States aren't doing enough to make healthcare more affordable for their residents, according to a report Tuesday from research and consulting organization Altarum.
Nearly every state has expanded healthcare coverage in recent years. But many haven't made inroads on healthcare affordability, even though voters on both sides of the aisle say that it's one of their top priorities.
There are several steps that states can take to lower out-of-pocket costs, cut down on low-value care and rein in excess prices, but many have left a lot on the table.
The report found that state policies to expand coverage and lower out-of-pocket costs were closely tied to lower healthcare affordability burdens like switching medication due to cost or trouble paying medical bills.
But the researchers found that even in the states with the lowest rates of affordability burden, a quarter of residents report that healthcare costs hurt them. Maryland, Massachusetts, New York, California, Connecticut and Washington, DC, had the lowest shares of residents hampered by healthcare expenses. In Mississippi, 57% of adults reported that healthcare costs were a major drag on their finances.
"The healthcare affordability state policy scorecard provides a call-to-action and road map for people and policymakers to strengthen efforts to address healthcare affordability," said Lynn Quincy, director of Altarum's Healthcare Value Hub.
The nation has been waiting for Washington to solve its healthcare affordability woes. But the issue has proven remarkably tricky, even when it seems like federal policymakers agree on what ought to be done about it. Per capita healthcare spending grew from 3.9% in 2017 to 4.6% in 2018.
States can help fill the policy void, but they need to focus more on issues like engaging stakeholders to reduce low-value care and taking steps to rein in healthcare prices, Altarum said.
Massachusetts and Maryland led the way on curbing low-value care, requiring validated patient safety reporting and stopping payments for so-called "never events". They also monitor low-value care through claims data and have hospital antibiotic stewardship programs to reduce low-value care like prescribing antibiotics for illnesses caused by viruses.
Just nine states have tried to lower healthcare prices, with Oregon leading the way. The state hammered down healthcare prices through efforts to increase price transparency, creating a permanent organization to oversee healthcare spending, establishing all-payer spending benchmarks and building out claims data for all payers.
Altarum's scorecard ranked states on their levels of uninsured residents, people delaying or going without needed care, known low-value care delivered by providers, and relative private-payer prices. It considered both policy actions taken by states and measured outcomes.
Massachusetts took the top spot overall, while Mississippi was last. Alabama, Hawaii, Montana, North Dakota, South Dakota, Vermont, West Virginia and Wyoming didn't receive an overall ranking because Altarum had incomplete data. New Jersey, New York and Colorado earned praise from Altarum because they've done the most to make out-of-pocket costs more affordable.