home to about 44 percent of the population, and 38 percent of the uninsured population. About one in seven suburban residents is uninsured, the study said.

This is a demographic shift from the latter half of the 20th century, when historically, rates of health insurance coverage were higher in the suburbs.

The Health Affairs study used survey data from 2005 to 2015. Initially the uninsured rate was lower in the suburbs, but by 2015 that gap had closed, so that the number of those with coverage was about the same as those in suburban and urban areas.

Despite the shift, healthcare policy hasn't changed its focus from urban and rural areas.

Federal funding for community health centers often bypasses suburban locations. The funding is dependent on getting a medically underserved population designation from the Health Resources and Services Administration.

This is difficult as poor areas in the suburbs are often balanced out by affluent neighborhoods, or because there are several large hospitals in the region.

"Because fewer suburban providers appear to be willing to treat uninsured patients, suburban patients often must travel long distances to urban safety-net providers," the study said.

Without the public transportation that's often lacking in the suburbs, emergency departments become the primary source of care for the suburban poor, the study said.

The Affordable Care Act in 2010 helped to lower uninsured numbers nationwide, especially in Medicaid expansion states. The uninsured rate was flat from 2005 to 2010, and then decreased, the study said.

However, the study found that the ACA did not differentially improved coverage and access for suburban residents.

"Current policies that identify areas of medical need and determine safety-net location have not adapted to shifts in the geography of poverty," the study said.

The study used national survey data from the Behavioral Risk Factor Surveillance System telephone survey of adults 18 to 64 years old for the years 2005 to 2015.

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