By Anna Gustafson, Michigan Advance
Michiganders are having trouble accessing and paying for both physical and mental health care and want their state and federal lawmakers to prioritize driving down health care costs, including by capping insurance deductibles and curbing what insurers can charge patients, according to a new survey.
Lansing-based EPIC-MRA, a survey research firm, in June asked 609 registered voters in Michigan about a range of health care matters. The final results, which health policy and nonprofit leaders from across the state discussed during a panel discussion on Wednesday, painted a picture of Michiganders whose household finances have been seriously impacted by health care bills, have had trouble finding mental health providers covered by their insurance plans, and find their insurance deductibles to be unaffordable.
“By more than a 3-1 margin, voters’ main concern with health care is that out-of-pocket costs are too high,” EPIC-MRA President Bernie Porn said during Wednesday’s panel discussion organized by the Michigan League for Public Policy, a Lansing-based think tank, and Consumers for Quality Care, a Washington, D.C.-based coalition of health care advocates. “As a result of high out-of-pocket costs, medical debt is widespread. Fifty percent of voters have either had their households’ finances seriously affected by medical debt or know someone who has.
“And among voters that have had their finances affected, 71% say they or someone close to them have had medical bills go into collections,” Porn continued.
The survey was conducted between June 15 and 20. The margin of error is 4%.
Highlights from the survey include:
- 89% said it is more important now than ever that insurance plans cover mental health care.
- 84% said the amount they pay for health care increases every year.
- 81% of Democrats said they are more likely to support a candidate who makes reducing health care costs a top priority. 70% of Republicans and 54% of independents said the same.
- 67% said it’s impossible to know what their health care costs will be because out-of-pocket costs are so unpredictable.
- 67% said health care costs are rising faster than other essential needs.
- 58% said it’s difficult to find mental health providers that are covered by their insurance.
- 51% said they have skipped or delayed going to the doctor over concerns about out-of-pocket costs.
- 50% said their household, or the household of someone close to them, have had their finances seriously affected by medical debt.
- 38% said deductibles are the biggest problem when it comes to health care costs.
To address these problems, the survey reported:
- 68% said health insurers and pharmacy benefit managers should pass the rebates or discounts they receive from drug companies on to patients.
- 66% said there should be a cap on the amount health insurers can make patients pay for their deductibles, copays and other out-of-pocket costs.
- 64% encouraged capping insurance deductibles “at a level that is low enough that people don’t go into debt when getting the health care they need.”
- 59% said the federal government should be able to negotiate prescription drug prices for those on Medicare.
Michigan League for Public Policy President and CEO Monique Stanton noted that at the state level there are a number of bipartisan bills that could help to drive down health care costs but have stalled in the state Senate.
“They go a long way to begin to tackle some of the rising costs associated with health care coverage and access,” Stanton said.
Those bills include House Bill 4346, which would cap insulin copays; House Bill 4349, which would require hospitals to post charge descriptions for certain items and services online; House Bill 4353, which would require an insurer to count all drug rebates received for a medication toward a family’s maximum out-of-pocket costs or plan deductible; and House Bill 4358, which would stop insurance companies from removing a prescription drug from its list of offerings during a plan year.
Each of those bills, which have garnered bipartisan support, have been passed by the House but have stalled in the Senate Health Policy and Human Services Committee, which has not held hearings for any of these bills.
If these bills are not passed by the Senate and sent to the governor by the end of this year, lawmakers would have to reintroduce the bills in the following session.
What happens is that we get into having to decide whether or not to pay for food or gas to get to work (because of high health care costs).Vanessa Greene, CEO of the Grand Rapids African American Health Institute
Black, Latinx Michiganders face additional barriers to health care
Michiganders of color, including Black, Latinx and Arab residents, often struggle more than their white peers when it comes to accessing affordable health care – and policymakers must center those inequities, panelists said Wednesday.
Vanessa Greene, CEO of the Grand Rapids African American Health Institute (GRAAHI), noted that 13.2% of Hispanic Michiganders and 8.9% of Black Michiganders do not have health insurance, compared to an overall average of 6.3% of state residents, according to the Michigan Department of Health and Human Services’ (DHHS) 2021 health equity report.
A 2021 GRAAHI report found that Black individuals were 4.5 times more likely than white people to experience infant mortality in Kent County, and were 3.5 times more likely than other racial groups to die from heart disease. Black women in Kent County were also 40% more likely to die from breast cancer than white women, regardless of the stage at which the cancer was diagnosed.
Greene also highlighted that while the average American family spends around 11% of their household income on health care premiums and out-of-pocket health care costs, that amount approaches 20% for Black households, according to the Century Foundation, a progressive think tank headquartered in New York City.
“Then what happens is that we get into having to decide whether or not to pay for food or gas to get to work” because of those high health care costs, Greene said.
Lawmakers must address these inequities when crafting policy, Greene said.
“One of the things that’s really important is research … not just looking at what inequities there are but research related to solutions,” she said.
Michiganders of Middle Eastern and North African descent also have trouble accessing and affording health care — but it’s much more difficult to track those inequities because the federal government does not include those communities in U.S. Census data, said Collin McDonough, the federal public policy associate at the Dearborn-based Arab Community Center for Economic and Social Service (ACCESS).
“MENA (Middle Eastern and North African) Americans are functionally erased from data and programming at the federal level,” McDonough said.
“Using private research, we can roughly estimate some health concerns, but we have no government-sponsored data or research on the MENA communities,” he continued. “… Through private research we know MENA Americans have more prevalent rates of several types of cancer, lower life expectancies, higher rates of hypertension, higher rates of smoking and a significantly higher rate of mental health disorders.”
To be able to address these health disparities, it’s crucial that the federal government does a better job at collecting data on Middle Eastern and North African populations, McDonough said.
Expanding mental health care
While the overwhelming majority — 89% — of Michigan voters surveyed by EPIC-MRA said health insurance should cover mental health care in a way that makes it affordable, 58% said it’s difficult to find mental health providers.
Robert Sheehan, the executive director of the Community Mental Health Association of Michigan, said the findings are distressing but not surprising.
Out-of-pocket costs for mental health care are a significant barrier for Michiganders, Sheehan said. While there’s a federal parity law that requires insurers to cover mental health services to the same extent they cover physical health services, Sheehan said that doesn’t always occur and there remain cost barriers because mental health patients can see those providers more frequently than physical health doctors.
“I may see my physician one day a year but see my therapist six to 10 times,” Sheehan said.
Sheehan added that “half of psychiatrists in Michigan and across the country do not take insurance.”
To address this, Sheehan said Michigan needs to pass a parity law that would force insurers to provide more expansive mental health care coverage.
In 2008, Congress passed the Mental Health Parity and Addiction Equity Act, which limited higher copayments, separate deductibles, and stricter preauthorization for behavioral health services as compared to other medical and surgical services.
U.S. Sens. Tim Kaine (D-Va.) and Elizabeth Warren (D-Mass.) in July reintroduced the “Behavioral Health Coverage Transparency Act,” which aims to strengthen the oversight and enforcement of parity laws.