The cost of medical care (from monthly insurance premiums to doctor’s visits and suturing costs) has been rising each year, placing a heavy burden on Californians. As a result, many people end up postponing or skipping the care they need.
To contain costs, California will create an Affordable Care Agency in 2022, and the board on Wednesday voted to phase in statewide spending targets. The goal would limit growth in spending by payers, including individuals, employers and governments, to 3.5% next year and steadily decline to 3% by 2029.
The plan was supported by consumer advocacy groups but criticized by industry groups as unrealistic and potentially leading to cuts in patient care.
“This is an important step toward containing health care costs over the long term and encouraging the health care industry to make much-needed changes,” said California Health and Human Services Secretary, who chairs the Affordable Care Commission. said Dr. Mark Gurley.
Over the past 20 years, health spending has increased by an average of 5.4% each year. Meanwhile, median household income is increasing by an average of 3% per year.
“When I started working in Monterey 10, maybe 11, 12 years ago, I was paying $67 a month for me and my kids,” said Jen Villa, a Monterey high school teacher, in the 2016 Affordable Care Award. He said this at the Board of Directors meeting. march. “Fast forward to here and you’ll pay $508.”
At the press conference, Villa revealed that he suffers from diverticulitis, a condition in which part of the digestive tract becomes inflamed and infected.
“I don’t go to the hospital because I can’t pay the copay,” she says. “I don’t go to the doctor because I can’t afford medicine. I went to the panaderia and asked the guy to not even give me a pack, just one tablet of penicillin that cost $20, and to support me until the pain goes away. Ta.”
Starting in 2026, the agency plans to gradually impose spending caps on medical institutions by holding them accountable.
“Progressive enforcement approaches include technical assistance, requests for explanations at public meetings, the imposition of performance improvement plans, and ultimately the assessment of fines where warranted.” the ministry said in a press release.
Laurel Lucia researches health care affordability at the UC Berkeley Labor Center, which advocates for working families. She said mandatory statewide spending targets put downward pressure on the health care system.
“This shifts some of the responsibility to health care providers to figure out how to slow spending growth,” she said.
Lucia said healthcare organizations could use more incentives to spend resources effectively.
“There is a lot of waste in the health care system right now, and there are opportunities to reduce government spending and increase access to preventive care,” she said.
Anthony Wright of the nonprofit Health Access supported the 3% recommendation.
“From the perspective of many payers and patients in our health care system, this is a relatively modest goal. But we have to start somewhere,” he said.
Eight states, including Massachusetts, Washington and Oregon, have set similar spending targets and are seeing slower growth.
“Some people may debate whether the speed limit should be 55 or 65, but I think they and I both recognize that it’s important to have a speed limit.” Mr. Wright said.
Carmela Coyle, CEO of the California Hospital Association, opposed the 3% goal. He said inflation was higher at 3.4%. Additionally, more people are getting insurance and the state’s population is aging, both factors that will drive up spending.
“So the real question we need to ask is: What is the impact on California’s ability to access the care they need when they need it? And what is the impact on quality? ” she said.
In a letter to the board, CHA said it will likely exceed its 3% goal and that a longer timeline is needed to reduce costs.
“The agency is charged by law to do more than limit spending,” Coyle said in a statement released by CHA after the vote. “It is imperative that the Board develop a process to analyze the impact of its decisions on patients and reconsider its future goals to ensure that all Californians receive equitable, high-quality care.” .”
While Californians’ health care costs may not immediately go down, it is the agency’s intent to ensure that spending continues to exceed the public’s budget. Mr Gurley said he hoped the measure would improve health conditions.
“The push here is centered around high-value systems, he said. “Rather than systems that are just cheap and cost-effective, we need to focus on delivering low-cost, yet critically important care, such as primary care.” It gives us the opportunity to focus on proven strategies.”
The Affordable Care Agency will continue to meet monthly to address state-mandated costs, such as assessing consolidation in the health care market and improving workforce stability.
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