State News

California’s Health Care Affordability Board started holding regular meetings in January 2023, according to State of Reform. Established within the California Office of Health Care Affordability (OHCA), the board will establish the state’s overall health care cost growth target for spending, as well as targets for different sectors including delivery systems, geographic regions, and individual health care entities. The board’s first report will capture baseline spending for 2022-2023, including data reported from health plans, health insurers, and fully integrated delivery systems. Notably, OHCA has the authority to enforce the cost targets through technical assistance and requiring performance improvement plans with escalating financial penalties for failure to meet targets.

The Milbank Memorial Fund assessed the effectiveness of several policies aimed at improving access to primary care in Columbia County, Arkansas, a primary care desert. Expanding Medicaid has made primary care more affordable, and the state has encouraged a Medicaid patient-centered medical home program that has helped practices deliver higher-quality primary care. However, the area’s lack of medical schools and residency programs have made it difficult for health systems and practices to recruit and retain new doctors. The county does not have any mobile clinics, federally qualified health centers, or school-based health centers, though it does have a rural health clinic that serves as a safety net provider. The pandemic encouraged usage of telehealth services, though the county’s lack of broadband has hindered widespread adoption. Furthermore, the county has a higher proportion of Black residents than the rest of the state, and many county residents lack trust in medical institutions and their providers.

Connecticut has received federal approval for a Section 1115 demonstration waiver that will support the Covered Connecticut program, reports the Connecticut Office of Governor Ned Lamont. The approval provides federal matching funds to sustain the existing program, which offers federal premium subsidies, cost-sharing reductions and eliminates out-of-pocket costs for enrollees.

Even with insurance, many Missourians face challenges affording healthcare, reports the Missouri Foundation for Health. Nine percent of Missourians remain uninsured and three-in-five Missouri adults struggle to afford healthcare due to high costs. These challenges are disproportionately shouldered by households that include a person with a disability.

The 2021 California Health Interview Survey results (released in 2022) show that Black or African American adults and American Indian and Alaska Native adults had disproportionately high rates of adverse childhood experience, according to State of Reform. In addition, 27 percent of Californians stated that they did not receive medical care due to cost or lack of insurance.

Most of those who qualify for health coverage on New Mexico’s healthcare exchange, beWellnm, will be receiving large healthcare savings, reports Los Alamos Daily Post. These savings in premiums, deductibles, co-pays and other out-of-pocket costs are due to the federal Inflation Reduction Act of 2022, as well as New Mexico’s Health Insurance Marketplace Affordability Program. This state program reduces premiums and out-of-pocket costs not just for New Mexicans who qualify for coverage on the marketplace, but also for small businesses and their employees. It also provides resources for planning, design and implementation of healthcare coverage initiatives for uninsured New Mexicans.

The Healthcare Value Hub’s Healthcare Affordability State Policy Scorecard ranked Kansas 49 out of 50 states and the District of Columbia in healthcare affordability, reports Kansas Public Radio. Poor healthcare affordability may stem from private payers in Kansas paying more than double Medicare rates for the same services and could be improved through the creation of healthcare price transparency tools and spending oversight committees to curb excess prices.

Uninsured patients in New Mexico are often charged up to ten times more for medical treatments than insured patients, reports KRQE. These statistics, taken from a study prepared for the New Mexico Center on Law and Poverty, have dire implications for uninsured New Mexicans, namely, that they will likely incur medical debt. The study looked at the prices of 17 different medical services across 43 New Mexico hospitals and revealed that prices varied widely between those with and without health insurance. For instance, for a certain coronary artery stent, the average list price was around $85,000 but the average insurance payments totaled only around $44,000, meaning that the uninsured patient was stuck with a bill almost double what an insured patient would receive. New Mexico passed the Patients Debt Collection Act in 2021, which bans hospitals from suing low-income patients or sending them to collections, but advocates claim that more protections may be required, given the disparities in hospital charges.

The state of California has kept funds collected from fines levied against residents who do not have health insurance, rather than using the funds to lower costs, according to Kaiser Health News. Revenues collected from the state’s individual mandate were supposed to fund state-based subsidies for low- and middle-income residents who purchase coverage through Covered California, but following a boost in federal subsidies during the pandemic, the Newsom administration claimed the state subsidies were no longer necessary. Penalties collected total $1.3 billion from 2020 through 2022 and are now being held in a special fund for future use in health affordability programs when the federal subsidies expire.