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Dentist Amy Gustafson, left, and dental assistant Jamie Urlacher put a filling in for a patient at the Riverstone Health Dental Clinic.

CASEY PAGE/Gazette Staff

The ability of adults to obtain basic health care services in the United States has declined in nearly every state over the past decade, even for those who have health insurance -- and Montana is no exception, according to a report released by the Robert Wood Johnson Foundation.

Researchers at the Urban Institute looked at three key health access indicators for adults 19-64: having unmet medical needs due to cost; having a routine checkup; and having a dental visit during the year. Researchers found a marked deterioration across all three measures between 2000 and 2010.

Adults without health insurance saw larger declines in the ability to obtain basic health care services compared to those with coverage. By 2010, nearly half of uninsured adults, 48.1 percent, had an unmet health need due to cost, compared to 11.2 percent of insured adults.

While the problem is most pronounced among the uninsured, the issue affects people with insurance as well. Over the past decade, rates of unmet medical needs rose in 42 states. The share of adults receiving routine checkups fell in 37 states. And the share of adults who had dental visits declined in 29 states. In all, 49 states experienced a significant decline on at least one of the three measures over the decade. Only West Virginia and the District of Columbia did not.

"This report is sobering because it demonstrates how profoundly a lack of insurance translates into a lack of medical care," said Dr. John Lumpkin, senior vice president and director of the Health Care Group at the Robert Wood Johnson Foundation. The report also shows that those with insurance are avoiding care for many reasons, including costs, he said.

For Montana the report shows:

-- In 2010, an estimated 92,000 adults had an unmet medical need due to cost. Uninsured adults were 24.4 percent more likely than uninsured adults to have an unmet need due to cost in 2010.

-- The share of adults who had a routine check-up decreased by 11.6 percent from 2000 to 2010, to 48.9 percent. Uninsured adults were 29.4 percent less likely than insured adults to have had a routine check-up in 2010.

-- The share of adults in the state who had a dental visit decreased 8.0 percent from 2000 to 2010, to 57.2 percent. Uninsured adults were 30.8 percent less likely than insured adults to have had a dental visit in 2010.

In Montana, and specifically Yellowstone County, public health agencies could be filling some of that gap.

"For many people health insurance is inextricably linked to access to health care, but Community Health Centers such as RiverStone Health Clinic, provide high quality primary preventive care to everyone, regardless of their insurance status," said John Felton, president and CEO of RiverStone Health, Yellowstone County's public health agency.

This past year, more than half of the people served at RiverStone Health did not have health insurance. This latest report mirrors the results of the agency's 2010 community health assessment in that the cost of health care followed by finding a doctor and getting an appointment were significant barriers for people who are uninsured.

In regard to dental care, RiverStone Health has been able to increase the physical space in its dental clinic boosting its capacity to serve more people. RiverStone is now experiencing twice as many visits per month than before the expansion and nearly all of these individuals are uninsured.

"Having health insurance alone does not increase access to health care," Felton said. "We must continue to invest in developing our health care workforce, expanding our clinical capacity and creating environments where the healthier choice is the easier choice."

The share of adults receiving a routine checkup decreased nationwide by 5.1 percent from 2000 to 2010, to 63.2 in 2010. The share of uninsured adults with a routine check-up fell by 11.6 percent, to 37.9 percent in 2010.

The share of adults receiving a dental visit dropped by 3.9 percent between 2002 and 2010, to 65.2 percent nationwide in 2010. The share of uninsured adults with a dental visit fell by 9 percent to 37.5 percent in 2010.

Nationally, the report finds the share of adults experiencing unmet medical needs due to cost rose by 6 percent from 2000 to 2010 -- to 18.7 percent in 2010 -- affecting nearly one in five U.S. adults aged 19-64. Declines in access were significantly more pronounced for the uninsured, with the share of uninsured adults experiencing unmet needs due to cost rising by 10.8 percent from 2000 to 2010. States with the largest percentage of residents with unmet needs due to cost in 2010 were Mississippi (26.0 percent), Texas (25.3 percent) and Florida (25.1 percent). States with the lowest were North Dakota (8.2 percent), Massachusetts (8.7 percent) and Hawaii (9.7 percent).