Congress Must Relieve Americans' Out-of-Pocket Costs
With historic inflation and an ongoing pandemic, Americans have enough to worry about right now. The reality is that these uncertainties have only added to one of consumers’ biggest long-term struggles: health care costs. Today, rising costs are putting a strain on families’ budgets at a time when they can least afford it, forcing them to make unnecessarily difficult decisions when it comes to health care.
A 2021 study found that out-of-pocket costs – the bills consumers have to pay for the care insurance doesn’t cover – are continuing to swell. These costs neared $500 billion in 2021 and are projected to rise astronomically – to nearly $800 billion – by 2026. Decades-long rises in health care prices are on the cusp of being fully affected by inflation, threatening to leave families flatfooted very soon. Now, a Kaiser Health News-NPR investigation has found that 100 million Americans ― including 41% of adults ― are grappling with medical debt, a crisis that has been years in the making.
New research from Consumers for Quality Care, conducted by Impact Research and Public Opinion Strategies, found that Americans are overwhelmingly concerned right now about the cost of health care and being able to afford their care. By a two-to-one margin, 45% of voters reported that out-of-pocket costs were too high, and 80% said the amount they pay out-of-pocket for health care seems to be going up every year. Sixty percent of Americans report they have skipped or delayed getting care because they are concerned about how much they will have to pay out-of-pocket.
With a near-record number of Americans having access to health insurance and sectors of the health care industry continuing to make sky-high record profits, it is now up to lawmakers to address the root causes and common sources of soaring costs and medical debt: insurance companies and hospitals.
Bad insurer practices are harming patients, even though more people than ever have coverage. Insurance companies are forcing patients to jump through hoops to get care and leaving many to pay out of their own pockets to get the treatments they need. For the Jones Family, who must pay $12,000 out-of-pocket before their insurance will cover anything for their son battling a heart condition, this is devastating. Lawmakers must level the playing field for insured Americans, who just want insurance to act like insurance again.
Bad hospital practices have a role to play here, too. Hospital spending leads the country’s health care spending, and despite a federal law designed to help consumers understand these costs and shop smarter, many hospitals are failing to comply with price transparency requirements. Even more outrageous is that nonprofit hospitals – which are provided substantial tax breaks – are getting billions more in tax breaks than they spend on charity care and community benefits. Lawmakers should take a closer look at these practices, which harm the ability of patients to access life-saving care.
If lawmakers fail to address these issues, the 100 million Americans in medical debt will only continue to climb. Insurers should be there when you need coverage the most, not denying coverage as it did for Joe Pitzo’s life-saving brain surgery to beat cancer. Hospitals should also put aside toxic practices like suing patients and garnishing wages of patients like Nick Woodruff who faced thousands of dollars in bills after being treated for an infection related to his diabetes.
Patients should always be at the center of the health care debate. As Congress continues to debate health care-related legislation this summer, CQC will continue to make sure that consumers’ concerns are central to these discussions. Millions of Americans are counting on lawmakers to hold insurers and hospitals accountable for bad policies that put profits over patient care. Without action, out-of-pocket costs and medical debt will only continue to burden millions.
Mary Smith is an accomplished leader in global business, legal, and health care industries with experience working on health care issues on both the state and federal levels. She previously served as the CEO of the Indian Health Service during the Obama Administration. Smith now serves on the board of directors of Consumers for Quality Care. Follow her at @marysmith828.
