Affordability is the word of the year. It was all anyone could talk about before the midterms, and newly elected politicians are tripping over themselves to make it their priority in the year ahead. Here in California, where the cost of living is already a daily concern, healthcare is at the center of that conversation. On November 3, Californians elected a new governor, new congressional delegation, and a whole new state Legislature. Nearly every candidate on the ballot promised to lower costs. Now that they’ve been elected, they should explain to voters what that means for the cost of healthcare.
A new poll from Patients Come First, a national patient advocacy organization, shows healthcare affordability is a top concern for patients across the country, and Californians are no exception. Nearly 83 percent of those surveyed said candidates’ positions on healthcare were important to their vote, and nearly half (45 percent) strongly believed healthcare is a very important issue when deciding how to vote. More people say that healthcare, premiums, and out-of-pocket costs have become less affordable in the last two years. Those numbers should get the attention of newly elected and re-elected officials in the state. Healthcare was not a side issue for voters – it was key to their vote.
Californians know this story well. As healthcare costs keep climbing, patients are looking for relief. Those costs are straining people’s ability to get care, with many saying they have had to cut back or forgo care altogether in recent years. Financial anxiety about healthcare is widespread, both over unexpected bills and the coming year. Patients should be able to count on being able to afford the care they need without having to compromise other necessities, like groceries. But a lack of transparency in our healthcare system makes that hard to do. Worse, many people do not even know what is driving up their healthcare costs.
79 percent of Californians surveyed had never heard of the 340B drug discount program, a federal program that lets participating hospitals and clinics serving low-income patients buy medications at steep discounts. The program was initially meant to help vulnerable patients, but because of a lack of transparency requirements, hospitals do not have to pass those savings on to patients or report how they spend them. When Californians were told that hospitals may not always use 340B savings to benefit patients, 74 percent found it concerning.
Pharmacy benefit managers (PBMs) are another part of the healthcare system most Californians know little about. These middlemen manage prescription drug benefits for insurers and employers, setting the price for what patients pay at the counter. 68 percent of California voters had never heard of PBMs, yet 87 percent agree that PBMs should face greater oversight if their business practices make it harder for patients to get medication. In many states, PBMs can keep the rebates and discounts they negotiate instead of passing them on to patients.
Another example of a lack of transparency within the healthcare system. But last year, California took on PBM reform with SB 41, which bans spread pricing and requires PBMs to pass rebates through. Now, we need to make sure it is enforced and does not face any obstacles on the pathway to supporting healthcare affordability and access to medications. A job that falls largely to the people we elected on November 3.
Healthcare will become more affordable when we rein in PBMs and reform the 340B program, not just in California but nationwide. That means defending PBM reforms as they take effect, supporting 340B transparency here at home, and urging California lawmakers to back federal 340B reforms. Californians have made their priorities clear. Lawmakers in Sacramento and Washington need to listen because voters are paying attention. The election winners must be held to what they ran on. Affordability in health care is possible, but only if Californians know who’s driving up costs and demand reforms that hold them accountable.
Kimberly Montano is a radiologic technologist and mammographer.
