Improve Health Care Affordability Monitoring in Your State



Healthcare costs in Massachusetts are increasingly becoming unaffordable despite measures to curb these rises. In a 2021 survey, 41% of Massachusetts residents reported challenges in affording healthcare in the previous 12 months, including over 50% of Black and Hispanic respondents. The Massachusetts Health Policy Commission is considering the establishment of an affordability benchmark to monitor consumer spending and ensure accountability in the healthcare system, although it is reportedly still in the early stages of developing such a benchmark.

Healthcare Affordability Crisis in Massachusetts

The soaring cost of healthcare in medical hub Massachusetts remains a significant issue. Though the state made strides in limiting overall expenditure, consumers didn’t always benefit from the savings. Therefore, the establishment of an affordability benchmark by the Massachusetts Health Policy Commission in collaboration with the legislature is crucial. This measure would hold the healthcare system accountable for consumers’ rising costs, controlling how much they pay for healthcare services.

High Health Care Costs

Massachusetts has grappled with high healthcare costs, with expenses often passed on to consumers through insurance premiums and copays. Nearly a third of residents reported going without needed healthcare due to cost, according to the 2024 annual report by the Center for Health Information and Analysis. A poll from Blue Cross Blue Shield of Massachusetts also revealed that 40% of respondents delayed care due to cost.

Increasing Insurance Cost

The high healthcare costs are reflected in the escalating cost of insurance. The average commercial health plan cost $595 per member per month in 2022, a 5.8% increase from the previous year. This figure doesn’t include out-of-pocket expenses for mental health care, for example. Both premiums and cost-sharing outpaced wage growth and inflation between 2020 and 2022.

Efforts to Contain Costs

Massachusetts was the first to establish a health care cost growth benchmark. This benchmark forces providers and insurers to testify publicly on how they are controlling costs. Also, providers failing to adhere to the benchmark must implement a performance improvement plan.

Need for an Affordability Benchmark

However, there is a need for a separate affordability benchmark. Capping healthcare costs does not always translate to limiting consumers’ expenses due to the complex nature of the healthcare system. A new measure monitoring spending by patients with commercial insurance would ensure better comprehension of consumer costs and accountability in the health care system.

Role of Accountability in Affordability

To be effective, the affordability benchmark should be paired with accountability. The challenge lies in creating a fair system to hold all components of the healthcare industry accountable. David Seltz, executive director of the Health Policy Commission, mentioned that they are in the early phases of developing an affordability benchmark and considering various accountability methods.

Learning from Other States

While no state has done exactly what Massachusetts plans, other states like Rhode Island, Connecticut, Vermont, and California have tackled healthcare affordability within broader cost containment efforts.

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