How to improve health care for low-income Americans? Supporters of the Affordable Care Act say the key is expanding access to health insurance.

But in New York, that situation appears flipped, according to a report to be released Wednesday by The Commonwealth Fund.

Low-income New Yorkers fare better than residents of most other states at getting affordable medical services. But their illnesses are not always prevented or treated as effectively as other Americans, and they are more likely than most to end up in the hospital when such a trip could be avoided.

That's according to "Health Care in the Two Americas," a report examining low-income people's experience getting health care in 50 states and the District of Columbia.

New York ranked 17th on measures intended to show how well the state's health care system serves low-income families. About 40 percent of New Yorkers were considered low-income, defined as earning 200 percent of the federal poverty level $22,980 a year for an individual and $47,100 a year for a family.

The state was listed among the best performers in making health care accessible and affordable to low-income residents. It also scored well on measures indicating residents lead long, healthy lives, including relatively low rates of obesity and premature deaths.

But it landed among the lower half of states on measures of prevention, treatment and avoidable hospital admissions.

The reasons lie mostly in problems downstate, said Cathy Schoen, the report's lead author.

Asthma-related hospitalizations among children from low-income communities in New York were eight times higher than in Oregon, the state with the lowest rate. New York City health officials are working to remove asthma triggers from deteriorating homes, Schoen said.

The state's health system, especially downstate, is fragmented, with lots of specialty care and insufficient coordination, Schoen said. That accounts for high rates of readmission to the hospital for the same condition, among other things.

Original post:

Health care seen wanting, but access better