Despite Massachusetts’ reputation as a medical mecca, health care here is becoming increasingly unaffordable. And while states have taken important steps to reduce overall health care cost increases, those savings are not always passed on to consumers.
This makes it important for the Massachusetts Health Policy Commission to work with the Legislature to establish affordability benchmarks. This is a new metric that highlights how much consumers are paying for health care and could be used to hold health systems accountable for retaining patients. Cost reduction.
The state has long struggled to contain high health care costs, which are passed on to consumers in health insurance premiums and copays.According to the Health Information Analysis Center 2024 Annual Report, 41 percent of Massachusetts residents surveyed in the 2021 survey had difficulty paying medical bills in the past 12 months, including more than 50 percent of Black and Hispanic respondents. was included. Nearly one-third of residents reported not receiving needed medical care due to cost.a poll A survey conducted in February and March 2024 for Blue Cross Blue Shield of Massachusetts found that 40 percent of respondents reported delaying treatment because of cost.
Considering that insurance premiums are high, it is not surprising that paying for treatment can be difficult. The average commercial health plan cost in 2022 was $595 per member per month, or $7,140 per year, an increase of 5.8% from the previous year, according to the CHIA report. The average person with commercial insurance paid an additional $730 in cost-sharing annually. Plans are so expensive that more small businesses are offering high-deductible health plans, and 1.7 million Massachusetts residents enroll in health plans with at least $1,400 deductibles. did. High deductibles can deter people from seeking medical care because they know they will have to pay out-of-pocket until the deductible is met.
From 2020 to 2022, both premiums and cost sharing increased faster than wages and inflation. And these numbers do not include the cost of care received outside the insurance plan. For example, many mental health physicians require out-of-pocket payments.
Massachusetts was the first state to establish increased health care costs. standard. The Health Policy Commission works with Congress to set health care spending growth targets each year. Health care providers and insurance companies must testify publicly at annual hearings about how they maintain costs. The commission has the authority to require providers who do not comply with benchmarks to adopt performance improvement plans. (He has only ever negotiated one plan with Commander-in-Chief Brigham.)
This benchmark is important and needs to be expanded. For example, this editorial board has supported requiring pharmaceutical companies, pharmacy benefit managers, and drug wholesalers to testify about cost factors associated with prescription drugs. The provider screening process should be expanded to include all hospitals and specialty providers, not just primary care hospitals.
However, because health care systems are complex, containing health care costs does not necessarily mean limiting costs for consumers, so another affordability benchmark is also needed. For example, even if a drug company lowers drug prices through rebates pocketed by pharmacy benefit managers, patients still pay the same amount.
“While there may be savings at the system level, they don’t necessarily translate into direct consumer experience,” said John, senior director of policy and government relations at Health Care for All, a health care consumer advocacy group. Alex Sheff said. .
That’s why new measures to monitor the spending of patients with commercial insurance (i.e., insurance purchased through an employer or state exchange) would give consumers a better understanding of costs and give health systems a greater responsibility to control costs. It will be a valuable tool for inflicting damage. Ideally, this metric would help policymakers understand whether costs are more borne by certain groups, such as people with disabilities or chronic conditions, or people of different races, ethnicities, ages, or income levels. It can be analyzed as follows.
To be effective, affordable benchmarking must be combined with accountability. The challenge will be to develop fair ways to hold the entire system accountable.
The simplest measure of affordability has to do with how much consumers pay for insurance. But insurance companies’ profits are already regulated, and the amounts they charge reflect the prices charged by doctors and drug companies.
David Seltz, executive director of the Health Policy Commission, said the commission is still in the early stages of developing affordability benchmarks, but that it has plans to include affordability as another component of the current health care cost review system. He said he is considering various methods of accountability. and performance improvement plans. Requires the Department of Insurance to consider affordability when approving premium rates. and development of new systems. Commissions can develop affordability indicators on their own, but accountability measures require legislative approval. Lawmakers need to ensure that a robust system is in place to contain consumer costs, and that it is done in a way that includes health care providers, insurance companies, and the pharmaceutical industry.
While no state has done exactly what Massachusetts is considering, other states are addressing health care affordability in broader efforts to contain costs. rhode island, connecticut, vermont stateand California.
The best way to keep people healthy is to make sure everyone has access to the care they need, when they need it, without having to worry about whether they can afford it.
Editorials represent the views of the Boston Globe Editorial Board.Please follow us @GlobeOpinion.
