Report: States in highest demand for free healthcare reveal political pitfalls

Key points:

Dr. B’s No-Cost Care program provides free online medical consultations to patients who qualify based on financial need. Our first No-Cost Care Report analyzed data from over 15,000 patients across the United States to determine in which states patients most need free access to health care.

Among the top 10 states in high demand for free care, we found:

• 7 out of 10 voted for Donald Trump in the 2020 presidential election.
• 9 out of 10 are currently under Republican governorship. 
• Following the “Medicaid Unwinding” of April 2023, patient utilization notably increased by 67%—with monthly consultations increasing disproportionately in our top 10 states.
• While healthcare access and employment rates have significantly improved under the Biden Administration, people in these states continue to disproportionately struggle with unemployment levels, below-average income, higher poverty levels and debt shares outside of national averages.

Founded during the early days of the Covid-19 pandemic, Dr. B has expanded to offer $15 online treatment for 30+ common conditions across primary care, dermatology, sexual health and reproductive health.

During this expansion, the US government transitioned from the Donald Trump to the Joe Biden Administration, the federal Public Health Emergency for Covid-19 ended, and Medicaid coverage expanded during the pandemic reverted to pre-pandemic, state-determined budgets.

To determine if this period of dramatic transition affected health outcomes for the most vulnerable, we looked for resulting trends among Dr. B patients seeking care at no cost.

Our No-Cost Care program and approach

Since launching our No-Cost Care program in 2022, Dr. B has treated over 15,000 patients at no cost across all 50 states and Washington, DC.

To determine the utilization of this program, we compare No-Cost Care to total state consultations. Then, define trends by comparing data points across states with high, moderate, and low demand for No-Cost Care access.

• High demand = above 22% (22 states total)
• Moderate demand = 16%-22% (21 states total)
• Low demand = 15% and below (7 states + Washington, DC)

For this report, the Dr. B team analyzed data from our 15,000-patient set in February 2024.

To compare No-Cost Care patient trends against state and national healthcare and pandemic economic recovery records, we focused on the ten states with the highest demand for free care.

For these ten states, No-Cost patient consultations make up at least 30% of total state patient consultations.

Political findings: Top No-Cost Care states skew red

Taking a national view of patient consultations, the percentage of No-Cost Care against total consultations was almost evenly split among patients in states that voted for Donald Trump in the 2020 elections and states that voted for Joe Biden—with Trump at ≅24% of No-Cost consultations and Biden at ≅21%.

The ten states with the lowest percentage of No-Cost Care consultations were also equally split between Trump- and Biden-voting states.

However, states with the highest demand for no-cost care reveal a clear political divide.

As the above graph details, seven of our top ten high-demand states voted for Donald Trump in 2020. Further, nine of the ten are currently under Republican governorship—with only Delaware having voted for Biden and under Democratic governorship.

Increased access under the Biden Administration

President Joe Biden signed The American Rescue Plan into effect in March 2021. On a federal level, the plan increased premium tax credits and lowered health insurance premium costs for millions of Americans. National uninsured rates soon reached historic 8% lows. During the 2024 enrollment period, a record 21 million Americans then signed up for or renewed their coverage.

The above graph comparing the pre-pandemic period of the Trump Administration (2018-2019) through the early year of the Biden Administration’s efforts (2021-2022) confirms that this federally mandated plan improved access for the majority of our top ten No-Cost Care states. Today, fewer adults in these states have a high medical cost burden, lack of access to a personal health provider or cost-related barriers to care.

Additionally, these states have shown increased enrollment rates for ACA health insurance coverage and improved rates for uninsured adults.

The Medicaid Unwinding impact

While the Biden Administration’s efforts may have increased access to affordable care, the “Medicaid Unwinding” of April 2023 withdrew such access for many American adults.

On a national level, utilization of our No-Cost Care program increased by 67% in the eight months following the unwinding. Average consultations increased by 29% in our top ten high-demand states, while states with low- to moderate-demand increased by 25%.

Additionally, in 2024, as fewer adults were able to renew their Medicaid coverage in our top ten states, disenrollment rates were higher in these states (39%) than in our lower-demand states (34%).

This suggests that state decisions regarding Medicaid expansion programs, delivery communication, benefits, appeals and other administrative details are vital when meeting individual patients’ needs.

Economic implications of our Top 10 states

By the start of 2020, the Biden Administration’s economic plan yielded a national unemployment rate of 3.5%. Currently, unemployment rates are holding steady between 3.7% and 3.9%, with job growth trends continuing in the healthcare, government, construction, and hospitality/service industries.

Despite these national gains, unemployment rates in three of our top ten high-demand states (Delaware, Nevada, and South Carolina) have not improved under the Biden Administration.

These states struggle disproportionately with employment rates and employment benefits rates. As a result, they also have poverty rates and debt share rates higher than national averages. Across the board, people in these states also experience above-average levels of student loan debt, medical debt, credit card debt and auto/retail loan debt.

Report conclusions

The states improved by the Biden Administration's policies experienced significant improvement in healthcare access—especially when considering cost-related barriers to care, median out-of-pocket healthcare spending and uninsured rates.

But despite the above, adults in our high-demand states continue to struggle with employment, median household income and average household debt—rates outside of national averages. Further, while all ten states experienced improved broadband internet access from the pre-pandemic to post-pandemic periods, half do not meet national averages of individual access to phone or video medical appointments.

The end of expansions to Medicaid coverage provided during the Covid-19 Public Health Emergency and the “Medicaid Unwinding” programs also drastically affected our patients, with decisions made by state officials disproportionately affecting patients across the US.

Our findings suggest that while healthcare and other areas of access have improved under federal policies established during the Biden Administration, low-income and high-debt ratios remain considerable barriers to accessing care, making Dr. B’s No-Cost Care program a vital resource for many adults across the US.

Sources and analysis:

Data compiled and analyzed by Sheila Pineda, Head of Service Operations for Dr. B. Analyzed from monthly No-Cost Care utilization Feb 2022-April 2023 and May 2023-Dec 2023.

• State public health data collected by Shadac, US News and America’s Health Rankings
• Covid-19 Health Disparities data collected by KFF
• State economic data collected by Wisevoter 
• Centers for Medicare & Medicaid Services. (2024). Marketplace 2024 open enrollment period report: Final national snapshot.
• U.S. Bureau of Labor Statistics. (April 5. 2024). Employment situation summary.