You know health care is top of mind when the Wall Street Journal publishes a multiple choice questionnaire about health care costs. My staff and I recently took the WSJ quiz and we did pretty well (thanks to our last All-Alliance event, we all knew how much debt medical students have), but we were surprised by some of the answers. For example:

• roughly 1% of the members with employer-sponsored health insurance account for about 20% of the group’s spending;
• the average cost of employer-based health insurance for a family last year was $19,616;
• cost is the reason 50% of Americans delayed needed health care over a 12-month period;
• the average cost of an average ER visit was $1,389 in 2017, a 176% increase over the preceding decade;
• prescription drugs accounted for a 69% increase in spending from 2000 to 2016 and beat out hospital care and physician and clinical services for the care with the highest increase;
• the median level of debt for medical students is $200,000;
• our per capita health care spending is about double what Canada pays;
• in the US, federal, state, and local governments pay for about 45% of health care; and
• 90% of Americans have health insurance.

I’d like to spend some time on that last one. While it sounds great that only 10% of Americans are without insurance (thanks largely to the changes on insurance enrollment made possible by the Affordable Care Act), if you look closer at this data, you find a very different story.

A recent survey by The Commonwealth Fund found that while insured, 45% of US adults between 19 and 64 are actually underinsured. They defined that term as a person;

1. having out-of-pocket costs over the last year that are 10% or more of their household income (excluding premiums);
2. with out-of-pocket costs over the last year that were 5% or more of a household living below 200% of the federal poverty level (that’s $24,120 for an individual or $49,299 for a family of four); or
3. with a deductible of 5% or more of total household income.

The Commonwealth Fund found that of the people buying insurance on the individual market, 42% are underinsured. And even those who get health insurance from their employer are not immune, 28% of them are considered underinsured, compared to 20% four years ago. And of those considered underinsured, 47% reported having bills and debt problems resulting from medical care.

In addition, a Kaiser Family Foundation (KFF) study shows that low-wage workers are paying a disproportionate amount of their income on health insurance. KFF found that the cost of average family coverage rose 5% in one year to $20,576 in 2019 and workers paid an average of $6,015 or nearly 30% of that amount. The cost of premiums and deductibles for job-based health insurance surpassed increases in both wages and inflation. So, just having health insurance is not enough. You have to have the right amount of coverage and receive the right kind of treatment at an affordable rate. That means high quality, low-cost health care.

Of course we can’t talk about cost and quality without talking about eliminating waste and that’s why I am proud to report that we are working on our latest report using the Milliman MedInsight health waste calculator. As in past reports, we will present findings on tests and treatments commonly regarded as overused by the medical community. What’s new is that we will also report findings at the medical group level.

This is very exciting. It is not only the first report of its kind in the state but we are breaking ground here as the first in the nation. We expect these results will be the cause of some celebrations and some disappointments, but mostly, conversations about how everyone can improve. I would be remiss if I did not acknowledge that this report would not have been possible without the support of our provider members and, in particular, the Quality Improvement Committee. I’m sure you join me in my deep appreciation for their willingness to draw the curtain back and their support for public reporting.

All the best,

Nancy Giunto