The ability for adults to obtain basic health care services has declined in nearly every state over the last decade, especially among those without insurance, according to a report from the Robert Wood Johnson Foundation.

Researchers at the Urban Institute looked at three key health access indicators for adults aged 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 insurance saw larger declines in the ability to obtain basic services compared with those with coverage. By 2010, 48 percent of uninsured adults had an unmet health need due to cost, compared with 11.2 percent of insured adults.

People with insurance also struggled to obtain care. 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. Only West Virginia and the District of Columbia did not.

Nationally, the report finds that the share of adults experiencing unmet medical needs due to cost rose by 6.0 percentage points to 18.7 percent from 2000 to 2010, affecting nearly one in five U.S. adults. Declines in access were significantly more pronounced for the uninsured, with the share of uninsured adults experiencing unmet needs rising by 10.8 percentage points from 2000 to 2010.

The share of adults receiving a routine checkup decreased nationwide by 5.1 percentage points, to 63.2 percent. The share of uninsured adults with a routine checkup fell by 11.6 percentage points to 37.9 percent.

The share of adults receiving a dental visit dropped by 3.9 percentage points to 65.2 percent nationwide. The share of uninsured adults with a dental visit fell by 9.0 percentage points to 37.5 percent.

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