Anecdotally, we know that Pennsylvanians are struggling with rising health-care costs, but until recently, Pennsylvania lacked the data to describe that struggle. It became clear that the problem is both widespread and serious, according to the first-ever Pennsylvania-specific survey on health-care affordability.
The survey — conducted by Altarum’s Healthcare Value Hub with support from the Robert Wood Johnson Foundation in late 2018 — showed that one in two Pennsylvania adults struggled to afford health care in the last year and four in five are worried about affording health care in the future.
According to the survey, struggling to afford health care took many forms, including being uninsured because of high premium costs, delaying or forgoing care due to cost, and struggling to pay medical bills. The survey also showed a concerning trend: Pennsylvanians are coping by making decisions that don’t align with their doctors’ recommendations and may jeopardize their health, such as delaying care (29 percent), avoiding getting care altogether (21 percent), skipping a test or treatment (24 percent), failing to fill a prescription (19 percent), or cutting pills in half or skipping doses (17 percent).
When they do get care or treatment, nearly one-third of Pennsylvanians struggled to pay those bills. As a result, they are being referred to collections; using up all or most of their savings; skipping payments on basic necessities such as food, heat, or housing; or racking up debt.
In particular, Pennsylvanians pointed to the rising cost of prescription drugs as being a pressing problem. A full two in three Pennsylvanians say they are worried about the cost of prescription drugs, and 76 percent pointed to drug companies as a “major reason” for high health care costs.
This is supported by other data that show that prescription drugs are one of the key drivers of high health-care costs. Nationally, the cost of prescription drugs has risen by 30 percent since 2010, with the most common brand-name drugs outpacing inflation, on average, by nearly eight-fold and with double-digit increases between 2012 and 2016.
Other data show that certain populations – including medically vulnerable and older Pennsylvanians – are particularly hard hit by soaring drug prices. According to a recent AARP report, the average older Pennsylvanian takes four to five brand-name prescription drugs regularly. The average annual retail cost of these drugs exceeds the average senior’s median income by 20 percent, meaning that some seniors, even those who have insurance, have to choose between medications and such basic necessities as food, heat, or housing, or work past retirement just to afford their prescriptions.
The harm of high prescription drug costs isn’t limited to those who take multiple prescription drugs regularly. Even healthy people are paying more for health care because of the high and rising cost of prescription drugs because they represent a large share of premiums. For Pennsylvanians insured through the individual marketplace, for example, prescription drugs represented one in five of every health care dollar spent in 2015, up 50 percent from the previous year.
Across party lines, Pennsylvanians want relief from the high cost of health care. More than three in four Republicans, Democrats, Independents, and non-affiliated Pennsylvanians alike said the health-care system needs to change. Four in five support a variety of government actions to curtail unfair prescription drug pricing and unreasonable price hikes, along with advanced notice provisions, higher transparency, and standards for making drugs more affordable. Other changes endorsed by respondents included making it easier to switch insurers if a health plan drops your doctor (93 percent), showing what a fair price would be for specific procedures (92 percent), and requiring insurers to provide up-front cost estimates to consumers (91 percent).
It is time for Pennsylvania lawmakers to turn their attention to policy solutions that will make health care more affordable in our state; Pennsylvanians can’t wait any longer.
Antoinette Kraus is director of the Pennsylvania Health Access Network, the state’s largest statewide health coalition, and is a member of the Inquirer’s Health Advisory Panel.