Defining Health Care Affordability to Improve Health Policy in CT
By Jill Zorn |
Universal Health Care Foundation of Connecticut is focused on achieving access to quality, affordable health care for everyone in our state. But what does that word “affordable” truly mean?
Here is one definition:
“Health care is affordable in Connecticut if a family can reliably secure it to maintain good health and treat illnesses and injuries when they occur without sacrificing the ability to meet all other basic needs including housing, food, transportation, child care, taxes and personal expenses or without sinking into debilitating debt.”
Or, another way of putting it is that if the cost of coverage and care is more expensive than your ability to pay, you have a health care affordability problem – you are skipping medication doses, avoiding care or “sinking into debilitating debt”.
Or, here is one simple equation that represents health care affordability:
ability to pay ≥ cost of coverage + cost of care
Cost of Health Insurance Coverage
In this country, unlike in most other advanced nations, the cost of your health coverage depends on who you work for – as some employers pay for more of the cost of health insurance premiums than others. Also, some employer health plans have higher out-of-pocket costs than others. Or you may get your coverage from Medicare or Connecticut’s Affordable Care Act (ACA) marketplace Access Health CT – each of which has a different cost structure for both premiums and out-of-pocket payments. Or, you may have a very low income or serious disability and have Medicaid coverage.
Cost of Care
But health care affordability also depends on how much care you need and how expensive that treatment is. Your health status is crucial – how well you are able to maintain your health, what chronic health conditions you have. But cost can even depend on where you live, because the prices for health care services are higher in some parts of the state than others and because some communities have higher rates of disease burden than others. And your health status is definitely tied to other demographic factors such as race, ethnicity and age.
Ability to Pay
The other side of the health care affordability equation is how much money you have on hand to cover the cost of coverage and care. Your ability to pay depends on several crucial factors, most importantly:
- Household income
- Household size and composition
- Other necessary expenses including food, housing and transportation
Connecticut Self-Sufficiency Standard
The Connecticut Self-Sufficiency Standard Report was just released that gets at the “ability to pay” part of the health care affordability equation. The report details how much income families require to afford their basic needs, including housing, child care, food and transportation.
Key findings are summarized here. Overall, 23% of families in Connecticut are living below the standard. But there is a lot of variation based on family size and composition, race and ethnicity, and location. For example, 15% of white families live below the self-sufficiency standard, while 39% of black families and 47% of Latinx families live below the standard.
The self-sufficiency standard uses actual data to determine costs, so it is a much more useful measure of the true cost of living in Connecticut than the outdated Federal Poverty Level standard. Even with fairly “bare bones” estimates of costs, “…the self-sufficiency standard shows that incomes well above the official federal poverty thresholds are nevertheless far below what is necessary to meet families’ basic needs”. It also allows for modeling based not only on family size, but on the age of children. That is necessary because child care for a pre-schooler is much more expensive than for a child who is already in school.
Health care expenses are included in the report. In fact, “While the self-sufficiency wage rose statewide by 31% between 2005 and 2019, the cost of health care rose by 77%. This tells us that health care is one of the main drivers in the increasing challenge to reach self-sufficiency.” But the information and modeling options in many cases underestimate the true cost of health care.
Health Care Affordability Standard for Connecticut
Given the central concern of health care affordability to policy makers, Connecticut’s Office of Health Strategy and Office of the State Comptroller are working together to develop a Health Care Affordability Standard for Connecticut, building upon the work already completed in the self-sufficiency standard report. It will be a modeling tool that will “…project the economic impact on households of varying health care costs including premiums, deductibles and co-pays. The modeling tool will calculate affordability based on different wages and family sizes in different regions in our state and will also take into account medical risk level and type of insurance coverage.”
The intention is that the health care affordability standard will help us dig deeper into the cost of care and coverage side of the equation mentioned above. Armed with that information, policy makers will be able to understand who faces the worst affordability challenges and what impacts proposed policy changes might have to alleviate those challenges.
Connecticut Self-Sufficiency Standard Reports and Publications: This site includes links to two reports, several fact sheets, detailed data and a PowerPoint presentation that summarizes the findings.
Two interactive tools allow you to see how different factors impact financial self-sufficiency in Connecticut
There is an established standard for housing affordability: 30 percent of household income. This metric is “based on the notion that, when spending on housing exceeds the 30 percent threshold, people don’t have enough money left over to pay for life’s other necessities.”