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Wednesday, August 26, 2015

To Tackle Health Disparities, Make Care More Affordable

Neah Morton

Wellstone Fellow

Yasmin Peled

Health Equity Intern

Communities of color face significant health disparities and are more likely to suffer from certain chronic conditions, like diabetes, where early detection and treatment could mean the difference between life and death. One way to improve the odds for people with these conditions is to increase access to services, like necessary medications or periodic medical tests, that prevent the progression of, or complications from, those diseases.

Unfortunately for many lower-income consumers with high-deductible health insurance plans, the out-of-pocket expense of this essential care is well beyond their financial reach, causing them to forgo care. Making care more affordable by reducing the costs consumers bear for these services could prevent costly complications and improve health outcomes across the board. 

Communities of color suffer disproportionately from certain chronic conditions

Compared to non-Hispanic whites, African Americans, Latinos, American Indian/Alaska Natives, and Asian Pacific Islanders are not only more likely to experience serious chronic conditions, like diabetes, hypertension, and asthma, they are also more likely to experience worse health outcomes from these conditions. In other words, they are more likely to get sick, and to get sicker.  For instance, in 2013, the rate of asthma prevalence in Puerto Rican children was 2.75 times the rate in white children, and for African American children it was 1.8 times higher.  Moreover, 2009 data indicates that the asthma death rate for African American children was triple that of white children.*

High cost-sharing is a barrier to preventing the progression and complications of many chronic conditions

Although chronic disease disparities in communities of color seem bleak, there is hope. For many chronic conditions—asthma, diabetes, and hypertension included—early detection followed by effective management can stop or delay the progression of these diseases (sometimes referred to as secondary preventive services).

Having health insurance can help enormously in making the services consumers need to manage their diseases more affordable.  However, the high level of cost-sharing required by some plans—particularly high deductibles —can sometimes pose an unsurmountable hurdle, causing as many as one in four adults to skip care. People with low to middle incomes (139-249 percent of poverty) are most likely to forgo health care due to cost. Given the lower average income levels in communities of color, high-deductible plans, with lower premiums that make them seem more affordable, are likely barriers to improving disparities for chronic conditions.  

While medication and treatments exist that make an enormous difference in helping people with chronic conditions manage their health, they can be costly. For example:

In many plans, people must pay the full cost of such services until they meet their deductibles. This is beyond the financial reach of many, especially people of color. When these services are unaffordable, people are more likely to delay or forgo this care, and end up sicker, according to a Robert Wood Johnson Foundation report.

Reducing financial barriers to obtaining access to these services will improve outcomes and reduce health disparities

There are two essential changes insurance plans can make to aid in combating health disparities:

  1. Invest in providing pre-deductible coverage of services that prevent the progression of and complications from chronic conditions, and 
  2. Charge no or nominal co-pays for these chronic disease management services.  

This “first dollar coverage” means that the patient could receive these services at low or no-cost without having to pay his or her deductible.  For example, Maine Community Health Options, a nonprofit insurer, established the Chronic Illness Support Program, which gives members access to services necessary to manage certain conditions, like asthma and diabetes, pre-deductible and at much lower cost-sharing.  

Eliminating financial barriers to care consumers need to halt the progression of, and complications from, manageable chronic diseases must be a priority for health equity advocates. Today, even as more people than ever have health insurance, a significant portion have plans with high deductibles, which nevertheless render needed care unaffordable. Advocates and decisionmakers must understand how these plans may exacerbate health disparities and should work with insurers to develop coverage alternatives that bring these life-saving services within everyone’s reach. 

*Note: Recent data on asthma mortality for Puerto Rican children is unavailable.

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