Healthcare Affordability in Red States: Where are We Now?
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The healthcare landscape has entered new territory as 2019 is the first year that consumers are no longer required to pay a fine for being uninsured under the Affordable Care Act (ACA). Consumers also have access to new plans that offer lower premiums with minimal coverage outside of the marketplace. These plans, introduced by the Trump administration, provide minimal coverage as a way to offset the predictions of rising costs of health premiums. Experts fear that these plans will fail to protect consumers from serious medical bills and cause individual markets to shift as healthy people consider leaving risk pools for lower costs.
As open enrollment season began for 2019, enrollment numbers were lower than any other year since the ACA was established according to data obtained through Healthcare.gov, which runs the marketplace for 39 states. Couple these changes with the majority of states falling into the red after the 2018 election and you have a whole new outlook for healthcare affordability in the United States.
Efforts to Repeal and Replace
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As the country watched the death spiral of the ACA, it was common to hear patients and their loved ones talk about fears of affording care under any new plan offered. There were fears that the ACA’s demise would end with millions of Americans going back to being uninsured in an era that covered more people than ever before. Fears swelled over the possibility that Medicaid dollars would be cut significantly by red states who spend more on business development than on programs for women and children who live below the poverty lines. The ACA offered the first solution of any kind to these social issues.
Even though Congress was unable to “repeal and replace” the Affordable Care Act, they were able to make significant changes that impact people who need healthcare services. They released the Better Care Reconciliation Act of 2017 that set to dramatically reshape Medicaid by ending coverage expansion to people who struggle to pay for medical care. The GOP created the American Health Care Act that claimed to deliver the control and choice individuals and families need to access care that’s right for them. However, this bill had no support in the Senate and failed to come to fruition.
The future of the of the ACA has fluctuated dramatically under the Trump administration. As the mandate ended, control of Medicaid expansion and other social service programs shifted back to individual states, making where you live more critical than ever.
Blue v. Red States
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Funding for health and wellness programs is a problem nationwide. Where you live can significantly affect your ability to afford coverage. Programs such as Medicaid are governed by each state, allowing more conservative states to limit access to lifesaving coverage based on income levels that can already make living difficult before being told you have a chronic health condition.
Red states are falling in line with the federal position on health care policy. These states are limiting access to care, which leaves many sick patients paying higher premiums. However, in red states, focus is often on real estate development and business owners before public issues, like cost of living, lack of transportation, and healthcare affordability. The stories from states where “Obamacare” is a dirty word can turn any left-leaning liberal red in the face, but not red on the ballot.
Healthcare Spending
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According to a USA today article, healthcare spending comprises well over one-quarter of total state direct spending across the country. However, spending varies from state to state, ranging from around $1000 to over $3000 per person. Medicaid spending, or the state-run programs for people of lower income levels, accounts for the most substantial part of state healthcare dollars spent.
When examining the states with the lowest healthcare spending per person, four of the five lowest dollars spent are in red states, including South Dakota, Nebraska, Georgia, New Hampshire, and Idaho. Other factors to consider when understanding state spending is the number of people over the age of 65, the percentage of the population with a disability, and the number of people with insurance.
Understanding the View from Red States
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In West Virginia, Joe Manchin, a Democratic Senator shot a hole in a document with the words “Lawsuit on Coverage of Pre-Existing Conditions” scrawled across it on his campaign trail to show that he did not support taking away insurance for those with pre-existing conditions. Joe Manchin won his race and currently holds a senator seat in a state that has a red governorship. The debate over pre-existing conditions is a highly debated one as many Republicans support legislation that would allow health plans to limit coverage or charge higher fees for those with pre-existing conditions.
The Centers for Medicare and Medicaid (CMS) have issued federal guidance allowing the states to deny coverage to patients who received non-profit charitable assistance. Maryland is one of 42 states to adopt this rule that can only be offset by legislation that could protect patients. This new rule could make healthcare coverage even less affordable for those with chronic conditions such as HIV/AIDs, cancer, and arthritis. Without financial assistance, those with chronic diseases can be forced to make difficult decisions such as medications versus rent, food, or heat — a choice no American should have to make.
Impacting the Healthcare Industry
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Patients aren’t the only ones affected by changes in health policy. Shortages of healthcare providers have been an issue throughout history. As the ACA caused the rates of uninsured Americans to decrease and offered Marketplace subsidies to people below 400 percent of poverty, nurses and physicians faced a simple issue of supply and demand. The shortage of nurses and doctors further complicates matters of access to care.
Under the ACA, more patients were seeking care in emergency rooms and from primary care physicians, placing even more strain on a system already bursting at the seams. Patients who sought care hadn’t been seen for years, making healthcare issues more complex. This was all happening during a time already projected to see substantial growth in the number of Medicare enrollees due to the aging American population.
The healthcare industry has turned to nurses to combat the shortage of physicians. More than 214 programs are available nationwide for nurses with an associate’s degree or diploma to obtain master’s degrees, which would allow them to work in independent practice roles. There are four distinct roles for nurses with advanced degrees, which includes nurse practitioners, nurse midwives, certified registered nurse anesthetists, and certified nurse specialists.
Another profession in high demand is for those who hold a Master’s Degree in Social Work. As patients face chronic conditions and search for affordable health care, they need help from someone who understands the social, spiritual, and physical needs of the sick. Patients seek help from social workers who can connect them to social services and community-based programs that might be able to fill in the affordability gaps left in red states.
Costs that Can’t Be Paid
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Your grandparents might be able to tell you stories about paying $10 a month for 20 years to pay off medical bills. However, in today’s contentious healthcare industry, providers and hospitals attempt to collect outstanding balances for a short period before sending your bill on to collections agencies. If your statement remains unpaid, you might find yourself listed on a lawsuit for medical bills. This has many Americans wondering if this is legal, to which the simple answer is, “yes.”
While this practice is typically reserved for sizeable debts, some families tell stories of being sued for as little as $60. Experts urge those who have been served papers detailing a lawsuit to not ignore the notice as failing to acknowledge the suit means that the debt collector wins by default.
As the healthcare affordability debate continues to wage on in the United States, every American must be aware of the issues. Our expanding homeless and low-income populations, continued growth in the number of people over the age of 65, and the increase of chronic conditions has put the healthcare industry in a position of uncertainty.
