Health care is expensive here, and more
patients are skipping care to avoid high out-of-pocket costs -- even if they
have insurance.
By Mitchell Schnurman 6:00 AM
on Feb 9, 2020
Maybe voters can do
what companies have not: move the needle on health care prices.
For decades,
employers have complained about the rising costs of health care, but
ultimately, they’ve accepted the increases -- and passed along much of the
expense to workers.
Now, a growing number
of Americans who have health insurance are finding it too expensive to use.
Many are electing to not fill prescriptions, skip follow-up treatments and not
see a doctor when they’re sick -- all because of the costs.
An estimated 44
million people with insurance were “underinsured” in 2018, according to the
Commonwealth Fund, a nonprofit foundation supporting health policy research and
reform. It defined the underinsured as adults with coverage and out-of-pocket
costs that eat up a big share of family income -- at least 5% or 10%, depending
on their pay.
In 2018, almost 1 in
4 Americans were underinsured, compared with 1 in 11 in 2005, Commonwealth
said.
That’s one sign of
problems in health care, and here are some more: In a Kaiser Family Foundation poll last month, 56% of
respondents said they supported “Medicare for All,” and two-thirds said they
favored a public option.
In a Morning Consult poll, almost 2,000 registered
voters ranked health care as a top priority in the 2020 presidential election,
ahead of the economy, immigration and gun control. Their top concern on health
care? By far, it was the cost.
“The voter, the
patient, the employee -- that all refers to the same person, and they don’t
like the way the system is working,” said Den Bishop, president of Holmes Murphy,
an insurance brokerage and consulting firm. “It costs too much and it’s too
complicated. And most Americans are saying they’re ready to give up on the
private sector.
“That’s something
everyone in health care should be paying attention to,” Bishop said.
The Affordable Care
Act, passed in 2010, was primarily aimed at expanding access, and it reduced
the number of uninsured in the U.S. by almost 20 million. Gains were more
limited in Texas because the state didn’t expand Medicaid for low-income
residents, a key opportunity with the health law.
But getting insurance
is just the entry point into the U.S. health care system.
“People not only need
coverage; they need coverage that’s protected and has out-of-pocket costs that
are affordable for their family income,” said Lynn Quincy,
director of the health care value hub at Altarum, a
nonprofit research firm. “In Texas, many residents are struggling with those
costs.”
In a recent scorecard, Texas ranked low on
affordability, in part because it’s “among the most expensive states, with
private payer prices well above the national median,” Altarum reported. Almost
half of Texans had problems with out-of-pocket expenses and one-third had
trouble paying medical bills, the report said.
In a 2019 state scorecard by Commonwealth, Texas
ranked dead last on access and affordability. More adults in the state went
without care because of the cost and a greater share didn’t have a usual
provider, the group said. The cost of health insurance also consumed a greater
portion of Texans’ income.
“Texas has a very bad
spending and pricing problem, and they don’t seem to be doing anything about
it,” Quincy said.
In December, the
Texas House named a select committee to study health care
costs. It aims to examine the primary drivers of rising expenses and identify
ways to improve the system and reduce costs.
Because other states
have started tackling the issue already, the House committee “has a window of
opportunity to identify state-based strategies that would trigger dramatic
improvements,” according to a recent letter from Tom Banning, CEO of the Texas Academy of Family
Physicians.
In his letter to the
House committee, he touted the importance of investing more in primary care. An
East Texas network of primary care physicians, he wrote, produced an 8%
reduction in costs and saved over $2.5 million for more than 5,000 members.
“Until we have an
honest conversation about what’s driving up costs, we’re gonna continue
nibbling around the edges,” Banning said in a phone interview.
The group has hired a
health policy firm in Washington to develop a menu of options to rein in
prices.
“It’s obviously at
the top of voters’ minds,” Banning said. While the health law extended coverage
to millions, “that’s all fairly meaningless if you can’t afford to access
health care services.”
Several accountable
care organizations, known as ACOs, have generated savings for Medicare patients
and others. And Baylor Scott & White’s ACO has kept a tight lid on prices for its
employee health plan.
Most big companies in
Dallas-Fort Worth are unwilling to restrict their workers’ choices of providers
and facilities, said Bishop, whose brokerage helps clients select health
insurance plans.
In an ACO, a limited
integrated network is crucial to generating savings, but companies generally
worry more about losing talent.
“To keep people
happy, employers want to offer access to every major hospital -- and that’s
expensive,” said Bishop, who recently wrote The Voter’s Guide to Healthcare.
Because the economy
has been strong, many companies have simply accepted rising health costs and
continue to share the increases with employees. And there’s the rub, Bishop
said, because many workers -- who are also voters -- have had enough.
“We’re absolutely at
a tipping point, but it’s not the employers this time,” he said.
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