Last fall NPR, Harvard, and the Robert Wood Johnson Foundation partnered to survey Americans about their perceptions of health care. Kansas was one of seven states 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.
Pat Hook is a retired nurse. So, she knows about the consequences of not following her diabetic treatment plan to the letter.
“I got a good lecture from my doctor the last time I went. 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," she says. "Everything I already knew. But that doesn't change anything.”
Hook, who lives in the tiny town of Mayfield, about 40 miles southwest of Wichita, says 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.
“Right now I’m in the doughnut hole, and I can’t afford my insulin. Last month I went to get my medicine, and it was $708, and I couldn’t get it," she says.
The “doughnut hole” is part of Medicare’s prescription drug coverage. Once a person’s drug costs reach a certain level, their coverage is reduced until their drug spending reaches an upper threshold.
“I stretch my insulin a lot," Hook says. "I may take one shot a day, versus four. Pills, I skip ‘em to once every three days.”
Hook says she buys only the most basic food items. 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, their savings are gone.
“Between taxes and health care, medication…yeah, it’s gone," she says.
Hook was one of about 1,000 Kansans who answered the telephone survey. Harvard’s Robert Blendon, who led the polling effort, says Kansans were more likely than the national sample—or 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," Blendon 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.”
Which raises a question: Are health care costs really a bigger problem in Kansas than elsewhere? Paul Hughes-Cromwick is co-director of the Center for Sustainable Health Spending at the Altarum Institute, a non-profit health research institute. He says the last time the federal government updated state-level health care spending data was 2009, so comparisons are difficult. Hughes-Cromwick says health care spending growth is at historically low levels nationwide. He suspects Kansans are reacting to a couple of things: First, their incomes are growing at a slower pace than health care costs. And second, health insurance changes are requiring consumers to shoulder more of their health care costs.
“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—but when things are insured and you don’t really see the bills, or you’ve got a small $20 copay or something, now we’re in an era where co-pays, deductibles, out-of-pocket cost sharing is increasing," Hughes-Cromwick says.
And those out-of-pocket costs are largely related to prescription drugs, according to Cynthia Cox, of the nonprofit Kaiser Family Foundation.
“Out-of-pocket costs for hospital stays on average decreased, and that’s in large part because of the Affordable Care Act expanding coverage to more people. But at the same time, out-of-pocket costs for prescription drugs actually increased from 2013 to 2014," she says.
Retired nurse Pat Hook’s struggle to pay for the drugs she needs is shared by many Americans. As people grow older, many are diagnosed with chronic conditions like diabetes, heart disease and stroke. Troy Ross, who heads the Kansas City-based Mid-America Coalition on Health Care, says the drugs needed to treat those conditions play a key role in escalating health care costs.
“It’s the ongoing progression of chronic disease across our state that is driving health care costs, and all too often that bubbles up and surfaces in the form of folks having to go to hospitals, urgent care centers and ERs," he says.
Ross says even though many Kansas politicians would like to blame the Affordable Care Act, it just isn’t the culprit. While the law is contributing to a rise in health insurance costs, it’s not the primary reason for the increases in health care and prescription drug costs that are burdening people like Pat Hook.
