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Affordability Standards

We are advancing the development of state-level “affordability standards” as one important policy lever states can utilize to better understand, and ultimately improve, affordability for people.

The affordability of health care is a matter that concerns people across America regardless of political affiliation, socioeconomic status, or geography; however, the absence of an agreed upon and standard definition of affordability definition or metric makes creating equitable solutions to accessing health care difficult to operationalize. Utilizing data to understand and define what is affordable for families and individuals earning different incomes and living in different communities allows policymakers to create solutions to ensure health care is more affordable. Instituting affordability standards would help keep policymakers, providers, and insurers accountable for providing care that is accessible and equitable.

Our Approach

It is clear that people want and need more affordable health care, a need all the more pressing during a pandemic.

I personally don’t have health insurance because it [is] way too expensive. I want it for my family and I, but we just don’t make enough money for it. My husband is a firefighter and we can’t even afford it for him! He has a high risk job and I think for people that work in those environments, their healthcare should be all the more affordable for them.

Conservative, Disability: No, Female, Government Insurance, Non-College, Under 40, White/Caucasian

While it may seem like defining affordability doesn’t mean health care becomes more affordable in reality, it actually moves us to a much better place and creates a pathway for actually creating more affordable coverage and care for a number of reasons:

  • They create actionable policy guidance that is based on evidence and they create a baseline from which states can measure the impact policies have on people’s ability to afford health care. It also creates opportunity to bring policies in line with those definitions; it is hard to advance policies aimed at creating more affordable care and coverage without understanding what that actually means.
  • Federal measurements of “affordability” do not adequately define affordability, and the definitions used are complex, differ from program to program, and are misaligned with what consumers actually experience. For example, federal definitions don’t factor in both premiums and out-of pocket costs or the large variations of costs that consumers experience in different parts of the country or even within parts of a state. And we know costs extend beyond just health care as well–including transportation to see a provider, time off work, lost wages, etc.

Our Current Initiatives:

Unsurprisingly, the COVID pandemic has shifted priorities among state policymakers. As noted, COVID delayed Colorado’s regulation on affordability standards, and other states may face similar challenges as the pandemic continues. Further, uncertainty at the federal level has meant that states are again reassessing priorities, with potential for this work to be deprioritized in some states.

  • Affordability standards in place: MA and RI
  • Affordability standards under development: CO and CT
  • Affordability studies underway/advocate action: IL, NJ, and VT