Cut consumer health care costs in California

Health care was a top concern for consumers leading into the mid-term elections. Consumers in California and across the country are facing higher bills, less transparency, bureaucratic nightmares and, of greatest concern, less comprehensive care and are understandably angry and confused.

Fortunately, lawmakers are paying attention. As Congress got back to work after the government shutdown, key committees held hearings on lowering health care costs, ensuring access to care and increasing transparency while we heard a similar call in the State of the Union address. Something needs to change and lawmakers have an opportunity to reach across the aisle and act.

Recent surveys from Ipsos on behalf of Consumers for Quality Care found that Americans are deeply frustrated by unpredictable costs and the lack of transparency in health care. They struggle with predicting how much they will have to pay for health care when they need it. They fear health care costs even more than they worry about costs associated with retirement, college, housing or child care and they want more clarity to avoid getting hit with surprise bills and shocking fees.

According to survey respondents, the most frustrating aspects of the health care system for Californians are insurance costs like premiums, copays and deductibles (68 percent), hospital fees and unexpected bills (63 percent), and insurance networks that are too narrow, covering too few doctors and specialists (56 percent).

Unfortunately, there are too many areas where health care policies are increasing consumers’ out-of-pocket costs, while increasing health care industry earnings. One good example of this is after-the-fact emergency department denials. Some insurers are instituting policies that would force policy-holders to pay for an emergency room visit if the insurer later deems it a non-emergency. Patients are essentially being asked to self-diagnose. As a result, many patients will likely delay or go without emergency care rather than risk being unexpectedly required to pay emergency department costs out-of-pocket.

This isn’t just a problem in the emergency department, however. Hospital care more broadly is the largest single component of total personal health care spending in the U.S., and the latest National Health Expenditure (NHE) data shows health care expenditures grew by 3.9 percent in 2017. Surprise bills, billing errors and vast swings in average prices for similar tests and procedures are pushing patients into severe financial stress and requiring countless hours on the phone between the bureaucracies of hospital administrators, care providers and insurers. A recent federal policy recognizes the opacity in hospital prices and requires hospitals across the country to publish their pricing lists online. Unfortunately, in most cases, the actual lists are hard to find, and the services are either vague or coded in a way that isn’t likely to provide consumers with any useful information about what they can expect to pay. Greater clarity in hospital pricing is essential.

And consumer frustration is not limited to within the hospital walls. At the pharmacy counter, practices like restricting pharmacists from informing customers that a lower price might be available by not using insurance and changes to health coverage in which insurers no longer allow drug copay coupons to count towards patients’ deductibles mean consumers continue to be caught in the middle of industry disputes about price and transparency.

As our leaders come together to discuss consumer access to affordable health care, it’s time to do right by patients. A broad, bipartisan majority of voters across the United States (77 percent) believed that policymakers are focusing on the wrong things to improve health care in 2018. They want a new approach from politicians – not just in Washington, but also in states – to tackle costs and ensure greater clarity in the system. That means shining a light on and reforming policies that strain consumers’ pocketbooks while padding the bottom lines of the health care industry.

The goal sounds simple: higher-quality, lower-cost health care. After years of fights, we know it is not as easy to achieve as it sounds. But today, as in past years, a better health care system remains a priority in California. Lawmakers and the health care industry should take heed.

The Honorable Donna M. Christensen is a member of the Consumers for Quality Care Board. She retired from the U.S. House of Representatives in 2015 where she served nine terms. She is the first female physician to serve as a Member in the history of the U.S. Congress.

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