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United States of SCare

Published On October 31, 2019

By: Joanna Dornfeld, Kristin Wikelius

The stories all start the same: a healthy individual unexpectedly needs medical care and after treatment they are left fearful of the bill to come. With never ending costs and narrowing health care coverage, it is clear that health care can be just as scary as Halloween. In honor of the spooky holiday, we are dedicating this blog to discuss some of the most frightening things about health care and highlight policy proposals that can make everyone’s Halloween (and every day) a little less scary. 

As health care costs continue to increase, people are increasingly deciding to avoid or delay seeking care. Even as premiums in the individual market stabilized in 2019, a recent Kaiser Family Foundation report found that the cost of premiums, copays, and deductibles for employer sponsored health plans are rising faster than wages and inflation. A Pennsylvania woman who beat breast cancer has been saddled with thousands of dollars in debt from her treatment. As a result, she has put off going to the doctor and instead tries to eat healthy and do self-exams on her breasts. 

In response to these stories, states are enacting policies to reduce the cost of health insurance coverage and create new affordable options for consumers. Washington and Colorado enacted legislation to create additional insurance options for people who purchase their own coverage.  Additionally, Maryland enacted legislation allowing the state to use income tax data to help uninsured individuals enroll in coverage. 

Even if an individual has health insurance they still might not be protected by the shock of a monstrous surprise medical bill. An Oklahoma father called his insurance company, as his daughter was being wheeled in for emergency surgery, to ensure that his insurance would be covered as in-network. When he received a bill in the mail, it was to his horror that the care was not in-network. Since these stories have become a fixture in the media, states have taken action to protect their constituents. Just this week, the Ohio state legislature introduced legislation to join the 27 other states that have enacted various surprise billing laws. Congress is following the lead set by states, with bipartisan legislation to protect people from surprise bills passing out of Committees in both the House and Senate. 

Health insurance isn’t the only frightening health care cost. Earlier this year a Health Affairs report found that from 2008-2016 oral prescription brand-name drug prices increased 9 percent, and 15 percent for injectable brand-name prescription drugs. In 2014 alone, insulin prices rose 49 percent. The skyrocketing cost of prescription drugs is forcing many individuals to decide whether to buy their medication or pay their rent, forcing some patients to risk their lives and ration their medications. With 79 percent of Americans saying that the cost of prescription drugs is unreasonable it is obvious that tackling the cost is paramount. States are working to address these nightmarish situations through innovative solutions. For example, Colorado’s groundbreaking law will cap insulin copays at $100 per month for people with private insurance and Florida, Colorado and Maine enacted laws to allow for the wholesale reimportation of prescription drugs. 

Lack of coverage and access to mental health services remains a challenge, with demand for these services pushed even higher by the opioid epidemic that has plagued this nation. In 2017, more than 150,000 Americans lost their lives to drugs, alcohol, or suicide. A recent Society of Actuaries report found that in 2017 the opioid crisis has cost the U.S. economy over $179 billion. Access to equitable, affordable, and quality mental health and substance misuse treatment is critical to addressing this crisis. As the laboratories of innovative solutions, states are responding by improving mental health coverage and expanding access to mental health and substance misuse services. Minnesota enacted a comprehensive state response to the opioid crisis which provides grants for prevention, education, treatment and rehabilitation efforts. Additionally, New Jersey and Minnesota passed legislation that increases enforcement and oversight of mental health parity laws to make coverage for mental health services and substance use disorder treatment services equal to coverage of physical health care services. 

As scary as health care can feel, states have been proactive in their implementation of policies aimed at solving the many issues impacting everyday people. Constituents can rest easy, knowing that even if legislation moves at a slow pace in Washington, their state elected officials are working towards solutions to ensure health care is not as frightening as Halloween.