Health Care Affordability is a National Concern

Consumers from all walks of life cite health care costs as a high priority for our nation’s policymakers. According to Kaiser Family Foundation data, health care costs top the list of household expenses Americans worry most about affording. About half the public, regardless of socioeconomic status or health condition, say they are either “very” or “somewhat” worried about paying for unexpected medical bills or their health insurance deductibles.

A Healthcare Affordability State Policy Scorecard recently released by Altarum’s Healthcare Value Hub identifies areas where states are doing well, as well as areas where they can improve. Why focus on states? According to the report, state policymakers are close to the unique, local market conditions that influence health care affordability for residents. These policymakers are often most familiar with the state’s policy environment and more capable of responding to residents’ needs than national legislators. They also have a robust policy toolset available to help ensure consumers have affordable coverage.

While there is more than one path for states to achieve health care affordability, core elements include:

  • Enacting policies to ensure affordable coverage options for all;
  • Ensuring coverage options feature affordable cost-sharing and do not leave consumers underinsured or create barriers to high-value care; and
  • Addressing the underlying causes of high health care costs by reducing spending on low-value care and curbing excess prices.

How does California Score in Health Care Affordability?

According to the scorecard, California has relatively high health care spending per person with very high recent spending growth – ranking sixth in the nation for health care affordability policy. However, 26 percent of adult residents feel financially burdened, with the most common problems reported as paying for the cost of prescription drugs and medical bills. Overall, this percentage remains relatively low due to meaningful policymaking efforts. The study concludes that attention to price growth may be the key to sustaining this result.

According to the checklist, here are the areas where California has implemented policies, but has room for improvement:

  • Expand Medicaid to cover adults up to 138 percent of the federal poverty level.
  • Provide high-quality, affordable coverage options for people whose incomes are too high to qualify for Medicaid (e.g., Basic Health Plan, reinsurance or augmented premium subsidies).
  • Provide options for recent immigrants that do not qualify for other coverages.
  • Conduct strong rate review of fully insured, private market options.
  • Protect patients from inadvertent surprise out-of-network medical bills.
  • Limit the availability of skimpy and confusing short-term, limited-duration health plans.
  • Require insurers in a state-based exchange to offer evidence-based standard plan designs.
  • Require validated patient-safety reporting for hospitals.
  • Universally implement antibiotic stewardship programs using Center for Disease Control’s seven core elements.
  • Create an all-payer or multi-payer claims database to analyze healthcare price inflation, price variation and utilization.

Clearly, consumers identify health costs as a top issue that must be addressed by both sides of the political aisle. Health care affordability problems cause stress and anxiety for families, plus result in less optimal and equitable health outcomes. While there is much room for improvement, California receives strong credit for achieving a health care policy environment that improves access to coverage, protects consumers against surprise medical bills and pursues strategies to reduce the cost of high-value care.

Pacific Federal is a subsidiary of Zenith American Solutions.