NPR, Harvard University and the Robert Wood Johnson Foundation partnered to survey Americans last year about their perceptions of health care.
Kansas was one of seven states — Florida, New Jersey, Ohio, Oregon, Texas and Wisconsin were the others — singled out for a closer look . And the thing that stood out about Kansans was the degree of concern they expressed about the cost of health care.
As a retired nurse, Pat Hook knows all too well the potentially catastrophic consequences of not following her diabetic treatment plan to the letter.
“I got a good lecture from my doctor the last time I went,” said Hook, who was one of about 1,000 Kansans who answered the telephone survey. “Told me that if I didn’t get on my insulin and stay on it, that my kidneys were gonna fail, I was gonna go blind — everything I already knew. But that doesn’t change anything.”
Hook, who lives in the tiny town of Mayfield, 40 miles southwest of Wichita, said she has no choice but to triage her own care. Even though she’s covered by Medicare, she can’t afford the insulin and other drugs she needs to control her diabetes.
“Last month I went to get my medicine, and it was $708, and I couldn’t get it,” Hook said. “That’s just my copay, because I’m in the doughnut hole. I couldn’t have afforded that if I was working.”
The “doughnut hole” Hook referred to is a gap in Medicare’s prescription drug coverage. Once a person’s drug costs reach a certain level, their coverage is reduced until their drug spending hits an upper threshold.
The Affordable Care Act includes provisions to close the “doughnut hole” over time, but in the meantime people like Hook struggle to balance their finances and their health.
“I stretch my insulin a lot. I may take one shot a day versus four,” she says “Pills, I skip ’em to once every three days.”
The scrimping isn’t limited to medication. Hook says she buys only the most basic groceries: milk, bread, cheese, potatoes. To save on gas, she and her husband limit their trips to Wellington, the county seat 10 miles away. They haven’t taken a trip or vacation since she retired five years ago. And still, they’ve spent all of their savings.
“Between taxes and health care, medication … yeah, it’s gone,” Hook says.
Harvard’s Robert Blendon, who led the polling effort, says Kansans were more likely than the national sample — and those in the other six states singled out in the poll — to report serious financial difficulties caused by health care costs.
“They think they’re going up,” he says. “They’re more concerned about the future. They’re worried about their insurance premiums. They’re more likely to say their own health care costs are unreasonable.”
So are health care costs really a bigger problem in Kansas than elsewhere?
Paul Hughes-Cromwick, co-director of the Center for Sustainable Health Spending at the nonprofit Altarum Institute, says a lack of timely state-level information makes valid comparisons difficult.
“The last time the government updated the state-level spending data was 2009, and they’re about to issue it again, but not until next year,” he says.
Hughes-Cromwick says overall health care spending growth has seen a historic slowdown during the last few years.
He thinks what’s really hurting Kansans is that their incomes are growing at an even slower pace, and insurance changes are requiring consumers to shoulder more of the cost for health care.
“Health care costs have been rising faster than our incomes for about as long as I’ve been alive — and I’m not a young guy,” Hughes-Cromwick says. “Now we’re in an era where copays, deductibles, out-of-pocket cost sharing is increasing.”
Those out-of-pocket costs often are related to prescription drugs, according to Cynthia Cox, an associate director with the nonprofit Kaiser Family Foundation.
“When we poll people and ask them what their top health care concerns or priorities are, prescription drug costs always have been coming to the top,” she says.
From 2013 to 2014, the average out-of-pocket cost for hospital stays dropped, she says.
“That’s in large part because of the Affordable Care Act expanding coverage to more people,” Cox says. “But at the same time, out-of-pocket costs for prescription drugs actually increased from 2013 to 2014.”
And that’s an issue for aging Americans like Hook who have chronic conditions such as diabetes, heart disease or stroke.
Troy Ross, who heads the Overland Park-based Mid-America Coalition on Health Care, says the drugs needed to treat those conditions play a key role in escalating health care costs.
“Year in and year out, if you look at the drivers of health care costs, almost exclusively you’re going to see what is the ongoing progression of chronic disease across our state that is driving health care costs,” he says. “All too often that bubbles up and surfaces in the form of folks having to go to hospitals … going to more urgent care centers and ERs.”
Ross says that as employers continue to shift more health insurance costs to their workers, employees may try to save money by cutting back on their use of health care services.
“Folks will simply stop going to see their primary doctor for a preventive health visit,” he says, and that may lead to larger health costs down the line.
Ross wants to see the health care system shift from paying on the basis of the number and type of services delivered to the value of those services in maintaining a patient’s long-term health.
Helping people better manage their chronic diseases — or even prevent them altogether through healthier lifestyles — is the ultimate answer to rising health care costs, he says.
Bryan Thompson is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
