By Ray Serrano
The latest push in Washington to lower healthcare costs is overlooking the needs of those with the most at stake: Latino patients.
Latino communities carry some of the highest rates of chronic disease in the country. Latino adults are more likely than U.S. adults overall to develop diabetes – and significantly more likely to suffer its most dangerous complications, including kidney failure. They’re more frequently diagnosed with liver disease and face elevated risks from several forms of cancer.
And too often, the health system fails Latino patients when it matters most – with care delayed, denied, or disrupted. Insurers and other supply chain middlemen increasingly shape those experiences – determining which treatments are accessible, when they are approved, and how much patients ultimately pay.
Confronting that reality should be the starting point for any serious reform effort. Instead, many of the “cost-saving” proposals gaining traction in Washington risk reinforcing the very access barriers Latino patients already face.
In the name of lowering drug costs, certain policymakers are advancing proposals that would tie Medicare reimbursement rates to prices set by foreign governments. Reducing U.S. drug prices is an admirable goal. However, the approach is fundamentally misguided.
Many of the reference countries in these proposals rely on centralized health systems that use cost-effectiveness metrics to determine which treatments are worth covering. These metrics often disadvantage diverse populations and delay or restrict access to newer therapies.
Importing those pricing models means importing their tradeoffs onto American patients – without delivering on affordability.
These latest price-setting proposals won’t meaningfully lower patients’ out-of-pocket costs. Savings will largely route to the government, and patients’ premiums and cost-sharing obligations could rise.
These proposals would, however, introduce new pressure points throughout the system – with Latino patients among those hit hardest. When reimbursement is reduced, insurers respond by tightening controls over when and how treatments are used.
Already, insurers in the Affordable Care Act marketplace deny around 20% of in-network claims and 33% of out-of-network claims, according to a recent analysis. Many approvals only come after appeals – if patients persist that long. For Latino patients managing one or more chronic diseases, those delays translate into costly complications, hospitalizations, and deteriorating health.
If policymakers are serious about delivering more affordable care and better health outcomes, the solution isn’t government price-setting – it’s removing the barriers insurers and middlemen have built into the system. Barriers that place unnecessary burdens on Latino patients.
Start with a crackdown on consolidation in the supply chain. When insurers, pharmacy benefit managers, and hospitals all operate under one corporate roof, it creates “healthcare monopolies.” These monopolies steer patients toward higher-cost or in-house options – even when more affordable, higher-quality care is available elsewhere.
Policymakers should also ensure that any cost savings secured from manufacturers actually reach patients. Today, steep rebates and discounts are negotiated behind the scenes and often retained by supply chain middlemen instead of reducing what patients pay out of pocket for their medicines.
As a result, Medicare drug plans often pay vastly different prices for the same medicine. In 2024, one cancer drug cost about $3,600 in Illinois but more than $12,000 in central Pennsylvania. Those inflated prices ultimately translate into higher out-of-pocket costs for seniors.
Reforms should increase transparency and require that these negotiated savings flow directly to patients.
Short-sighted policies that narrow access, delay treatment, or limit innovation ultimately fail the patients who can least afford those setbacks. Lawmakers can take a smarter approach – one that lowers costs without restricting care.
Dr. Ray Serrano is the director of research & policy at the League of United Latin American Citizens.