With Monday’s looming Affordable Care Act open enrollment deadline, a new analysis of Americans in all 50 states and the District of Columbia finds that health care costs are still a top concern.

The nearly 180,000 Americans surveyed as part of the Gallup-Healthways Well-Being Index report that residents in southern states particularly continue to struggle to afford healthcare or medicine. In 2008, when approximately 19.7% of respondents were struggling with health care costs; Gallup states that 18.6% of Americans were still challenged medical costs in 2013.  

Alabama, West Virginia, Mississippi, Kentucky and North Carolina were situated at the top of the troubled states. Lower concerns were raised in Iowa, Minnesota, Hawaii, North Dakota and Massachusetts, according to the research organization’s State of the States’ report.  

According to research, Gallup explains that southern states also hold low overall well-being scores, trailing the rest of the country. Also, there was a strong connection with states holding high uninsured numbers.

“States with higher percentages of residents who struggled to afford healthcare or medicine also tend to have higher uninsured rates, lower ratings of the standard of living, or both,” the March 28 report states. All 10 states reporting struggles passed the national average of 17.3% for those uninsured.

“Lacking health care coverage, however, is not a perfect predictor of Americans’ ability to afford needed health care in a given state,” the survey notes. “Though the uninsured rates in Alabama and West Virginia are above average, they were not among the top 10 states lacking insurance coverage.”

Previously, Gallup reported that one-third of Americans did not have health insurance. Despite this void in coverage, approximately 66% were satisfied with the health system as is, without changes from the ACA.

Also, earlier this month, the Washington, D.C.-based research organization stated that its national sample without health insurance fell to 15.9%, a 1.2% drop since 2013’s fourth quarter. However, the Gallup-Healthways Well-Being Index stated that the percentage of individuals obtaining their health insurance from their current or former employers dropped by two percentage points to 43.14% in 2014’s first quarter. The poll noted that 18.1% of Americans obtain their primary health insurance through a plan fully paid for by themselves or a family member.

“This drop could be a result of the ACA [Affordable Care Act], which aims to provide health care coverage to more Americans through multiple provisions, including federal and state health care marketplaces where Americans can purchase health insurance coverage at competitive rates,” the study stated March 10.

Despite the competitiveness of the marketplace and opportunities for employers, recent studies have shown that health care price transparency has been a sore spot for most states. Moreover, as 45 states flunked this year’s test, not one state received an “A” grade and only Maine and Massachusetts claimed a “B” grade, according to the second annual Report Card on State Price Transparency Laws. The data is compiled by nonprofit organizations Catalyst for Payment Reform and the Health Care Incentives Improvement Institute.

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