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By Rose Hoban

Compared to the rest of the nation, residents of the South have more trouble accessing health care and are more likely to delay going to the doctor. That’s because, according to several new reports, Southern states have the highest rates of poverty, and thus more residents who lack health insurance.

According to a new analysis of U.S. Census data done by the Kaiser Family Foundation and the Urban Institute, people who live in the South and Southeast (see map) are less likely to be insured than those who live in the rest of the country.

One in five non-elderly people (21 percent) living in Southern states are uninsured, according to the analysis, a rate that is about the same for North Carolina, at 20 percent.

Some of the reasons for the high levels of non-insurance are high levels of poverty and low-wage employment. The analysis found Southern states have some of the nation’s highest rates of poverty, despite the fact that three-quarters of Southerners live in households with at least one worker. Nine out of 10 workers in Southern states earn less than 400 percent of the federal poverty level ($46,680 for an individual).

But Southern employers are less likely to provide insurance for their workers, meaning that many workers in Southern states report delaying seeking care and having problems paying for care once they do go to the doctor, the report said.

In North Carolina, close to 1.8 million of the state’s 9.8 million residents (about 22 percent) live below the national poverty line of $11,670 for an individual.

People living in Southern states also have difficulty accessing care, according to the report, with about 22 percent of Southerners living in areas that have shortages of health care professionals.

That rate is considerably lower in North Carolina, where only 12 percent of residents live in shortage areas. Nonetheless, data from 2011 shows that 18 of North Carolina’s 100 counties have fewer than five family-practice physicians and many counties lack specialists such as obstetrician/gynecologists and pediatricians.

The analysis noted that many people in the South would have qualified for Medicaid under the expansion of the program provided for in the Affordable Care Act. However, most Southern states did not expand the program, leaving many residents in a coverage gap in which they are too poor to qualify for subsidies on the federal insurance marketplace, yet earn too much to qualify for Medicaid.

In North Carolina, no childless adults can qualify for Medicaid unless they are disabled. Poor parents can only qualify for Medicaid if they earn less than 45 percent of the federal poverty level ($8,905 for a family of three).

Across the country, about 4.8 million people fell into this “coverage gap”; the vast majority of them (3.8 million) live in Southern states. The Kaiser Family Foundation estimates about 319,000 of those people in the coverage gap are in North Carolina.

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