New study finds hundreds of thousands struggle with medical bills and unmet health needs in Kansas, Missouri

Research Triangle Park, NC — With stakeholders concerned about rising costs and access to health care, a new study finds that roughly one-quarter of adults (ages 19 to 64) in both Kansas and Missouri, and one-third of children in both states, live in households carrying medical debt. Those percentages represent almost half a million people in Kansas and more than a million in Missouri.

An even greater share of the population had problems paying off medical bills in the past year. In addition, one in five lacked health insurance coverage. These findings—from the Kansas and Missouri Consumer Health Access Survey (KMHS) administered by RTI International—provide the most comprehensive data to date on health care access in Kansas and Missouri to inform policymakers and other stakeholders.

Download the KMHS Final Report, Methodology Report, and Survey Questionnaire

“This report confirms that medical debt and lack of insurance financially ruins hundreds of thousands of families in Kansas and Missouri,” said David Jordan, president of the United Methodist Health Ministry Fund. “These extreme levels of financial stress mean families avoid seeking healthcare when they need it and they miss more days of school and work. Lack of insurance is an issue that policymakers must address both for the welfare of families and the health of our states’ economies.”

The survey was funded by five health foundations that work in the two states: the REACH Healthcare Foundation; the Kansas Health Foundation; Health Forward Foundation; Missouri Foundation for Health; and, United Methodist Health Ministry Fund.

“It is critical in today’s changing landscape to have up-to-date information particularly on those most in need,” said Bridget McCandless, M.D., president and CEO of the Health Care Foundation of Greater Kansas City (Health Forward). “The data will help Health Forward identify where there are opportunities for improvement around access, affordability and the continuing unmet health needs of the Kansas City area.

“Communities often need richer detail on access to health care and coverage in their communities than federal surveys can offer,” explained Thomas Duffy, senior survey research scientist at RTI and project director of KMHS. “The bi-state survey allowed the funders to capture consumer data from a larger geographic area and expand the list of survey questions to gain a deeper understanding of health challenges in all areas of the two states.”

The survey found that approximately 60 percent of working-age adults in Kansas and Missouri have a diagnosed chronic condition such as heart disease or diabetes, while one-third have a mental health diagnosis, substance abuse or addiction. Among those with chronic health care needs, significant numbers reported that they are going without needed care due to cost or lack of coverage. Among adults with a chronic condition, 19 percent in Kansas and 28 percent in Missouri did not get needed care in the past year. Among adults with a mental health diagnosis, 22 percent in Kansas and 35 percent in Missouri did not get needed mental health care or counseling.

“This survey raises awareness of health access needs in Kansas and also helps us understand the complex issues facing the state,” said Steve Coen, Kansas Health Foundation president and CEO. “Improving access to care for vulnerable populations is a critical component of our KHF work to improve the health of all Kansans.”

Barriers to dental care were reported by 40 percent of residents in both states, and among people of all racial and ethnic backgrounds and income levels. Access barriers to dental care were significantly higher for people with public coverage than private coverage and were highest for uninsured adults. More than 90 percent of uninsured adults in both states also lacked dental coverage; nearly two-thirds reported a dental access problem such as no dental visit in the past year or unmet dental care needs.

“People living in all regions of Kansas and Missouri reported difficulty accessing dental care, with gaps in care and dental insurance coverage cited across all racial and ethnic groups,” said Brenda Sharpe, president and CEO of the REACH Healthcare Foundation. “This ongoing high level of unmet need points to the urgency of pursuing innovative solutions for expanding the availability and affordability of dental care.”

The survey found these problems to be significantly more prevalent among low-income residents with family income below 138 percent of the federal poverty level. In Kansas and Missouri, roughly one-quarter of adults ages 19 to 64 reported family income under 138 percent of the federal poverty level. Of this low-income adult population, 44 percent of adults in Kansas and 33 percent in Missouri lacked health insurance. Of low-income adults with chronic conditions, 32 percent in Kansas and 52 percent in Missouri did not get needed care in the past year. Similarly, 34 percent of low-income adults in Kansas and 61 percent in Missouri with a diagnosed mental health condition did not get needed care.

Residents ages 19 through 64 in this income bracket would be potentially eligible for Medicaid coverage were either state to expand Medicaid under the Affordable Care Act.*

“The KMHS yields a robust picture of access issues affecting broad populations in the region and particularly for consumers below 138% of poverty,” Duffy explained. “The bi-state survey design revealed racial and ethnic disparities in access to care, particularly for Hispanic adults compared to white non-Hispanic adults, but more analysis would be needed to gain a full understanding of these differences.”

“Access to health insurance is fundamental to addressing racial and ethnic health disparities,” said Thomas McAuliffe, director of health policy for Missouri Foundation for Health. “This survey points us to some of the significant disparities communities of color face when entering into and obtaining services from the health care system. The charge is for substantive dialogue more intense analysis to occur around solutions.”

Survey Methods

The Kansas and Missouri Consumer Health Survey (KMHS) focused on health and dental insurance coverage, unmet needs for chronic conditions, including mental health diagnoses, and unmet need for serious injury and prescription drugs. Adults residing in Kansas and Missouri were randomly selected to complete the survey through dual-frame random digit dial cellphone and landline sampling. A total of 4,274 adults and 1,159 children via an adult proxy were interviewed. The sample was adjusted using population weights so that estimates represent the non-institutionalized resident population in each state. The survey was administered between September 2017 and January 2018 by RTI International in Research Triangle Park, North Carolina.

Download the KMHS Final Report, Methodology Report and Survey Questionnaire

*Respondents reported family income based on the 2016 tax year. In 2016, the 138 percent federal poverty threshold income was $33,534 for a family of four. (Source: US Department of Health & Human Services, Office of the Assistant Secretary of Planning and Evaluation (2016). Computations for the 2016 Poverty Guidelines. Obtained from:, March 22, 2018.)


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