(HealthDay News) — Significantly more adults in Florida and Texas struggle to pay medical bills or pay off medical debt over time compared with residents of New York and California, according to a new Commonwealth Fund report.

Comparing health coverage in the four largest states, researchers found that 40% of adults in Florida and Texas have trouble paying medical bills or said they’re paying over time, compared with 30% in the state of New York and 25% of those in California. 

The researchers also found that 43% of those in Florida and Texas said they didn’t see a doctor when sick; didn’t fill a prescription; skipped a medical test, treatment or follow-up; or didn’t get needed specialist care in the past 12 months because of cost. This compared with about 30% in California and New York.

Uninsured rates among working-age adults were 30% in Texas, 21% in Florida, 17% in California and 12% in New York. Uninsured rates among adults with low incomes were 51% in Texas, 33% in Florida, 23% in California and 13% in New York. 

Uninsured rates for young adults, aged 19 to 34 years, were 34% in Texas, 26% in Florida, 23% in California and 14% in New York. 

Among adults with insurance, 39% in Florida and 36% in Texas said they had at least one problem getting needed care in the past 12 months because of cost, compared with 28% in California and 27% in New York.

California and New York fully expanded Medicaid coverage under the Affordable Care Act, but Texas and Florida did not, the report authors explained. 

“Fully expanding Medicaid would help reduce the high uninsured rates in Florida and Texas” and help people afford the care they need, Sara Collins, PhD, vice president for health care coverage and access at the Commonwealth Fund, said in a foundation news release.

Read more about disparities in health care.