On Tuesday, three Health Care For All consumer advocates sat before the Joint Committee on Public Health to explain the damaging effects of out-pocket-costs and to lend their voices to making change. Laura Hudson of Northhampton, Valerie Spain of Cambridge, and Dr. Steve Slaten of Worchester testified in support of H. 2084, “An Act relative to keep people healthy by removing barriers to cost-effective care.” The Health Care for All-authored legislation, sponsored by Rep. Carl Sciortino and Senator Patricia Jehlen, would set up an expert panel to make recommendations to DPH regarding which high value and cost-effective services and medication should not be subject to out-of-pocket cost sharing, like co-pays, deductibles, and co-insurance.
Barrier-Free Care in a Nutshell
The legislation draws from a concept known as Value-Based Insurance Design, which recognizes that out-of-pocket costs are intended to compel patients to reduce care, in an effort to contain costs. However, rationing necessary care – especially cost-effective drugs or treatments connected with chronic illnesses like diabetes, hypertension, HIV/AIDS, asthma, and mental health conditions – puts patients at risk of developing bigger, more expensive health complications down the road. For these services, we don’t want patients to limit their use. In these cases, out-of-pocket charges don’t make sense.
Just as the ACA ended cost-sharing for many preventive screenings, this proposal would eliminate cost-sharing for cost-effective care that prevents higher cost acute illness.
Laura, a caseworker and program coordinator with HIV/AIDS patients, stated that although her patients receive significant assistance through the HIV Drug Assistance Program (HDAP), “there are still significant barriers to care, such as annual deductibles and needing to pay a co-pay for each office visit.” She told the story of a patient whose annual deductible was so high, he was forced to go without his inhibitor medication for an entire month. She continued that the affordability challenge captured in his story has been compounded by more recent barriers, pointing to a recent Blue Cross Blue Shield policy that requires chronic illness patients to buy their medication in 3-month blocks. As a result, patients must forgo HDAP’s month-by-month co-pay assistance and pay 3 months’ worth of copays upfront. Laura noted that this barrier is particularly difficult for her patients, as many of them are prescribed more than one medication to deal with their illness. She continued that being able to consistently access care would not only improve the health of her patients, but would go a long way towards preventing the spread of HIV, as the inhibitor medication helps patients maintain an undetectable viral load.
Valerie, the director of Energize Everett, noted that her tiered network plan has exacerbated the challenges that out-of-pocket costs pose to her efforts to maintain responsible care for her Type 1 Diabetes. “I make 50K and now pay $50 a month in co-pays for diabetes supplies,” Valerie stated. Valerie continued that reducing her copays would improve her ability to maintain the excellent control over her health that she has worked hard to cultivate for years.
Dr. Steve Slaten, a psychologist, concurred with Laura and Valerie’s statements, noting that, as a someone with Crohn’s disease, it is not difficult to fall into the habit of self-rationing medication. “It is so easy to take it twice a day instead of the required 4 times a day to stretch out the money until the disease flares up again,” Steve stated. “I’ve had to deal with that.”
However, Steve really drove the point home when sharing the story of a friend in Worcester who lost his sister Sally to cancer. While undergoing chemotherapy, Sally and her family were unable to afford the co-pays that came with the extra oxygen equipment she needed on top of all of the other expenses that came with her care. When they were finally unable to pay, the company providing the equipment refused service and took back the equipment, leaving Sally to die weeks later from complications. Steve directly addressed the panel of lawmakers, stating:
From their perspective the insurance companies will tell you that providing free high value, cost-effective care for certain serious diseases is going to cost them money…and they are partially right. The savings of preventing ER visits and expensive care for acute episodes may not affect their bottom line this next fiscal quarter or in this fiscal year. The cost savings and health benefits of preventive strategies add up over years, but that is not the time frame within which insurance companies evaluate their financial performance. It is up to policy makers and legislators like you to decide that long term benefits are of greater value than short term costs.
At today’s Health Policy Commission “Cost Trends” hearing, Attorney General Coakley noted the dramatic growth in high-cost sharing plans. Health Care For All and its volunteer leadership team are committed, through our support of Barrier Free Care, to fighting this problem head on. We are continuing to build relationships with legislators through our grassroots initiatives so that out-of-pocket costs will be not pose the same barrier to care that they do today.