Worcester Telegram & Gazette

“Nearly one in four residents in Massachusetts (22%) indicated they cut pills in half, skipped a dose, or did not fill a prescription because they could not afford their medication.” — Massachusetts Medical Society (2024)

For many Americans, health care has become increasingly difficult to afford and access. As costs rise and options decrease, patients are forced to make damaging decisions to escape this system, such as delaying or skipping necessary care, harming their health and financial burden. Massachusetts is one of the most expensive states for health care, and it must take the necessary steps to ensure the wellness of all its residents.

More recently, out-of-pocket spending and cost sharing, such as deductible spending, have made up a significant fraction of lower- and middle-income household budgets in Massachusetts. As Attorney General Andrea Campbell presented in a 2024 report, “In 2022, Massachusetts households in the lowest-income ZIP codes enrolled in fully insured plans, on average, spent the highest percentage of household income (13%) on premium contributions and cost sharing relative to other income quintiles. They spent nearly five times more than households in the highest-income ZIP codes (2.7%).”

AG Campbell has recommended increased monitoring on household expenses, consumer protection and assistance, addressing the issue of deductible spending, as well as supporting hospitals serving low-income patients.

In addition to the solutions presented, it is urgent that other root causes also be addressed.

Need a break? Play the USA TODAY Daily Crossword Puzzle.

Medicaid, providing health coverage to more than one fifth of Americans, faces federal cuts as recently enacted by the federal government. These cuts are a matter of hundreds of billions of dollars, already leading to millions of Americans losing coverage for preventive care, emergency care and long-term care overall. Medicaid cuts have and will continue to significantly impact health care affordability and access for all Americans, also causing a shrinking of safety nets for more vulnerable groups. Cuts result in more uninsured or underinsured patients, leading to higher insurance premiums. Rising premiums will make health care less affordable and accessible.

One justification for these Medicaid cuts is to tackle fraud and abuse of the program’s eligibility requirements. In 2024, the Medicaid improper payment rate was 5.09%, translating to about $31.1 billion in federal funds, according to the Centers for Medicare & Medicaid Services. While this is a valid concern, what is the reason for so many Americans cheating this system?

Many of these fraud cases have selfish motives, but it is also important to consider the others, those that are symptoms of the broken system. A fraction of individuals who defraud Medicaid do so because of health care unaffordability. Additionally, eligibility criteria for Medicaid are often extremely strict. In Washington, D.C., for example, the asset limit for individuals seeking Medicaid coverage is around $4,000, and most people need more than that to survive.

According to one associate attorney who specializes in medical malpractice and professional liability, patients will come to their firm as a last resort, requesting application guidance. They are often advised to sell a number of assets just to qualify. The challenges in eligibility cause many to turn to alternate, fraudulent approaches. Medicaid fraud cannot be separated from the deeper issue of health care unaffordability.

One must also confront the mismanagement of private equity firms that has polluted the health care system, prioritizing profit over care. The recent bankruptcy of Steward Health Care, which had been backed by private equity firm Cerberus Capital Management, exposes how profit-driven businesses damage the stability of hospitals and challenge patients’ access to health care.

Steward once operated 31 hospitals across eight states, including eight in Massachusetts. As the AP reported, “Critics say the Steward bankruptcy shows the dangers of allowing private-equity executives to seek profits by taking over hospitals, loading them with debt and stripping their assets.” Since the company filed for bankruptcy in May 2024, five Steward hospitals were sold and two permanently closed. This directly impacts patients as options become limited and access significantly decreases. Patients, especially lower-income residents, are forced to travel distances for critical care. Improving health care access translates to overseeing private equity management, ending the exploitation of hospitals for profit.

The affordability and access of health care in the United States — specifically Massachusetts — is an urgent issue. It’s crucial that the leaders and general public of this state address the rising costs and shrinking of safety nets. It is necessary to rethink the broken health care system. Without meaningful action and change, the lives of millions in this state, and further across the country, are at serious risk.

Nazeefah Mowla is a senior at Shrewsbury High School.