‘Tis the season for health insurance. Open enrollment for Medicare, employer-sponsored insurance, and Pennie plans are in full swing. Plans are plentiful and highly subsidized.
On Pennie, Pennsylvania’s health insurance exchange, a 27-year-old in Pittsburgh with an income of $40,000 can get a bronze plan for $64 a month—after $137 a month in subsidies. That’s right: Taxpayers pay twice what the individual pays for insurance.
Of course, that same individual still faces a hefty $6,700 deductible. So, while getting insurance is relatively cheap, using it can be expensive.
A recent analysis of the Congressional Budget Office’s report on federal health insurance subsidies estimates all but 1 percent of the U.S. population has access to affordable insurance.
However, despite this high level of access, polls show dissatisfaction with our health care system and individuals delaying needed care. A recent Pennsylvania poll found 57 percent of Pennsylvanians say they have delayed care due to costs.
How can both statements—accessible insurance and inaccessible care—be true? It’s simple: Access to insurance is not synonymous with access to care.
In our health care system, the customer isn’t just the patient; it’s all the entities paying the bill. Often, that “person” is the insurance company, a human resources department, or—increasingly—a nameless government bureaucrat divorced from an individual’s specific health care needs.
Factor in the reams of red tape adding tens of billions to the cost of delivering health care, and you get today’s complex system. In this tangled web, we call American health care, it is relatively easy to get an insurance card, but accessing personalized care is expensive, time-consuming, and frustrating.
Despite their frustrations, most people don’t want a complete overhaul. In a June poll by America’s Health Future, 65 percent of national voters wanted to keep the current system but improve it.
The good news is we can do that. We can make it easier to access health care. We can create more personalized care by removing government regulations that limit competition between plans and access to providers within plans. Rather than continue down the path of public options (e.g., Medicare for All), we can strengthen the personal option—an abundant marketplace of affordable services that benefits patients and practitioners, not bureaucracy—through simple, commonsense reforms.
It starts with allowing Association Health Plans (AHPs), which enable companies to pool funds and reduce the cost of offering quality employee health insurance.
Pennsylvania regulations essentially prohibit AHPs, but legislation can change that so more small business workers have access to employer plans.
Thirty states already allow AHPs. And despite fears that they would skimp on health benefits (a fear articulated by Gov. Josh Shapiro in 2019, as the then-attorney general), AHPs established since the passage of the Affordable Care Act provide all essential health benefits. In fact, AHP legislation in the Pennsylvania House, House Bill 555, requires protections for essential benefits. That means these plans cover everything a Pennie plan covers, like preventative care, emergency care, prescriptions, and more.
AHPs have provided affordable and high-quality coverage to millions of Americans, with savings of up to 29 percent on average, according to the Foundation for Government Accountability.
Our commonwealth also maintains some of the strictest regulations on the scope of medical practice, limiting how and where providers, such as nurse practitioners (NPs) and pharmacists, can practice.
Slashing these restrictions would benefit practitioners and, moreover, patients.
Fortunately, current legislation proposes such reforms. Senate Bill 25 removes costly collaboration agreements, allowing NPs to serve more patients. This policy change will benefit those needing affordable care because NPs are more likely to serve rural and underserved areas.
Similarly, several states allow pharmacists to administer common childhood vaccines and diagnose and prescribe for basic ailments—even, as in Idaho’s case, help with diabetes. Imagine stopping at your local grocery store for a loaf of bread, eggs, and a proper ear infection diagnosis and medication for your child.
These reforms are just a few ways Harrisburg can begin to unravel the health care bureaucracy that makes using your insurance so daunting and cumbersome. If we truly value health care, we should do everything possible to make it as accessible and convenient as possible.
Elizabeth Stelle is Director of Policy Analysis of the Commonwealth Foundation, Pennsylvania’s free-market think tank. X: @ElizabethBryan
