Blog

Health care continues to be a leading concern for voters in this year’s election and with good reason. Whether it’s premiums, deductibles, prescriptions or other out-of-pocket costs, the price of healthcare continues to rise, putting even basic access out of reach for millions and creating barriers to better health even among people who have coverage. 

When it comes to healthcare, a new report from the Commonwealth Fund confirms what many health advocates and patients already know: Americans pay too much for healthcare and, all too often, that spending more doesn’t make us healthier. 

The Commonwealth Fund compared 10 countries’ health care systems based on criteria like access to care, care process, administrative efficiency, equity, and health outcomes. Their report, Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System found that the United States underperformed on most measures, coming in last on access to care and healthcare outcomes. 

Access to care is measured in terms of affordability and availability. Other countries that outperformed the US in the Commonwealth study offer universal coverage with low costs and few out-of-pocket payment requirements like those Americans face. While the US has made tremendous progress on reducing the number of uninsured people and on improving the quality of coverage, 26 million people are still uninsured, forced to pay the full cost of care out of pocket. 

Moreover, being covered by insurance in the United States doesn’t guarantee affordability. A significant share of the insured population still struggles to afford care because of high deductibles, co-pays and other cost-sharing. Previous research from Commonwealth shows that 43% of people with employer coverage, 45% with Medicaid, 51% with Medicare, and 57% with an ACA (Affordable Care Act) plan have trouble affording care despite their coverage. Around 15 million Americans have medical debt from one or more unpaid medical bill. 

High costs in the Unites States are driven by factors like corporate profits, rampant price-gouging from unregulated industries like the pharmaceutical manufacturers, administrative complexity, and waste. These features of the health system curtail access to care, resulting in worse health outcomes than other countries where care is more accessible because it’s much more affordable. Meanwhile in the United State, patients—even those with coverage—skip medical tests, treatments, or follow-up visits, and avoid filling prescriptions because they can’t afford them. 

In some cases, patients also can’t access care because of the shortage of providers in many areas. People that live in rural areas or provider desserts must travel long distances at significant expense to access healthcare. The report notes that U.S. patients are more likely than patients in other countries to say they don’t have a regular doctor or place of care and have limited options for getting treatment after regular office hours. Research shows that continuity of care is associated with lower mortality, more consistent prevention and improved health outcomes. The recent COVID crisis both exposed the extent of the direct care staffing shortage in the United States and worsened matters by putting incredible physical and mental health strain on workers, many of whom left the field or are still struggling to recover. Employment across the health care sector remains below pre-pandemic trends, per KFF. A massive deficit in doctors, nurses and direct care workers is forecast even as demand for staff increases. The aging of the American population is creating dire need for many more care workers, as is the exploding mental health crisis, and escalating rates of chronic disease. All these factors will contribute to access and ultimately, to health outcomes and mortality rates for Americans in the future. 

Life expectancy in the United States is declining for the first time in history. According to the report, life expectancy here is more than 4 years below the average in other countries. High rates of gun-related deaths, overdose deaths, and preventable and treatable deaths contribute to shorter lives. 

The Commonwealth report reveals that when Americans can access care, the treatments they receive are high-quality. The United States is a top performer on care process factors like prevention of disease and patient safety.  For instance, there has been successful reduction in adverse events during hospital stays for heart attacks, pneumonias, and major surgery between 2010 and 2019. While more delivery system reform is needed to keep improving quality, there’s at least a good foundation and progress to build upon. 

To improve affordability and quality of coverage as well as address some of the socioeconomic and political factors that contribute to poor outcomes will require complex solutions.  Reforms in Congress that can curtail the monopoly power of insurance and drug corporations, investment in Medicaid, Medicare and public health infrastructure and meaningful efforts to recruit, train, support and retain an army of health care workers to meet the growing need for services and treatment must be prioritized. 

The outcome of the 2024 elections will either create increased opportunity for these kinds of changes or will continue the United States on a path of underperformance. In either case, there will be real health consequences for millions of Americans and generations to come.

President Biden and lawmakers in Congress have made tremendous strides in increasing access to healthcare–both by expanding coverage and by lowering the cost of services like prescription drugs in Medicare. These are fantastic steps that stand in contrast to Republican efforts to repeal or water down coverage, cut Medicare and Medicaid, and loosen up regulations so that insurance corporations can offer more high-cost “junk” plans. 

But it’s not enough. Millions of people who have coverage, whether through their employers or through the Affordable Care Act, can’t afford to use it because of too high out-of-pocket costs that deter people from getting care, drive households into debt, or force families to choose between their healthcare and other routine expenses like housing and groceries. 

Insurance coverage is critical for improving health, but it can only work if people can afford the premiums and the out-of-pocket costs. And both are rising.

The Affordable Care Act (ACA) that HCAN and many other allied groups helped pass in 2010 has survived dozens of political, legislative and legal attacks to now reach record enrollment and majority support from the public. Bigger tax credits over the last two years have reduced premiums for middle-class families saving them an average of $800 annually.  The law also continues to provide critical consumer protections for people with all kinds of insurance by stopping discrimination against pre-existing conditions, ending gender discrimination, eliminating caps and limits on coverage, and many others. The ACA has both expanded coverage and improved the quality of coverage for hundreds of millions Americans. 

But affordable premiums for insurance coverage are just the first step in accessing healthcare. Actually using the coverage when you are sick to pay for services that are beyond preventive care often proves more challenging. Deductibles, co-pays, and other out-of-pocket “cost-sharing” expenses may render coverage moot when patients can’t afford their share of the cost or when they have to shell out thousands before their insurance plan starts to pay for treatment. 

For example, deductibles, the amount a patient must pay toward the cost of in-network covered services before the insurance plan will start paying, have risen substantially from 2014 to 2024 in ACA plans with combined medical and prescription drug deductibles. 

The problem isn’t exclusive to the ACA: millions with employer sponsored plans are also facing increased deductibles as well as skyrocketing premiums. The number of employer plans that require patients to pay a deductible is rising as the number of employers offering high deductive plans grows.

High Deductible Health Plans (HDHPs) typically have reduced premiums but leave people at greater risk of being underinsured and at increased risk for medical debt.  In fact, these plans are intended to reduce overall usage of health care by increasing the burden on patients.

While people with ACA premiums are getting more affordable coverage because of President Biden’s commitment to increased premium assistance, the overall cost of healthcare continues to rise and the more generous premium assistance isn’t permanent.  The average cost of workplace health insurance premiums for family coverage reached nearly $24,000  in 2023, jumping 7.0% from 2022, according to KFF’s latest survey of employer-sponsored coverage. These increases are outpacing wage growth: while premiums for family coverage rose 7.0% in 2023, wages grew about 5.2% and inflation rose 5.8%.  Costs for employer coverage are expected to increase 6.5% for 2024. Affordable Care Act coverage will increase by around 6.0% in 2024. These increases are the largest in a decade.

Health insurance companies made record profits during the pandemic because many fewer people used their healthcare plans, resulting in fewer claims to pay. But big profits continue as the pandemic has receded. In 2023, the seven big for-profit health insurers alone made more than $40 billion in profits on revenues in just the first six months of the year. Profits were up 8.1% compared to the year before. Given the soaring premiums in 2024, we can expect to see similar profits this year even as medical debt continues to soar and families struggle to afford the basics. 

The anxiety that millions of Americans feel about the state of the economy despite low unemployment and improvements in inflation is no mystery: affordable healthcare is a constant worry in a system where profit trumps affordability or health outcomes. That’s why more action is needed to increase competition among insurers, reduce premium and out-of-pocket costs, and also to reduce drug prices, which is a key driver of overall health care costs. 

In recent years, the United States has made huge strides in healthcare access. Not only is the  rate of uninsured people lower than ever before thanks partially to record Affordable Care Act enrollment, but recent reforms aimed at lowering prescription drug costs by taking on Big Pharma price-gouging in Medicare will continue to improve affordability for seniors and people with disabilities who often struggle the most with health costs. 

But despite expansions in coverage and some progress on lowering costs, a new study from the Commonwealth Fund confirms that far too many Americans are still struggling to afford healthcare in today’s economy despite having insurance, which is supposed to make health care accessible. Over half of people with Medicare coverage struggle to afford it as do over half of people with ACA marketplace or individual coverage. Nearly half–45%–of people in Medicaid say healthcare is difficult to afford and even 43% of people with employer sponsored coverage say the same. Naturally, for the nation’s remaining uninsured population, things are even worse.

A key factor in the affordability problem is rising premiums. A new KFF report shows that the average cost of workplace health insurance premiums for family coverage reached nearly $24,000 this year, a 7% jump from 2022. Meanwhile, wages grew about on average 5.2% and inflation rose 5.8% last year. Plus, the cost of everything else including housing and groceries is also rising. Given these conditions, it’s easy to see why “Bidenomics” isn’t hitting home for many voters.

Currently, 2 in 5 patients report delaying getting care or skipping it all together because of affordability concerns including incurring medical debt. Nearly a third of adults reported having medical or dental debt, and nearly half of them said it’s at least $2,000. That’s a significant sum for seniors in Medicare on a fixed income or for low-wage working families. Currently, Medicare doesn’t cover dental, vision, or hearing and many private insurance policies also omit coverage for these services as well as for comprehensive mental health treatment. 

Clearly, there’s more work to be done to put healthcare in reach even for people who now have coverage and much more to do for people without coverage. The number of uninsured people is also rising because of the end of Medicaid coverage following the Public Health Emergency connected to covid. In the last year, over 10 million people have lost Medicaid coverage. Some of these people will be able to get insurance during the current ACA open enrollment period and some will not be able to afford coverage, even with improved affordability on the ACA exchanges. 

Without more progress reining in corporate price-gouging to reduce profits in healthcare, there’s little hope when it comes to bringing down costs for consumers. Policy-makers at every level should make this a top priority. It’s not just essential to the economic stability of families, it’s also politically popular.  

Lowering drug prices is the tip of the spear for reining in healthcare costs more broadly given that prescription drug price gouging drives increases in premiums and contributes to medical debt. A recent poll from Hart Research showed that 96% of Americans agree that lowering drug prices and the cost of prescriptions is an important way to help people afford the cost of living and nearly three-quarters of Americans favor Biden and Democrats in Congress passing Medicare negotiations. 

Appetite for lowering drug prices isn’t limited to Medicare enrollees: 7-in -10 voting age adults in the U.S. support lowering drug prices. Regardless of political affiliation, Americans want their lawmakers to lower drug prices and take on Big Pharma greed.  That’s why Democrats in Congress are forging forward to build on the success of the Inflation Reduction Act. New Jersey Congressman Frank Pallone, a key architect of the original reforms that were included in the IRA has already filed a bill to expand negotiations, the insulin cap and accountability for drug corporation price gouging in the 118th Congress. If passed, that bill could lower costs for millions more people in Medicare and for hundreds of millions with private coverage.

Pallone’s leadership stands in stark contrast to some of his colleagues in the US House of Representatives who are actively trying to repeal the modest reforms in the existing law just one year after its passage. Led by Tennessee Republican Andrew Ogles, 23 GOP Members of the House are pushing a bill to repeal the law as their allies in Big Pharma file lawsuits to overturn Medicare negotiations. Johnson & Johnson, Astellas, Bristol Myers Squibb, and Merck joined the U.S. Chamber of Commerce and industry lobby group PhRMA to stop Medicare negotiations. Plus, GOP House Speaker Mike Johnson just hired former Pharma lobbyist Dan Ziegler, a former lobbyist for the drug corporations as his Policy Director. 

Americans need healthcare they can depend on, but despite progress, we’re not there yet. The time is now for lawmakers to address what every poll is telling them: it’s time to lower profits, rein in price-gouging, and make healthcare truly affordable in our country.

There are over 1.5 million Americans in long-term care nursing facilities today. That number is projected to grow as the elderly population explodes over the coming two decades. In fact, people 65 and older are the fastest growing age segment in the United States population, yet despite the coming tidal wave of aging people, there is very little attention paid to how the nation will provide for the increased demand for health and personal care services. 

Whether an aging person receives services in their home or in a long-term care facility, the care provided should be high quality, meet the individual’s needs, and enhance their quality of life. But all too often, we fail to meet this standard despite billions of dollars of investment that both tap public resources and deplete people’s lifetime savings and assets.

As we saw during the most intense periods of the COVID pandemic, the crisis is acute in nursing homes and long-term facilitated where more than 200,000 nursing home residents and workers died—around one-fifth of all COVID-19 deaths in the United States—because of short-staffing, poor protocol, and lack of attention to the real time needs of the residents. The phenomenon of short-staffing in nursing facilities didn’t start with COVID, but the tremendous loss of life during the pandemic put a spotlight on problems with the lack of oversight, accountability and consistent standards that characterize this sector. 

Despite the fact that the nursing home industry receives nearly $100 billion from American taxpayers every year, far too many facilities continue to provide substandard care. During this year’s State of the Union address, President Biden committed to improving the quality of long-term care in nursing homes with federal minimum staffing requirements, increased oversight and enforcement, and expanded workforce initiatives to recruit and retain staff. These improvements would offer much needed support for health care workers, improved care for residents and better protection for both. 

The Department of Health and Human Services (HHS) recently proposed new regulations that would take a critical step in finally addressing the needs of nursing home residents and their families. These new regulations would create a federal floor for staffing, ensuring that nursing home owners could no longer slash staffing to unsafe levels. The proposal would also require every facility to have a registered nurse on site 24/7, to have a minimum number of registered nurses and nurse aides to help provide routine care, and to staff according to patient needs based on a robust assessment of the facility’s residents. These proposals don’t go nearly far enough, but given that currently no minimum standard exists and that nursing home operators answer to no one on staffing, it would be a huge improvement and lay the foundation for even more.

Under the new HHS rules, residents would receive a minimum of 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day, exceeding existing standards in nearly all states. According to the Centers for Medicare & Medicaid Services (CMS), 75% of nursing home facilities would need to hire more nurses and nurse aides to meet even this very modest requirement. Additional analysis from KFF Health News indicates that number could be even higher, over 80%.

These new rules are long overdue. Not only does short staffing hurt patients, it increases the risk of injury for workers and drives more and more people out of care-giving professions. Providing care to elderly patients or people with disabilities who have mobility challenges, chronic disease, cognitive decline, dementia, or other common conditions requires patience, skill and physical dexterity. Workers should be fairly compensated, have safe working conditions and basic protections, including whistle-blower protections that also help patients. 

The for-profit nursing home industry vociferously opposes these minimum staffing standards, insisting there’s no way to meet them. But the reality is that the non-profit nursing home industry is, on average, providing staffing that already exceeds CMS proposed staffing levels. This raises the question of whether for-profit nursing homes could, in fact, meet the new standard if they spent more money on staffing and less on profits. 

Right now, any member of the public has an opportunity to weigh in on this debate because CMS is accepting comments on the proposed rules until the November 6th deadline. Anyone–residents in nursing homes, health care workers, family members, concerned advocates, service providers can submit a comment that describes why they support this important first step. Remember that once a comment is submitted, it will become part of the public record. 

Currently, the nursing home industry is weighing in very heavily against the proposed rules in an effort to protect the current status quo where nursing homes don’t have to meet any staffing standard. It’s up to all of us to keep fighting for better care and urge HHS and CMS to forge forward on the new rule.