sad piggy bank According to thestudy, "Health care affordability problems cause stress and anxietyfor families, crowd out other critical family spending, and lead topoorer and less equitable health outcomes," (Photo:Shutterstock)

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A new study from consulting firm Altarum finds that states arefalling short in the area of improving health care affordability.The study outlines a range of steps that could improve coverage andaffordability of health care, at a time when coverage has improvedbut affordability remains a challenge.

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The Health Care Affordability State PolicyScorecard ranks 42 states and the District of Columbia (lack ofdata kept some states from being ranked), and found thatMassachusetts, Maryland, Oregon, Minnesota, and New York made uptop five states for affordability. Nevada, Idaho, Georgia,Oklahoma, and Mississippi ranked the lowest.

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Related: 5 best and 5 worst states for healthcare

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However, the study noted that every state had room forimprovement, and that some areas were hard to quantify, such asaddressing the problem of low-value care. In addition, some statesrank high in both health care spending and affordability,suggesting that the states have policies that keep the consumercosts down while still spending more on health care overall.

Coverage—the first step

The Altarum study notes that in order to have affordable healthcare, Americans must have health insurance coverage. "Healthinsurance makes a difference in whether and when people receivenecessary medical care, where they get their care and, ultimately,how healthy they are," the study noted. "Uninsured people are farmore likely than those with insurance to postpone health care orforgo it altogether."

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The study had a list of recommendations for improving coveragethat included:

  • Expand Medicaid to 138 percent of the Federal PovertyLevel (FPL)—"Strong evidence suggests that expandingMedicaid to all residents improves health outcomes, financialsecurity and contributes to economic prosperity in a state," thestudy said.
  • Provide coverage options for residents with incomesabove 138 percent of FPL—a step that could provide optionsfor consumers who make too much for Medicaid coverage, but stillstruggle to find insurance.
  • Provide coverage for recent and undocumented immigrants—a suggestionthat could be controversial, but the report said expanding coveragewill improve public health.
  • Stronger rate reviews—the study recommendedstate regulators follow the example of California and Massachusettsduring the rate review process, putting an emphasis on improvingcoverage and affordability.

Affordability—a growing challenge

The report agreed with other recent studies: Americans are strugglingwith affordability of health care across the board.

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"Health care affordability problems cause stress and anxiety forfamilies, crowd out other critical family spending, and lead topoorer and less equitable health outcomes," the study said."Evidence of widespread problems goes far up the income ladder andaffects people of every stripe."

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The recommendations in this area included:

  • Protect consumers from inadvertent, surpriseout-of-network medical bills—states are limited in whatthey can do for self-insured plans, but the report noted that theissue has raised concerns, with 27 states taking steps to protectconsumers against surprise bills.
  • Protect consumers from short-term, limited-duration(STLD) health plans—STLD plans are promoted by some as alow-cost option, but the report noted that these plans fail tooffer many protections provided by ACA-compliant plans. "As aresult, out-of-pocket limits may not include what consumers pay fordeductibles and copays; the plans may limit coverage for doctorvisits and prescription drugs; and they do not cover pre-existingconditions," the report said.
  • State mandates that waive or reduce cost-sharing forhigh-value service—"Failure to receive high-value carelike flu vaccines, certain cancer screenings and other selectservices not only worsens health outcomes but can result in higherspending on medical care," the report said.

The report also looked at several other areas that affect healthcare affordability: addressing low-value care, curbing excess prices,improving transparency, and using all-payer or multi-payer claimsdatabases.

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The Altarum study concluded by saying states have shown theability to address health care coverage and cost issues withprudent policy decisions. "The scorecard shows that state policymakers have a robust tool set they can use to ensure all residentshave affordable coverage that features consumer-friendlycost-sharing and premiums that reflect the efficient delivery ofhealth care and fair health care pricing," the report said.

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