In March, a federal judge struck down the mandate for employers to provide health insurance coverage for certain preventive services under the Affordable Care Act without cost-sharing. While employers will be watching closely as the the decision is likely appealed and moves through the courts, self-insured employer plans could soon start charging patients to utilize those specified services or even drop coverage completely.
This is just one recent demonstration of the significant implications of federal, state, and local policymaking for the affordability of health care.
It is well-known that high out-of-pocket costs for health care services are a persistent challenge in the U.S. health care system and serve as a barrier to health care utilization, with patients often delaying or foregoing needed care due to prohibitive out-of-pocket costs. Given structural racism, policies governing coverage and payment disproportionately affect affordability of care for marginalized communities who already face systemic and persistent barriers to good health.
As a result, it is important to understand the impact of public policies on the affordability of care and to assess how they might be made more equitable in the future.
New Grants Will Inform Policymaking to Advance Equity in Affordability of Care
With support from the Robert Wood Johnson Foundation, AcademyHealth manages a number of research programs to assess the impact of policy decisions and proactively inform future policymaking to better align the health care system toward the goals of healthier families and communities. Since 2017, RWJF has funded research to help policymakers, health care practitioners, advocates, and others understand the impact of such policy changes under the Research in Transforming Health and Healthcare Systems (RTHS) program, managed by AcademyHealth.
The RTHS program over the last few years has increasingly focused on advancing racial equity and prioritizing the perspectives of those directly affected by policies studied, reflecting AcademyHealth and RWJF’s shared belief in elevating the voices of patients and communities in health care and policy decision-making. One of the most pressing concerns patients have raised is how their inability to afford care leads to missed diagnoses, delayed treatment, and financial crisis.
Together with RWJF, we are announcing four new grants under our RTHS program that will examine policies at the national and state levels and the implications of these policies on affordability and health equity. These studies are led or co-led by people from the communities most affected by the study topic who know best what gaps exist in their ability to afford the care they need for optimal health and well-being and are therefore best positioned to inform policy recommendations based on the study findings.
Two of the awarded grants respond to national policy decisions, while two examine the impact of new state programs.
One grant, led by Elizabeth Janiak and colleagues at the Planned Parenthood League of Massachusetts, will examine the 2022 U.S. Supreme Court decision in Dobbs v Jackson Women’s Health Organization’s impact on youth and subsequent state actions taken to curtail access to abortion. The study will quantify the monetary cost of abortion care and related interstate travel for youth with intersecting marginalized identities using a mixed methods approach, in order to inform the design of policymaker and health care provider supports for this population.
Rochelle Ruffer and Tyler Scribner of the National Indian Health Board, in partnership with Mathematica, will direct a study to create an estimate for fully funding the Indian Health Service (IHS) to inform how to improve affordability and access to high-quality IHS-funded health care to achieve health equity for American Indian and Alaska Native people. Strategic recommendations to the federal government will be driven by members of Tribal nations, who will collaborate with researchers on data analysis and interpretation.
Shifting to a state focus, Irene Su from the University of California, San Diego, and Helen Palomino of the Cancer Center of the Desert will co-lead a project to evaluate the impact of a new statewide health insurance benefit mandate for the provision of fertility preservation services to pediatric, adolescent, and young adult Hispanic/Latino cancer patients. The study will assess the impact of the mandate on disparities in patient experience and affordability of such services and identify best practices for implementation.
The fourth grant, led by Jessica Galarraga of MedStar Health Research Institute, and Andrea Williams-Muhammad of the Nzuri Malkia Birth Cooperative & Family Wellness Center, will assess the impact of the newly implemented Maryland Medicaid Doula Program on the affordability of doula care for Black birthing parents and infants. Informed by community members via an advisory board and community forums, the mixed methods study will analyze out-of-pocket costs for doula services among Medicaid-insured birthing parents; document the experiences of birthing parents, doulas, and policy and practice leaders with the program; and analyze how the doula benefit affects racial perinatal health disparities.
Together with RWJF, AcademyHealth will support grantees as they conduct their research and share findings as soon as they are available, as we have done for prior studies about health care affordability and access and Medicaid program innovation supported by the RTHS program.