Washington Ignores Real Barriers to Latino Health

The latest push in Washington to lower healthcare costs is overlooking the needs of those with the most at stake: Latino patients.

Latino communities carry some of the highest rates of chronic disease in the country. Latino adults are more likely than U.S. adults overall to develop diabetes -- and significantly more likely to suffer its most dangerous complications, including kidney failure. They're more frequently diagnosed with liver disease and face elevated risks from several forms of cancer.

And too often, the health system fails Latino patients when it matters most -- with care delayed, denied, or disrupted. Insurers and other supply chain middlemen increasingly shape those experiences -- determining which treatments are accessible, when they are approved, and how much patients ultimately pay.

Confronting that reality should be the starting point for any serious reform effort. Instead, many of the "cost-saving" proposals gaining traction in Washington risk reinforcing the very access barriers Latino patients already face.

In the name of lowering drug costs, certain policymakers are advancing proposals that would tie Medicare reimbursement rates to prices set by foreign governments. Reducing U.S. drug prices is an admirable goal -- and healthcare affordability is top of mind for American patients. However, the approach is fundamentally misguided.

Many of the reference countries in these proposals rely on centralized health systems that use cost-effectiveness metrics to determine which treatments are worth covering. These metrics often disadvantage diverse populations -- undervaluing treatments that deliver real benefits to minority patients -- and delay or restrict access to newer therapies.

Importing those pricing models means importing their tradeoffs onto American patients -- without delivering on affordability.

These latest price-setting proposals won't meaningfully lower patients' out-of-pocket costs. Savings will largely route to the government, and patients' premiums and cost-sharing obligations could rise.

These proposals would, however, introduce new pressure points throughout the system -- with Latino patients among those hit hardest. When reimbursement is reduced, insurers respond by tightening controls over when and how treatments are used. Prior authorization and step therapy requirements become more rigid -- forcing patients to try and fail on older treatments or navigate lengthy approval processes before accessing the care their physicians originally prescribed.

Already, insurers in the Affordable Care Act marketplace deny around 20% of in-network claims and 33% of out-of-network claims, according to a recent analysis. Many approvals only come after appeals -- if patients persist that long. For Latino patients managing one or more chronic diseases, those delays translate into costly complications, hospitalizations, and deteriorating health.

Layering additional constraints onto our existing system would only make care harder to reach, especially for communities already navigating structural barriers.

And over time, those access challenges would compound. Policies that shrink reimbursement levels also weaken the incentives that drive sustained investment in new therapies. For conditions that disproportionately affect Latino communities -- obesity, diabetes, liver disease, certain cancers -- that means fewer future cures.

If policymakers are serious about delivering more affordable care, and better health outcomes, the solution isn't government price-setting -- it's removing the barriers insurers and middlemen have built into the system. Barriers that place unnecessary burdens on Latino patients.

Start with a crackdown on consolidation in the supply chain. When insurers, pharmacy benefit managers (PBMs), and hospitals all operate under one corporate roof, it creates "healthcare monopolies." These monopolies steer patients toward higher-cost or in-house options -- even when more affordable, higher-quality care is available elsewhere.

This concentration of power fuels the insurance practices that delay treatment and override medical judgment. Prior authorization requirements, step therapy protocols, and arbitrary coverage denials are often justified as cost-management tools -- but they create dangerous hurdles that lead many patients to abandon treatment altogether. Breaking up these conglomerates and restoring competition would expand choice, improve access, and put downward pressure on costs -- particularly for underserved communities.

Policymakers should also ensure that any cost savings secured from manufacturers actually reach patients. Today, steep rebates and discounts are negotiated behind the scenes and often retained by supply chain middlemen -- namely, insurers and PBMs -- instead of reducing what patients pay out of pocket for their medicines.

As a result, Medicare drug plans often pay vastly different prices for the same medicine. In 2024, one cancer drug cost about $3,600 in Illinois but more than $12,000 in central Pennsylvania -- a more than three-fold difference driven not by manufacturing costs, but by opaque negotiations among insurers and PBMs. Those inflated prices ultimately translate into higher out-of-pocket costs for seniors.

Reforms should increase transparency and require that these negotiated savings flow directly to patients.

The same logic applies to public health dollars. The federal government spends almost $2 trillion on health care annually, yet much of it's diverted from patient care. Between Medicare Advantage overpayments that fund luxury perks and offshore tax havens that pocket patient discounts, public funding has become a windfall for insurers' bottom lines. Congress must curb these abuses and make sure taxpayer dollars go toward the health of our communities.

Affordability is essential. But short-sighted policies that narrow access, delay treatment, or limit innovation ultimately fail the patients who can least afford those setbacks -- including Latino patients who already face disproportionate health burdens. Lawmakers can take a smarter approach -- one that lowers costs without restricting care.

Dr. Ray Serrano is the director of research & policy at the League of United Latin American Citizens.