By Jamie Hartmann-Boyce & Theo Schall
Rising health care costs pose an existential threat to the well-being of Americans. Now is the moment for Massachusetts to defend its reputation for health care and health equity, not to be swept along with the national tide.
On Thursday, the Massachusetts’ Group Insurance Commission (GIC) will vote on changes to health care that could dramatically raise costs for the 460,000 state employees, retirees, and their dependents that the plans cover. The Massachusetts GIC acts as a central purchasing agency for health insurance plans. It’s often used as a benchmark for other state insurers in determining benefits – where the GIC goes, others will follow.
Unfortunately, rather than continuing to position Massachusetts as a leader in health care, the proposed changes would undermine health equity by making care unaffordable for working people and families. They could even end up costing GIC more in the end, as people delay care due to high costs.
The proposed changes include substantial increases to both copays and deductibles. Deductibles – the amount patients have to pay before their insurance kicks in – could double.
For some plans, this would bring the total to $750 for an individual and $1,500 for a family. In other words, despite paying for insurance every month, a family would have to pay an additional $1,500 each year before insurance actually covered the cost of care. Perhaps even more troubling, the proposals also include a 50% increase in copays – the fixed amount charged at an appointment – for a range of services.
The GIC lists its strategic priorities as “member affordability, behavioral health, and health equity.” None of these are served by the proposed changes. The increase in deductibles is judged by GIC to have “some misalignment” with health equity and to be strongly misaligned with “member affordability.” We would argue that doubling deductibles is not aligned with either priority. Bizarrely, the GIC has deemed “health equity” as “not applicable” to the proposed co-pay increases.
Studies (and common sense) tell us that greater cost sharing, such as increased co-pays, will result in fewer patients being able to afford treatment.
Let’s take emergency room co-pays, for example.
These are set to increase from $100 to $150, meaning any time anyone with a GIC plan heads to the ER, they would have to hand over $150. A review from the Kaiser Family Foundation found that even relatively small levels of increased costs (around $5) lead to reduced use of care, including for necessary services, with the impact disproportionately felt in lower income communities. Reduced use of care leads to worse health outcomes, including preventable disability and death. This impact will be most keenly felt by low income people who have pre-existing health care conditions.
Though higher co-pays are being proposed as a cost saving measure, changes that reduce access to care can perversely lead to overall increased costs to insurance plans, patients, and taxpayers. A 2013 study conducted in Massachusetts found that higher co-pays for ER visits led to a 25-30% decrease in high-severity ER visits in people from lower income communities. This led to increased longer term hospitalizations, as problems that could have been addressed in the ER instead became serious extended health issues.
Imagine this: a boy with asthma is struggling with an acute attack. His family cannot afford the $150 ER co-pay, so decide to wait it out at home. This permanently changes his airways, reducing his lung function for the rest of his life, and putting him at increased risk of severe attacks, breathing difficulties, and infections – all of which increase his chance of longer term hospitalizations and higher health care costs.
All of these, of course, also increase the possibility that this child, his family, and his community will suffer the tragedy of an entirely preventable death.
Massachusetts claims to be committed to health equity. Proposed GIC changes are a direct threat to this goal. On Thursday, the commission must vote to uphold the values Massachusetts residents hold dear.
At a time where health care costs are a significant national talking point, and the news is unrelentingly negative, Massachusetts has an opportunity to be a leader by maintaining affordable access to care for the individuals and families insured by GIC.
The Fair Share Amendment – a marginal 4% tax on millionaires – makes us a model for equity in public education, infrastructure, and transportation. If the commission says no to the proposed changes on Thursday, high quality health care in Massachusetts can provide another model for equity, bringing hope and literally saving lives.
Jamie Hartmann-Boyce and Theo Schall are in the Department of Health Promotion and Policy at the University of Massachusetts Amherst.