Cartoon – Affordable Healthcare Realized
Monthly Archives: November 2016
Cartoon – Wheel of Out of Pocket Expenses
Cartoon – Health Reform
Cartoon – Healthcare Access
When Having Insurance Still Leaves You Dangerously Uncovered
One of the few things that Donald J. Trump and Hillary Clinton seemed to agree on was that high out-of-pocket spending on health care was a problem. One of Mrs. Clinton’s most popular health care proposals during her campaign was to reduce out-of-pocket spending to more “manageable” levels for many Americans. President-elect Trump said he could fix this problem by repealing Obamacare and replacing it with something better.
As I’ve written before, while more Americans are insured, many are still underinsured — meaning that they are exposed to significant financial risk from out-of-pocket payments. Reducing out-of-pocket spending, however, will require some trade-offs. No easy solution exists, but there are examples out there worthy of consideration.
Before we can discuss any plan’s specifics, let’s look at exactly how the health care system extracts money from you. Plans differ in the amount of actuarial value they have. That’s the percentage of the cost of care that insurance will cover. If a plan has 60 percent actuarial value, then it covers 60 percent of your potential health care spending, and you cover 40 percent. Plans with higher actuarial value cost more. In the Affordable Care Act insurance exchanges, bronze plans have a 60 percent actuarial value. Silver plans have 70 percent, and gold plans 80 percent.
You pay up front for health insurance with a premium that is often charged monthly. But that’s not all the spending you’ll do. Almost all plans come with deductibles. This is an amount of money that you are responsible for paying for health care before insurance coverage kicks in. The reason plans have deductibles is that research shows you’re less likely to spend your money than the insurance company’s money. Plans with lower deductibles usually have higher premiums.
Even after you spend the deductible, you’re not done, though. Most plans come with co-pays. These are set fees that you have to pay each time you use the health care system. They may be $20 for a doctor’s visit, or $100 for an emergency room visit. Some plans use co-insurance instead. That’s when you pay for a percentage of your care instead of a set fee for each service.
The lower the actuarial value, the more you’re going to pay out of pocket in deductibles, co-pays or co-insurance. But plans on the Obamacare exchanges are all subject to an out-of-pocket maximum. In 2016, for a family, it was $13,700, and for an individual it was $6,850. Even the bronzest of bronze plans can’t ask you to pay any more, but they are more likely to let you hit the maximum.
That’s a lot of money. This is true even in the employer-based insurance market. In 2016, almost 30 percent of workers were enrolled in a high-deductible health care plan. More than half of employees with individual plans had deductibles of at least $1,000. Two-thirds of covered workers had co-pays, and 25 percent had co-insurance for primary care. Almost 20 percent of workers were in plans with an out-of-pocket maximum of $6,000 or more.
Mr. Trump offered no specific plans for reducing out-of-pocket spending. But that’s not surprising. It wasn’t that long ago that one of the most favored means by which conservatives proposed to bring down health care spending was to have consumers put more “skin in the game.” Many of them believed that if consumers were more exposed to health care spending, if they had to pay more out of pocket for care, then they would be more responsible consumers because of it.
In fact, calls have already begun for Mr. Trump to expose people to even more out-of-pocket spending. Right now, the Affordable Care Act has provisions that help reduce cost-sharing below the out-of-pocket maximum for those making less than 250 percent of the poverty line who purchase a silver-level plan. Those payments are made directly to health plans that cover those people.
It may be possible for the president to cut off those payments immediately, without any congressional involvement. If he were to do that, and it’s unlikely, it would either cripple those insurance companies, or they’d withdraw immediately from the exchanges, terminating coverage and leaving millions without health insurance overnight.
It’s also unlikely that the Trump administration would cover more people’s out-of-pocket payments with federal money. To argue suddenly that people should be shielded from the expense of health care would be a sea change for conservative health insurance design.
Beyond Birth Control, Women Could Pay More For Insurance Again Under TrumpCare
As the prospect began to sink in of losing access to free contraceptives if the health law is repealed or replaced, women have reportedly been racing to get IUDs or stockpile birth control pills before President Barack Obama leaves office. But birth control is just the tip of the iceberg, advocates say. There are a number of other women’s health benefits that are also at risk.
At or near the top of the list is guaranteed coverage of maternity services on the individual insurance market. Before the health law, it was unusual for plans in the individual market to pay for maternity services. But the Affordable Care Act required that care be included as one of the 10 essential health benefits that all individual plans must cover. In 2009, the year before the health law passed, just 13 percent of individual plans that were available to a 30-year-old woman in all the state capitals offered maternity benefits, according to an analysis by the National Women’s Law Center.
Some plans offered maternity services as an add-on through a special rider that paid a fixed dollar amount, sometimes just a few thousand dollars, the study found. But even with a rider, a woman’s financial exposure could be significant: The average total payment for a vaginal birth was $18,329 in 2010, according to a study by Truven Health Analytics.
Women were also generally charged higher rates for health insurance on the individual market before the law. According to the National Women’s Law Center’s analysis, 60 percent of best-selling individual plans in 2009 charged a 40-year-old non-smoking woman more than a 40-year-old man who smoked, even in plans that didn’t include any type of maternity coverage. That inequity disappeared under the health law, which prohibited insurers from charging women higher rates than men for the same services.
“Our concern is going back to a world where insurance companies are writing their own rules again, and returning women to those bad old days in health care and losing all the progress we’ve made,” said Gretchen Borchelt, vice president for reproductive rights and health at the law center.
Several other women’s preventive health services could be on the line if the health law is repealed or changed. Some may be easier to get rid of than others, say women’s health policy experts.
Tom Price, Obamacare Critic, Is Trump’s Choice for Health Secretary
f President-elect Donald J. Trump wanted a cabinet secretary who could help him dismantle and replace President Obama’s health care law, he could not have found anyone more prepared than Representative Tom Price, who has been studying how to accomplish that goal for more than six years.
Mr. Price, an orthopedic surgeon who represents many of the northern suburbs of Atlanta, speaks with the self-assurance of a doctor about to perform another joint-replacement procedure. He knows the task and will proceed with brisk efficiency.
Mr. Trump has picked Mr. Price, a six-term Republican congressman, to be secretary of health and human services, Mr. Trump’s transition team announced Tuesday morning.
Healthcare predictive analytics market should hit $19.5 billion by 2025, research shows
The market for healthcare predictive analytics should hit $19.5 billion by 2025, according to a new report by Grand View Research.
This is largely due to government authorities, health organizations and private players who are striving to decrease healthcare expenditures. Predictive analytics can help bend the cost curve by optimizing an organization’s existing clinical workflow, operations and payment strategies.
The data that feeds this trend is flowing freely. With the advent of the internet of things in healthcare and wearable technology, people are more closely tracking their health by the numbers, generating a huge amount of patient data on things like diet habits, physiological parameters and vital signs. Predictive modeling based on this data helps in understanding disease patterns, as well as key therapy trends and outcomes.
Staffing shortages top list of C-suite concerns in economic outlook, Premier says
Staffing shortages are top of mind for C-suite executives, with 41 percent of those surveyed for the Fall 2016 Premier Inc Economic Outlook calling it their biggest concern and the issue that will have the biggest impact on their system’s ability to deliver care.
That figure shot up 42 percent from the Spring 2016 outlook, results show. Health reform also topped worries, with 24 percent saying that would impact them most, followed by innovations in population health. Other concerns included drug shortages and emerging technology.
The survey polled healthcare executives on the biggest issues facing their supply chains and health systems as a whole. The most recent survey represents 52 health system C-suite executives across the United States.
Key findings also show workforce worries in other areas. The study found 72 percent of executives surveyed said they think the current supply of primary care physicians will not meet their needs over the next three years, and 51 percent don’t have enough nurse practitioners, physicians and other healthcare extenders.
Cartoon – Cost Estimation Process
HENRY KOTULA 