States Hold Keys To Health Care Affordability, But Are They Using Them?
Elise Lowry, Annaliese Johnson, Amanda Hunt, Tad Lee (HealthAffairs 2/8/2022)
Curbing excess prices
Massachusetts received the highest policy score in this domain, due to its active APCD, health care spending oversight entity, and health care cost growth benchmark. Maryland earned the top outcome score due to its active APCD, hospital spending oversight entity, and global budget model for hospitals. The Scorecard recommends Maryland expand its spending targets and oversight entity to cover all sectors of the health care Marketplace. Alaska has some of the highest inpatient private prices in the country (240 percent of Medicare rates) and has done very little to curb their rise. The Scorecard recommends Alaska create a robust APCD, strong price transparency requirements, establish a health spending oversight entity, and health spending targets.
Reducing Low-Value Care
Colorado scored well in this domain, in part due to its steps to identify low-value services through the Center for Improving Value in Health Care. Delaware is one of the few states where 100 percent of hospitals have adopted the Centers for Disease Control and Prevention’s Core Elements for hospital antibiotic stewardship, but it still scored poorly on both policies and outcomes. The Scorecard recommends Delaware consider using claims and electronic health record data to identify unnecessary care and enacting a multistakeholder effort to reduce it. Virginia earned the top policy score of this domain with its steps to measure the amount of low-value care being provided. It still scored poorly in outcomes, however, causing the Scorecard to recommend adding more measures and health systems to its initiative.
Expanding Coverage
Washington State scored highest in terms of policy outcomes in this area—in part, due to its public option. Still, 7 percent of Washington State residents are uninsured, leading the Scorecard to recommend offering coverage options for undocumented adults. The District of Columbia, and two states, scored the highest in coverage outcomes, likely because it extends Medicaid eligibility for single adults up to 215 percent of the federal poverty level. The Scorecard recommends the District add affordability criteria to its rate review process. Illinois also scored well in coverage outcomes, in part, because it uses state funds to provide coverage to certain undocumented immigrant adults. The Scorecard recommends Illinois consider options for residents earning too much to qualify for Medicaid, such as a basic health plan, premium subsidies, Medicaid buy-in, and a public option.
Improving Affordability of OOP.
California earned the top policy score in this domain with its comprehensive surprise medical bill protections, ban on short-term limited-duration health plans, and standard plan design in its Marketplace. However, it still has room to improve, with 12 percent of California adults experiencing health care affordability burdens. The Scorecard recommends California consider new policies targeting high deductibles and prescription drug costs. Iowa scored well in the outcome measure, with one of the lowest rates of residents who could not get needed medical care due to cost, but still has ample opportunity to improve its policies to ease consumer burdens. The Scorecard recommends Iowa enact stronger protections against short-term limited-duration health plans and reducing cost sharing for high-value services.
