This paper introduces an index of access to medical care that describes the use of services relative to the actual need for care. Findings on this particular measure suggest that, contrary to the implications of much of the existing literature, the poor continue to use fewer services–relative to the disability they experience–than do the nonpoor. Further, despite the advent of publicly financed economic solutions to these access differentials–Medicaid and Medicare, in particular–organizational barriers to entry, such as the long queues to obtain service and long travel times to care in some areas, still exist. The implications of these findings for the evaluation of existing and proposed national health policy efforts are discussed.