INDIANAPOLIS - COVID-19 has elevated the importance of quality health care, and Hoosiers with employer-sponsored insurance coverage are encouraged to carefully review their options for 2021.

Now is the time of year that open enrollment for private health-insurance plans is offered for the upcoming year. President and CEO of UnitedHealthcare in Indiana - Kim Sonerholm - said it's a good idea to sit down and review plan offerings, and take into consideration any anticipated health, lifestyle or financial changes.

"Only two-thirds of people who actually go through the process spent more than an hour looking at what is available," said Sonerholm. "It's broader than just health insurance and benefits. They have opportunities to enroll in dental and vision plans often, and kind of overlook those additional services that their employers are making available."

It's estimated that 54% of Hoosiers have employer-sponsored health care coverage. 15% are Medicare beneficiaries, who also need to review coverage options for next year between now and December 7.

Sonerholm said don't just go for the plan with the lowest premium, as co-pays and out-of-pocket costs also are a factor in the overall price. She said it's important to see if your doctor is in-network.

"About 76% of providers are in-network," said Sonerholm. "And it's important that they utilize those in-network physicians because they may be able to save money when accessing care in the future."

Many businesses also offer their workers employer-sponsored wellness programs that can bring down the overall cost of insurance. Sonerholm says 77% of UnitedHealthcare survey respondents who have access to such a program said it improved their overall health.

"Often times those programs are based around walking or getting up and moving," said Sonerholm. "That's something that a lot of us have struggled with during this pandemic where our lives have shifted to working remotely, and these types of programs can remind us to stay healthy and practice healthy habits."

Half of survey respondents said wellness initiatives helped reduce stress and improve productivity, and one in three said they took fewer sick days.

Nearly one million Ohioans have been diagnosed with diabetes, but the cost of insulin continues to be a barrier for people needing the medication.

Policy Matters Ohio Budget, Health and Child Care Researcher Kathryn Poe said the cost of insulin can reach hundreds of dollars - but with insurance the range is on average $50 to $80, not including the cost of supplies.

Poe said the increasing cost of the medication, especially over the past decade, has been driven by the three pharmaceutical companies that control the market: Eli Lilly, Novo Nordisk and Sanofi.

"We have a situation where only three companies are able to control basically the global supply of insulin," said Poe. "And in the United States, where there aren't proper checks and balances to regulate these companies, that means that there are unaffordable costs."

Researchers from Yale University found that among people who use insulin, nearly 1.2 million were financially burdened by their health-care spending over the course of a year.

A bipartisan bill filed earlier this year by state House lawmakers would cap out-of-pocket costs for insulin.

Poe says if passed, Ohio would follow other states that have passed insulin-affordability legislation that caps the cost of copays at around $35 for people with insurance.

"The one that's currently introduced in the Legislature, HB 384, actually caps the cost of supplies as well," said Poe, "which is really, really important."

While the Inflation Reduction Act capped out-of-pocket insulin costs for Medicare beneficiaries, Poe points out that more than 70% of adults nationwide who reported rationing insulin don't qualify.

It's estimated one in five adults younger than 65 limit their use of the medication because of cost.

"The high cost of the actual drug combined with the high cost of supplies has really made this crisis something that definitely kills people," said Poe. "People have lost their lives over this crisis."

But she added that for those with prescriptions who can afford it, they do have access to an emergency supply if they can't get to a doctor in time to refill.

In 2022, Gov. Mike DeWine signed a bill into law that allows patients to receive up to three emergency refills of life-saving medication within a year without a prescription.

Failing to dispense the drug could result in harm to their health.

This story was produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.




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Gov. Glenn Youngkin has vetoed legislation making prescription drugs more affordable. The bill would have created an independent body to evaluate drug prices and determine if increases are reasonable.

Surveys show the issue has support across party lines in the state.

Jared Calfee, state advocacy director for AARP Virginia, is disappointed the bill was vetoed. He said people are taking drastic action to afford their medicine.

"They are struggling to afford their medication," Calfee observed. "They're skipping doses or cutting pills in half, and rationing things like that to stretch out their medicine as long as they can. Those people were really looking for something to get done and now, now that's not going to happen this year."

The General Assembly has the power to override the veto, but not necessarily the votes. The biggest opposition to the bill was from pharmaceutical companies, which said it would hinder research and development. A 2022 report found Stelara, used to reduce inflammation in conditions such as Crohn's disease and ulcerative colitis, is the most expensive drug in the state, costing almost $23,000 per dose.

Calfee is confident the General Assembly will take up the bill again next year and feels it has enough momentum to get through both chambers. Now it depends on swaying Youngkin. Calfee argued drug companies cannot keep charging high prices.

"There's no not laughable way for them to justify some of these drug prices and what they're charging for medications, and just the way that they have increased prices year over year," Calfee contended. "Patients who need these drugs to survive are just going to be stuck paying whatever they want to charge for them."

Currently, 11 states have some form of affordability review for prescription drugs, although similar legislation is being considered in several other states.

This week, groups fighting for health equity known as the Health4All campaign are asking the California Legislature to remove barriers to the "Covered C-A" health insurance marketplace based on immigration status.

Assembly Bill 4 and a budget action would pave the way.

Sen. Maria Elena Durazo, D-Los Angeles, said right now, 520,000 undocumented Californians who do not get insurance at work should have access to subsidized plans under Covered California.

"They're left uninsured simply because they earn too much to qualify for Medi-Cal, even if it's by only a few dollars," Durazo explained. "They are still in a position where they have to choose between the health care they need or putting food on the table, or paying rent."

State lawmakers have expanded Medi-Cal in stages over the past 10 years to cover all low-income undocumented people. However, a family of four on Medi-Cal can only earn just over $43,000 a year and undocumented families are currently excluded from Covered California under the Affordable Care Act.

Carlos Alarcón, health and public benefits policy analyst at the California Immigrant Policy Center, part of the Health4All campaign, argued it is important to set up an easy way to shop for coverage.

"We're asking the Legislature to invest in establishing a separate health care market exchange, where all Californians, regardless of their immigration status, would be able to safely shop and compare for health care plans," Alarcón outlined. "Maybe down the line, provide these folks with the affordability assistance that they would need."

The coalition is asking the Legislature for at least $15 million to build out the mirror marketplace. However, detractors are concerned about adding to California's budget shortfall. Advocates also gave public comment on Monday in a subcommittee of the Assembly considering health care budget issues.


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