State News

California | Mar 31, 2022 | Report | Health Costs

California’s Marketplace is Reducing Cost-Sharing and Preventing Disenrollment

California’s health insurance marketplace is using automated enrollment and subsidies to reduce un- and under-insurance, according to The Commonwealth Fund. After the end of the COVID-19 public health emergency, California will automatically enroll nearly one-third of people losing Medicaid coverage into low-cost silver plans. The state will also pay the nominal premiums attributed to abortion services, which federal subsidies cannot cover, making more people eligible for $0 premiums. Finally, the marketplace will automatically upgrade some consumers from bronze plans to silver plans that cost the same amount due to subsidy enhancements, effectively lowering individual deductibles from $6,300 to $75.

Florida | Mar 29, 2022 | News Story | Consumer Voices

Healthcare is Unaffordable for Many Floridians

Interviews with many Floridians from different backgrounds and experiences all show that healthcare in unaffordable, according to a column in The Gainesville Sun. Interviews have included stories from Florida residents like Shay P., an uninsured resident who was charged $320 for an IV in the emergency room, including $10 for each gauze that was used. Neil E. has been uninsured for about 20 years due to the high cost of insurance and earns too little to qualify for premium tax credits. Lisa M. is also uninsured and has several chronic health conditions. She has to go without other necessities in order to afford her medications. She believed that being uninsured prevented her from catching her cancer diagnosis early, as the clinic she was going to did not have the specialist care she needed. Another survey from Perry Undem and the Robert Wood Johnson Foundation found that more than 4 in 10 Floridians are delaying or skipping care due to cost and half of Floridians are not very confident that they can pay for usual healthcare services.

Oregon | Mar 23, 2022 | News Story

State Recruits Teens to Spend $1 Million in Federal Recovery Funds

The Oregon Health Authority is recruiting teenagers for an advisory council that will decide how to spend $1 million in Covid recovery funds, reports the Oregon Capital Chronicle. The agency wants the money to help alleviate some of the impact of the pandemic on young people and said young people are the best ones to decide how those funds should be spent. The group will have limited constraints on how they spend the money in schools, with guidelines on the agency’s priorities including: enhancing culturally and linguistically specific services in schools; developing youth leadership; mental health and behavioral healthcare; and providing livable wages to unlicensed staff. The council will also define values for recovery, discuss youth needs and health inequities and talk about community engagement.

Colorado | Mar 18, 2022 | News Story | Health Costs

Colorado Survey Finds High Costs, Systemic Racism Plagues Healthcare

Almost half of Coloradans have delayed a recommended medical treatment due to affordability or access issues, reports Colorado Newsline, with 30 percent saying treatment was too unaffordable, while 19 percent said insurance denied them coverage. These results from a survey conducted in mid-January 2022 also found that people thought that the most unaffordable aspects of care were emergency department costs, surprise medical bills, health insurance deductibles, post-care bills and prescription drugs. In addition, just 34 percent of people felt very confident that they could pay for typical healthcare, underscoring affordability burdens felt across Colorado. Furthermore, 62 percent of respondents think that systemic racism is a problem in the country’s healthcare system, with Black and Hispanic or Latino respondents being more likely to see racism as an issue.

District of Columbia | Mar 17, 2022 | Report | Equity

Washington, D.C.’s State-Based Marketplace is Addressing Health Disparities and Systemic Racism in Healthcare

The District of Columbia’s Health Benefit Exchange Authority’s Social Justice and Health Disparities Working Group issued recommendations to address health disparities and systemic racism within D.C. Health Link plans, according to Health Affairs Forefront. Immediate actions include changing health insurance policies to eliminate cost barriers to care for conditions that disproportionately impact communities of color, starting with type 2 diabetes, and prohibiting race adjustment in a blood test that checks how well kidneys are functioning. In future plan years, the group will examine a no cost-sharing plan design for pediatric mental and behavioral health services, as well as for adult cardiovascular disease, cerebrovascular disease, mental health and HIV, as well as cancer of the breast, prostate, colorectal and lung/bronchus—other conditions that disproportionately impact communities of color in D.C.

California | Mar 14, 2022 | News Story |

Doulas Negotiate with California Medicaid Over Payment Rates

Doulas in California are negotiating with the state’s Medicaid program to secure a higher payment rate, according to the Los Angeles Times. California is transforming its Medicaid program to include services beyond healthcare and into social services, and including doulas was intended to address racial disparities, improve birth outcomes and diversity of California’s healthcare workforce. However, doulas say the state’s initial offer of $450 per birth is too low, with most other states offering reimbursements ranging from $770 to $900 and delayed the start of the program until an agreement is reached.

Massachusetts | Mar 10, 2022 | News Story | Equity

Connector Tying Copay Relief to Health Conditions

Officials at the Massachusetts Health Connector have put forward a framework for their 2023 health insurance offerings that would eliminate sick visit copays and cost-sharing on common medications for four chronic conditions for patients enrolled in ConnectorCare plans, reports WWLP.  Each year, the Connector sets parameters for plans sold through the insurance marketplace and establishes design elements of the ConnectorCare program, available to residents with incomes at or below 300 percent of the federal poverty level. In the upcoming year, officials are proposing $0 cost-sharing in the ConnectorCare program for diabetes, asthma, coronary artery disease and hypertension—conditions that disproportionately impact communities of color. Other “equity-minded components” include efforts to enhance behavioral health access, minimize barriers to gender-affirming care and ensure access to care for people with limited English proficiency.

Colorado | Mar 9, 2022 | Report | Price Transparency

Colorado Healthcare Affordability Dashboard Launched with Cost of Care Data

Colorado’s Center for Improving Value in Health Care (CIVHC) launched an affordability dashboard to provide users with information on healthcare cost drivers, reports CIVHC. The new affordability dashboard cost of care data digs deeper into service categories and new categories for spending, including long-term care and dental services. Additionally, the new dashboard investigates the outpatient service spending category and highlights the subcategories of spending that drive outpatient costs, including other uses (includes radiology, chemotherapy, hemodialysis and physical therapy), emergency department use and pharmacy (drugs administered in an outpatient setting).

Illinois | Mar 8, 2022 | News Story

The Bottom Line: ‘Ghost Network’ Haunts Affordable Access to Healthcare

Illinois Blue Cross Blue Shield members are having trouble finding in-network doctors due to a “ghost network,” reports WCIA. A “ghost network” refers to an insurance company’s inflated patient directory that over-promises and under-delivers on the number of providers who are actually available. While the company denies these claims, a thorough review of the company’s directory reveals that many doctors are not actually in-network, are not available, not taking new patients, and are located too far away, contrary to the directory. The complications arose after the insurance company escalated a contract dispute with Springfield Clinic and kicked all 650 of its providers off the Blue Cross Blue Shield network; patients who cannot find in-network care through the incorrect directory must shoulder high out-of-pocket costs to continue to see their providers. Those who cannot afford to do so may discontinue their care, with dire health consequences. 

Ohio | Mar 4, 2022 | Report

Governor Awards $25.9 Million in  Funds for 136 New or Expanded School-Based Health Centers

The Ohio Department of Health is awarding 15 contracts for 136 new or expanded school-based health centers throughout the state, according to the Office of the Governor. The clinics will provide primary care and preventative care, including vision, dental and behavioral health in school settings. These clinics will eliminate many barriers to obtaining care, such as transportation, child time out of the classroom, parents missing time at work and a lack of provider or medical home. These clinics have emerged as effective models to improve student access to healthcare and have helped close the gap for children in underserved communities.