Last month, the Washington, D.C., and Minneapolis-based non-profit United States of Care (USofCare) released its state legislative wrap-up report for 2024. USofCare’s analysis of the 2024 legislative sessions revealed three trends meant to address the healthcare affordability crisis: advanced policies that promote hospital accountability, protecting and expanding access to health coverage, and opportunities to innovate and improve healthcare affordability.
The report stated that legislators view growing hospital prices as the main driver of the affordability crisis. “State legislatures pursued bipartisan solutions to increase hospital accountability by limiting the ability of health systems and hospitals to consolidate, protecting people from the negative impacts of already consolidated systems, and enforcing requirements that certain hospitals give back to the communities they serve.” Red and purple state legislatures saw success with proposals to rein in hospital prices.
“Oregon’s Health Care Market Oversight program and the Massachusetts Health Policy Commission’s transaction review initiative served as models for other states to follow,” the report stated. Healthcare transaction oversight allows for review and approval conditions that examine the effect of transactions on consumers.
New York and Tennessee concentrated on solutions to protect people from consolidated health systems through contract clauses between health systems and insurance companies.
Sixteen states looked at legislations that regulate facility fees. According to the report, “Recent polling shows that 74% of voters support limiting or restricting facility fees, while 81% of voters support requiring that facility fees be disclosed to patients upfront before they are seen.”
Twenty-six states considered legislation regarding medical debt, including proposals to restrict wage garnishment, cap payment plans, and ban medical debt from credit reports.
The report mentioned that state legislatures expanded eligibility for current health coverage programs to reduce coverage gaps and protect coverage for critical healthcare.
According to the report, “to address the challenges that undocumented immigrants face, several states considered state-funded public insurance.”
Many states also sought to improve maternal health, reduce disparities, and improve coverage for pregnant people through Medicaid postpartum coverage extension. The report highlighted Arkansas as the only state not authorizing this extension.
The report stated that healthcare spending in the U.S. is projected to reach $4.9 trillion by 2024. “A number of state legislatures pursued policies to develop new low-cost health insurance coverage options to provide individuals and their families with dependable coverage. Additionally, state policymakers have explored reforms to make healthcare more affordable for their residents through solutions that protect people from surprise medical bills and medical debt, set cost growth targets, and increase prescription drug affordability.”
Some states created their own affordable coverage options. In Colorado, for example, 80,655 people were enrolled in the Colorado Public Health Insurance Option. Other states explored flexible policies, such as Medicaid buy-ins, to meet the needs of their residents.
According to the report, “Early results of Medicaid redetermination processes have sparked legislators’ interest in finding effective approaches to preserve health care access for the millions of individuals losing their Medicaid coverage while also addressing the needs of the remaining underinsured and uninsured populations.”
Vermont was mentioned in the report as an example of legislators considering a proposal for a public option for small businesses. Since small businesses are less likely to offer insurance coverage, a state-supported public option could help reduce coverage gaps and allow businessesF to expand their benefit packages.
The report stated that one in three adults reported the inability to afford prescribed medication. Many state legislators have implemented strategies to lower costs. Some have created prescription drug affordability boards, set price caps, or reformed pharmacy benefit manager (PBM) practices.
USofCare concluded that voters across party lines overwhelmingly support policies to curb hospital prices and implement transparency in healthcare billing. The non-profit expects policymakers to continue to push for equity-centered policies.
