By Mary Lynne Courtney, LWVWA Behavioral Health Issue Chair
What are the critical challenges facing healthcare in the U.S. today?
Most commonly, cost and accessibility are cited. However, related to, and contributing to, these problems are an increasing shortage of healthcare providers, health disparities among groups, an aging population, and the complexity of the healthcare system (in-network restrictions, prior authorizations, drug formularies, lack of interconnectivity of healthcare records).
Costs are rising for everyone: the cost to individuals (insurance premiums, deductibles, copays, drugs); employers providing health insurance for their employees; government programs (such as Medicaid, Medicare, the VA system, and Tricare); and the organizations providing healthcare services (hospitals, pharmacies, and providers). According to the Kaiser Family Foundation (KFF), in 2022, half of adults said that it was difficult to afford healthcare costs. This was particularly burdensome for Black and Hispanic adults, persons with lower incomes, and those without insurance.
Even persons with insurance struggle with costs. They may be underinsured, that is, someone whose medical costs, excluding premiums, exceed 10% of their income. Persons covered by insurance purchased on the public market are the most likely to be underinsured; however, even those with insurance from their employers may be underinsured. Since 2010, it is the latter group that has fueled the growth in the underinsured.
In spite of the high cost of healthcare in the U.S. (nearly18 percent of GDP), The Commonwealth Fund reported that Americans die younger and are less healthy than residents of other high-income countries.
High costs impact accessibility to healthcare, which in turn negatively impacts an individual’s health. A KFF survey in March 2022, found that 43% of adults said that they or someone in their household put off or postponed needed healthcare due to cost. Twenty-five percent said that they had not filled a prescription, cut pills in half, or skipped doses of a medicine due to cost. Location as is a factor in accessibility.
According to a National Institutes of Health (NIH) 2022 report, almost 63% of counties in the United States have been designated as primary healthcare professional shortage areas. Disproportionately more rural counties have received this designation.
What is the League position on healthcare?
The LWVWA Program in Action states that the League supports action “to control total system expenditures and to provide universal access to affordable health services with seamless coverage regardless of one's health status.”
What is the Washington State Legislature doing to address these problems?
Last year, the Legislature passed several bills that address expanding the healthcare and behavioral health workforce, establishing minimum staffing standards for nurses in hospitals, extending telemedicine authorization, increasing payments to hospitals for certain Medicaid patients, establishing the profession of dental therapy, requiring insurance coverage for hearing aids, and legislation addressing crisis response and suicide prevention. Workforce issues and access to healthcare and behavioral healthcare will continue to be addressed in the upcoming session.
Generally, legislation has addressed particular issues in healthcare, but important as these issues are, the legislature has not addressed the problem wholistically. An exception would be SJM 8006, which the League supports, a bill requesting that the Federal Government create a Universal Health Care Program and, if not, then issue waivers for the states to do so. In addition, the Washington State Universal Healthcare Commission created by SB 5399 in 2021, is looking at the entire healthcare system in the state, attempting to identify how Washington State might provide healthcare to all its residents. Its 2023 report to the Legislature, issued on November 1, states, “In the short-term, Washington is limited in both its ability to recoup federal funding to support a unified financing system, and to regulate coverage sources subject to or preempted by federal law. However, paths to achieving benefits parity in the short-term for Washingtonians eligible for Medicare, ERISA, and Medicaid have surfaced and will be examined further.”
So, we have much work to do to achieve a health care system that sufficiently addresses the coverage and cost issues that are so problematic for many people in Washington.
