State News

New Jersey’s Governor signed an executive order that launched the New Jersey Health Care Cost Benchmark Program that will provide everyone in the state with a shared understanding of how much healthcare costs are growing and factors contributing to high health costs and cost growth, reports ROI-NJ. Over time, the program aims to decrease how much healthcare costs grow each year and to contribute to making healthcare more affordable. The program also offers an important opportunity to implement market-based strategies rooted in broad stakeholder commitment and industrywide collaboration.

Despite having health insurance, Vermont carpenter Rick McDowell incurred more than $7,000 in medical debt following a stroke, according to Vermont Public Radio. Even though about 96% of Vermont residents have health insurance, they often don’t have the means to pay out-of-pocket costs. Vermont hospitals have consistently reported between $62 million and $85 million annually in unforgiven medical debt, which can hurt Vermonters finances and credit scores. Through story gathering, Vermont officials have found that fear of worsening medical debt pushes people to forego care, causing health conditions to worsen and ultimately increase the overall cost of care in Vermont.

For many people, basic dental care is out of reach, even for those who have health insurance, reports Foster’s Daily Democrat. Special insurance riders are needed before dentist visits will be covered by Medicaid, which only carries a dental benefit for children. Even people with dental coverage through their jobs can’t afford to pay their out-of-pocket costs. As a result, adults can be left with no access to a dentist and suffer through severe tooth pain, gum disease and worse, as well as develop serious oral diseases and other health problems. Because good dental care contributes to overall health, experts and physicians argue it should be covered by insurance. There have been efforts in New Hampshire to add adult dental benefits to Medicaid, and there are hopes a new bill will be reintroduced in 2022, after a previous version was vetoed by the governor in 2020.

Lori Dingwell of Waterbury, Connecticut, tested positive for COVID-19 in February 2021 and, though she has seen numerous specialists, has yet to fully recover, reports Connecticut Health I-Team. Suffering from long-haul COVID, Dingwell has racked up nearly $10,000 in medical debt and is paying out-of-pocket for her mental healthcare, as well as a large share of her medical treatment, though she has health insurance through the state's exchange. Dingwell does not qualify for Medicaid, though she is low-income, and Connecticut ranks among the highest in the country for per capita spending on healthcare, yet medical debt remains an issue for consumers. When Dingwell was referred to a COVID clinic, the staff informed her that she would have to pay for the majority of her treatment out-of-pocket; Dingwell gave up. 

A report from the Shriver Center, in partnership with Altarum, conducted five focus groups, comprised of primarily Black Indigenous People of Color (BIPOC) individuals, to learn about Illinois residents' views on healthcare coverage. The focus groups, which consisted of 30 participants and one group held solely in Spanish, revealed that two major barriers participants experience were the cost of healthcare coverage and the complexity of choosing and enrolling into healthcare coverage. Participants expressed that what they pay out-of-pocket can sometimes be enough to cause them to choose between healthcare and basic necessities. Participants also felt that eligibility and enrollment for both Medicaid and the Marketplace were complex and confusing. They also noted the stigma attached to Medicaid and suggested that Medicaid be rebranded with different names and marketing to encourage people to enroll. 

Oregon legislators held a hearing on prescription drug prices, hearing from stakeholders and consumers on the issue, reports Oregon Public Broadcasting. Joan Morgan with the Oregon Coalition for Affordable Prescriptions shared experience with her father’s cancer drug going from $4,000 to $10,000 per month. The drug was already unaffordable for her family at $4,000 per month. The family was able to access and afford the drug by purchasing it in Europe—for $243 instead.

Consumers in Oregon report not being able to afford their prescription drugs, despite a reduction in drug price increases, reports Oregon Public Broadcasting. Oregon lawmakers held a hearing on the results from the annual drug price transparency report and heard from consumers and advocates on their experiences affording prescription drugs. The number of drug cost increases decreased again in 2021, however the average launch price of new brand name drugs more than doubled—indicating that manufacturers may set a drug’s launch price higher to avoid making controversial price increases in following years. Findings from the report also included: 193 new “high-cost” drugs; cancer treatments make up the most of new high-cost drugs introduced; 71 drugs reporting annual price increases; the average price increase for generic drugs was 27 percent, compared to 13 percent for brand name drugs.

Montana’s richest nonprofit hospitals receive millions of dollars in tax exemptions each year to operate as charities, but Kaiser Health News reports that some fall short of other medical facilities in what they give back to their communities. Overall, Montana’s nearly 50 nonprofit hospitals directed, on average, roughly 8% of their total annual expenses toward community benefits, such as covering the treatment costs of people who can’t afford care, according to a KHN study of IRS filings ending in 2019. Notably, the state’s largest provider, Billings Clinic, spent roughly 5% of its operating costs on community benefits, while St. Luke Hospital reported 22%. Montana nonprofit hospitals face little to no oversight of their community benefit spending, though they use local needs assessments to help determine how to spend this money. A state audit estimated that hospitals combined had $146 million in tax exemptions in 2016 and reported spending $257 million on community benefits; however, the audit found that hospitals report benefits vaguely and inconsistently, making it hard to determine if they can justify their charity status.

Colorado’s Office of eHealth Innovation has released a refreshed version of the Colorado Health Information Technology Roadmap, a framework for leveraging technology to address gaps in the state’s healthcare systems, reports Colorado Newsline. The roadmap highlights three overarching goals: supporting better data sharing infrastructure; increasing access to healthcare through coordinated systems; and improving health equity. Success is defined as patients finding the care they need with doctors who are equipped to access shared clinical data, but connecting to the state’s health information exchanges can be difficult in rural communities. Implementing an electronic medical record system can be prohibitively expensive for smaller rural facilities. The roadmap also notes how COVID-19 highlighted inequities in telehealth use—the people who were most affected by the pandemic (the elderly and Black patients) could have been at a disadvantage for care, as they had lower rates of telemedicine adoption than the general population.