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Health care issues that voters are thinking about this election year


Are you struggling with the cost of health care? Well, that's an issue that voters wish the presidential candidates would focus on this election year. That's according to a poll from health policy research group KFF. It finds that nearly 3 in 4 adults say they're worried about being able to afford unexpected medical bills. And we're looking at health care all this week as part of our series We, The Voters.

So for more on what can be done to control costs, we're joined now by KFF's Larry Levitt. Larry, so let's start with those unexpected bills. In 2020, President Trump signed the No Surprises Act to try to protect consumers. How's that been working out?

LARRY LEVITT: Well, for consumers, it's been working out well. You know, before the No Surprises Act went into law, it was not uncommon for people to get these surprise medical bills. So you might go to an emergency room, unfortunately, and end up seeing a physician who was not in your network and would give you a surprise medical bill. So those are now a thing of the past.

MARTÍNEZ: We had a story earlier this week where we heard about the enhanced subsidies President Biden put in place for people signing up for health plans under the Affordable Care Act. So how is that affecting the cost?

LEVITT: That has reduced the cost for people who sign up for Obamacare dramatically. On average, ACA enrollees are saving over $700 per year - in some cases much more per year. And that's led to record enrollment. Unfortunately, these subsidies expire at the end of 2025, and the next president could be very influential in whether they're extended or not. People could see big premium increases.

MARTÍNEZ: Another place, though, where there's been movement on price recently is on insulin. And we looked into this during a recent visit to Georgia. That's where we met Errol Anderson. He was at home in Lawrenceville just outside of Atlanta with his dog Clariee.


ERROL ANDERSON: She gets very excited when there are random other people here to visit with her.

MARTÍNEZ: Anderson's house is set among tall trees, next to a pond with fish and turtles. Inside are more books than we could count.

ANDERSON: Because I'm a bookseller partnered with a bookseller, this is just our fiction collection.

MARTÍNEZ: While we could have spent the afternoon browsing the shelves, including his collection of vintage pop culture lunch boxes, we're here to talk about his experience living with diabetes. We sit down outside on a deck overlooking the pond.

What's life like for you as a diabetic?

ANDERSON: So my diabetes is in good control, but even so, like, I can just have a freak bad day, and it will just, like, lay me out. That's the most frustrating part of being diabetic, is just the sort of, like, X factor of you never know when your body might just kind of flake on you.

MARTÍNEZ: And that time where your body's flaking on you, I mean, what do you go through?

ANDERSON: Usually, it's low blood sugar or it's just an uncontrolled high blood sugar. So the effects of hypoglycemia, which is low blood sugar, tend to just be, like, relative incoherence and, like, feeling really, like, shaky and weak.

MARTÍNEZ: Anderson was diagnosed when he was 14 and started taking insulin. That's the hormone that turns food into energy and manages your blood sugar level. If you're diabetic, your body doesn't make enough of it on its own.

ANDERSON: I started with shots, started with what's called the original sort of regular insulin. It's cheap 'cause it doesn't work that well, and it's kind of difficult to manage. And when I was 18, I went into a coma in college because I took a certain amount of insulin, thought I was - had eaten enough, went back to bed and then woke up to EMS crews.

MARTÍNEZ: Now Anderson has much more advanced and more expensive technology to help. He rolls up his sleeve to show us a device about the size of a large digital watch embedded in his arm.

ANDERSON: That's my insulin pump. And then on my stomach, I have the continuous glucose monitor. So they Bluetooth talk to each other. At the beginning of the year, I'm paying, like, 1,200 a month for these things. I hit my deductible by usually, like, July, and then it gets much better.

MARTÍNEZ: The passage of the Affordable Care Act in 2010 meant Anderson didn't need to worry about being denied insurance coverage because of his diabetes. But...

Did anything change in the cost?

ANDERSON: No. (Laughter) It was very expensive. Even making $35,000 a year, my insurance cost me, like, $300 a month, and my insulin cost me, like, $300 a month.

MARTÍNEZ: Throughout this time, did you have questions as to why this was so expensive, considering so many people needed it?

ANDERSON: No. I knew it was about (laughter) capitalism. I always felt that it was about exploitation. I had learned very early on that Frederick Banting - the guy who first discovered insulin - he gave the patent to the University of Toronto for $1. And he said, this is lifesaving medicine. I want it to be free for everyone. Yet, these companies are getting insanely rich.

MARTÍNEZ: Recently, though, Anderson's been feeling some relief, at least from the price of insulin, since the passage of President Biden's Inflation Reduction Act in 2022.

ANDERSON: He passed an insulin cost cap of $35, which was huge and really, really important. It brought my cost down. And what the three major manufacturers of insulin did was voluntarily bring their cost down to $35 a month because the cost cap only covered people who were on Medicare.

MARTÍNEZ: And while the cap is saving Anderson a bunch of money every month, he's not celebrating.

ANDERSON: So that was lauded as, like, this great, generous thing. My frustration with that is that they have made millions and millions - billions probably - of dollars off of diabetics. And $35 is still a lot of money for a lot of people. So while I think it's great that this has come to the attention of the president and to Congress, it's not enough, and people should be really mad.

MARTÍNEZ: All right. Back now with Larry Levitt from KFF. Larry, so Errol Anderson might not be celebrating, but how big of a deal is that insulin cost cap for diabetics across America?

LEVITT: Well, it's a big deal. But as Errol said, there are some limitations. So it only applies in Medicare. There are about 3 million insulin users in Medicare. And for them, it's made a big difference. I mean, they were paying on average over $50 a month for insulin - in some cases much more - and that's now capped at $35 per month. And as Errol said, the makers of insulin have voluntarily applied the cap to people not on Medicare as well. But that's voluntary, and there's no guarantee it will continue without an act of Congress, which President Biden has called for.

But I think Errol touches on some other things as well. I mean, people have very high deductibles now. The average deductible is over $1,700 per person for people with employer-based insurance. And that's good insurance, and many people just can't afford that.

MARTÍNEZ: Larry, is there anything being done at all to address those high deductibles?

LEVITT: Well, you know, really not. I mean, the Affordable Care Act, or Obamacare, did a lot to reduce health care costs and increase coverage for people who qualify for it. But for the more than 150 million people with employer-based insurance, there really have not been a lot of solutions on the table, short of universal coverage or Medicare for all, which is likely not on the horizon in the near term.

MARTÍNEZ: That's Larry Levitt with a health policy research group, KFF. Larry, thank you.

LEVITT: Thanks for having me. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

A Martínez is one of the hosts of Morning Edition and Up First. He came to NPR in 2021 and is based out of NPR West.