People hate shopping for health insurance

Illustration of a plastic bag with "NO THANK YOU" printed multiple times on it alongside a health plus.

Americans rarely switch to new health plans when the annual insurance-shopping season comes around, even if they could have gotten a better deal, Axios’ Bob Herman reports.

The bottom line: People loathe shopping for health plans, and many are bad at it, for one major reason: “It’s just too hard,” Tricia Neuman, a Medicare expert at the Kaiser Family Foundation, told Bob last year.

Reality check: During any insurance program’s annual enrollment period, most people end up staying with the status quo, if it’s an option, instead of picking a new plan.

  • Fewer than one out of 10 seniors voluntarily switch from one private Medicare Advantage plan to another, according to new research from the Kaiser Family Foundation.
  • The same holds true for Medicare’s private prescription drug plans.
  • Most employers don’t usually change insurance carriers, often out of fear of angering workers, and keep plan options limited.
  • Employees, after several reminders from HR, usually default to what they had.
  • Fewer than half of people in the Affordable Care Act’s marketplaces actively re-enroll in new plans, even though the market was designed for comparison shopping.
  • Medicaid enrollees in some states have no say in the private plans they get.

Between the lines: Buying health insurance — $20,000 decision for the average family — is more complicated than buying furniture.

  • With consumer products, you pretty much know what you’re getting. With health insurance, you’re making an educated guess of how much health care you’ll use, hoping you’ll need none of it.
  • Health insurance terms and policies also are confusing, which turns people off from the shopping process.

The big picture: Shopping for insurance is difficult enough for most people. Shopping for actual doctors, tests and services is even more difficult and less widespread, and likely won’t change if prices are unlocked.




The Tricky Politics of Healthcare

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Last spring, at the dawn of the endless Democratic primary debates, it seemed as if presidential candidates couldn’t wait to endorse the idea of “Medicare for all.”

It was a fine slogan, even if they didn’t agree on what it meant. Everyone likes Medicare; every Democrat wants to move toward universal health coverage. What could go wrong?

Only this: Bernie Sanders had already written a detailed healthcare bill — and in it, Sanders laid claim to sole ownership of Medicare for all.

Sanders’ version of national healthcare is expensive and ambitious. It would abolish private health insurance, cover much more than Medicare does now, and raise middle-class income taxes to pay for it. It’s hard to imagine Congress considering it.

Other candidates were hit with a predictable question: Do you support Sanders’ bill, including the abolition of private insurance?

Elizabeth Warren boasted of having a plan for everything else, but she outsourced this one.

“I’m with Bernie,” she said.

Kamala Harris agreed, saying she wanted to “eliminate” the hassle of dealing with insurance companies.

Cue the backlash. It turned out that progressive activists who attend Democratic town halls are ready for Canadian-style government insurance, but millions of other voters aren’t.

Polls found that most voters thought Medicare for all meant everyone would be allowed to opt into Medicare if they wanted, not that private health insurance — the kind most Americans buy through their employers — would disappear.

They also weren’t keen on paying more in federal taxes, even though Sanders and other advocates argued that they’d save money on premiums and other healthcare costs in the end.

The moderate candidates pushed back. Joe Biden proposed a more gradual route toward universal coverage, a government-run public option that anyone could choose to buy, and that he said would be “like Medicare.”

Pete Buttigieg proposed a similar plan and dubbed it “Medicare for all who want it.” Both said they’d allow people to keep private insurance.

After weeks of waffling, Harris came up with hybrid: a government-run plan with private insurance as an option, similar to the role “Medicare Advantage” plays in the current Medicare system.

Oddly, Harris’ plan resembles present-day Medicare more closely than Sanders’, which would change Medicare into something much bigger.

On Nov. 1, Warren belatedly offered details of how she’d finance a Sanders-style Medicare for all through more than $15 trillion in new taxes on businesses and the rich. But that didn’t stop the criticism.

So last week, she backpedaled.

In the great debate between Sanders’ big leap to a single government-run health plan and Biden’s incremental steps toward broader coverage, Warren declared herself in favor of both.

She’s still in favor of Sanders’ plan. But she acknowledged that it would take a while to get through Congress. That’s if she can pass it at all — although she doesn’t say that part out loud.

So Warren proposed fast-track legislation in the interim to make traditional Medicare available to everyone over 50 and create a Biden-style public option plan available through Obamacare. She calls this the “Medicare for all option,” which sounds a lot like Buttigieg.

Meanwhile, she promises, she’ll try to pass a full Sanders-style bill later, probably in the second half of her first term.

By then, she said, “the American people will have experienced the full benefits of a true Medicare for all option,” and public support will be stronger. Never mind that most new presidents have more sway in their first two years in office, rarely years three and four.

Needless to say, Warren took flak from both sides.

Sanders, in Los Angeles, said he’d turn his plan into law right away — implying that Warren’s strategy is too slow.

A spokeswoman for Biden accused Warren of “double talk.” A spokeswoman for Buttigieg said Warren still “wants to force 150 million people off their private insurance, whether they like it or not.”

It’s true that Warren’s plan calls for abolishing private insurance and imposing huge new taxes — and voters aren’t sold on those ideas.

But Warren’s new plan is smart for one big reason: None of these proposals was ever going to sail through Congress — not even the relatively moderate Biden plan.

The Democrats’ debate on healthcare has suffered from a bad case of fairy dust.

They’ve argued plenty about policy — about how they want to change the nation’s health system and how they’d pay for it.

But their progressive candidates sometimes sound as if they’ve forgotten basic politics: Which proposal will help them win the White House? And how will they get it through a Congress in which Republicans might retain a majority (or at least a near-majority) in the Senate?

No president’s agenda survives its encounters with Congress unscathed. Barack Obama arrived in the White House in 2009 with big majorities in both houses, and his Affordable Care Act — less ambitious than even Biden’s current plan — barely survived.

In that sense, what Warren has done is useful. She’s tacitly acknowledged that she can’t get everything she wants on Day One, and she needs a backup plan. She doesn’t admit that Medicare for all will be hard to pass — “I’ll fight my heart out at each step,” she promises — but that’s what she means.

It’s a nod toward realism. It’s a step forward in the Democrats’ debate on voters’ top domestic issue.

And it’s an intriguing step forward in the still-brief political career of Elizabeth Warren. She’s no head-in-the-clouds Harvard professor. She’s become a cannier, more practical politician.


More older Americans need Medicare and Medicaid


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Retirement in America is growing less secure, physically and financially, given the omnipresent threat and cost of serious illness or disease, Bob reports.

Why it matters: Qualifying for Medicare does not guarantee that older adults will skirt potentially ruinous medical bills. Millions of seniors have also come to rely on the taxpayer-funded program for lower income people — Medicaid — and there’s no indication that will slow down.

By the numbers: More than 12 million Americans — most of them over 65 — have both Medicare and Medicaid coverage.

  • That represents about one-fifth of all Medicare enrollees, a percentage that has stayed stable over time even as more baby boomers enter the program.
  • This low-income population has some of the most expensive health care conditions and disabilities — averaging roughly $30,000 in annual spending per person, or double the average Medicare enrollee.

Between the lines: Some people who age into Medicare have very few assets and income, and therefore automatically qualify for Medicaid.

  • But retirees who consider themselves middle-class increasingly have to resort to Medicaid because high costs, like dementia or nursing home care, consume their entire nest egg.

What to watch: The federal government has been experimenting with ways to coordinate care better for this population, but that’s a reaction to seniors falling into poverty due to health care costs.

  • Unless policymakers address the high and rising costs of care, more retirees and their families will have to depend on both Medicare and Medicaid.




Moody’s chief economist: Numbers check out on Warren’s ‘Medicare for All’ funding plan

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Despite openly disagreeing with Massachusetts Sen. Elizabeth Warren’s single-payer healthcare plan, Moody’s Analytics Chief Economist Mark Zandi says the numbers check out, and the Democratic presidential candidate’s plan is fully financed without adding a new tax on the middle class, according to an op-ed he wrote for CNN Business.

“Criticism that Senator Warren’s Medicare for All plan can’t be paid for, at least not without putting a greater financial burden on lower- and middle-income Americans, is wrong,” Mr. Zandi wrote. He was asked by Ms. Warren’s campaign to review the plan, and in the op-ed, walks through his reasoning on each of the main funding mechanisms for the plan, including employer premiums, income and payroll taxes, bank taxes, and the wealth tax.

“I don’t agree with Warren’s vision for our healthcare system, but I admire that she has clearly and credibly laid out that vision and that she sought out the opinions of those who may disagree with her to provide independent validation of her numbers,” Mr. Zandi wrote. “That’s the kind of rigor we should expect from all of our presidential candidates.”

Read the full column here.


Strategists say Warren ‘Medicare for All’ plan could appeal to centrists

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Sen. Elizabeth Warren’s “Medicare for All” funding plan has come under fire from her rivals for the Democratic nomination, but some in her own party say her framing of the issue could ease the concerns of centrist voters.

The Massachusetts senator and leading Democratic presidential candidate said when she released her funding plan earlier this month that it “doesn’t raise middle-class taxes by one penny.”

She estimated that Medicare for All would require $20.5 trillion in federal spending and said that would be paid for with taxes that would directly fall on employers, corporations, wealthy individuals and financial institutions.

For Democratic strategists, Warren’s approach could be a way to soothe voters’ worries about Medicare for All while advancing key progressive ideas.

“The fact that she has devised a plan that would benefit middle class Americans without taxing [them] is certainly reassuring to a lot of people,” said Brad Bannon, a Democratic strategist who isn’t working for any of the presidential campaigns.

“What Warren’s plan does is giving voters bold change without raising middle class taxes,” Bannon added.

The plan has stoked controversy, with some critics questioning Warren’s claims that it will avoid raising taxes on the middle class.

A key component is payments that employers would make to the federal government, estimated to raise $8.8 trillion.

Some policy experts say that Warren’s proposed employer contribution is a tax that would ultimately be paid by workers. But others argue that burdens on the middle class wouldn’t go up because employers would be shifting from making payments to private insurers to payments to the federal government.

Supporters of Warren’s plan also note that the plan makes clear that Warren would eliminate premiums, deductibles and copays, which should be a relief for voters with questions about Medicare for All.

Adam Green — co-founder of the Progressive Change Campaign Committee (PCCC), which has endorsed Warren — said that “Warren’s Medicare for All financing plan is functionally like an $11 trillion tax cut for middle class families,” because it eliminates out-of-pocket health costs for workers and targets tax increases at the wealthy and corporations.

Warren is one of the leading candidates in the Democratic primary, and health care is one of the most prominent issues in the race. But her plan also came after she faced intense pressure to provide details on how she would fund Medicare For All.

She had avoided saying in debates whether she’d raise taxes on the middle class to pay for Medicare for All, leading to criticism from more moderate candidates such as former Vice President Joe Biden. Sen. Bernie Sanders (I-Vt.), the other top-tier candidate with a Medicare for All plan that would do away with private insurance, has said he would directly raise taxes on the middle class to pay for his plan.

Because Warren’s plan claims it won’t raise taxes on the middle class, it “takes some of the starch” out of attacks she’ll receive from Biden, Bannon said. It also “puts her up as a great selling point in the battle against Sanders,” he added.

The release of Warren’s plan also allowed her to provide answers to a question that debate moderators had consistently pressed her on, even as she rose in the polls and voters viewed her debate performances favorably.

“In each of the last debates, while pundits were obsessing about magic words around taxes, voters were consistently saying Elizabeth Warren won,” Green said.

Strategists also said they see Warren’s Medicare for All plan as an effort to reinforce that she is the candidate with detailed policy solutions.

Michael Fraioli, a Democratic strategist who had worked on Rep. Tim Ryan‘s (D-Ohio) now-defunct presidential campaign and is unaffiliated, said that Warren — who has used the slogan “I have a plan for that” — needed to provide details on her “signature issue” of Medicare for All.

Warren’s Medicare for All funding plan isn’t the only area where she’s taken steps to make her proposals for big changes to the economy seem more palatable to moderate voters. For example, Warren stresses that she’s a capitalist, unlike Sanders, who describes himself as a democratic socialist.

But it remains to be seen how effective Warren’s health care funding plan will be in easing the concerns of voters who have reservations about Medicare for All. 

Some of the fiercest critics of her plan have been her more centrist rivals in the Democratic primary, such as Biden.

The proposal also has drawn criticism from some Democratic-leaning economic policy experts, in addition to many tax experts on the right. For example, Larry Summers, a key player on economic policy in past Democratic presidents’ administrations, argued in a Washington Post op-ed on Tuesday that “the combined tax impact of Warren’s various plans is extreme.”

Jim Kessler, executive vice president for policy at the center-left think tank Third Way, said he thinks Warren tried to ease people’s concerns with her funding plan, but “there’s a lot of skepticism out there by reasonable people.”

“It needs to hold up to scrutiny and I’m not sure it can,” he said.

GOP politicians have also already started to attack Warren over her Medicare for All plan.

Senate Majority Leader Mitch McConnell (R-Ky.) said on the Senate floor Tuesday that Warren’s proposal was “breathtaking.”

“In order to take away employer-sponsored insurance from 180 million Americans, Democrats want to kill American jobs and bring the economy to a screeching halt,” McConnell said.

Democratic strategist Craig Varoga said that Republicans will likely ignore the fact that Warren’s funding mechanisms are targeted on businesses and wealthy people, and instead hone in on her proposing around $20 trillion in tax increases.

“Republicans will not discuss the specifics of Warren’s funding mechanism, only the size of it, and they will reduce it to bumper-sticker simplicity, that it’s the biggest tax increase in American history,” he said. “It doesn’t matter whether that’s accurate or not, or how it polls 12 months before the election, that’s what they will say, and Trump will say it louder than anyone.”

The Progressive Change Institute, also co-founded by Green, is planning in the coming days to make public the results of a poll, done in partnership with Public Citizen and Business for Medicare For All, that finds that a majority of registered voters support Medicare for All, both nationally and in battleground states.

However, a recent poll released by the Kaiser Family Foundation (KFF) and the Cook Political Report found that most Democratic voters in four key battleground states think Medicare for All is a good idea, but that most swing voters in those states view it as a bad idea.

Both the Progressive Change Institute and the KFF surveys were conducted before Warren released her funding plan. 

Ashley Kirzinger, associate director for public opinion and survey research at KFF, said it is “yet to be determined” how the plan will resonate with the public, given that Republicans will use it against Warren but that people become more favorable toward Medicare for All when they learn it will eliminate their out-of-pocket costs.

“People are still learning how it works,” she said.


Behind insurer strategies to snag higher MA star ratings

Each year billions of federal dollars are up for grabs as insurers compete to score a star rating high enough to earn a lucrative financial bonus in the Medicare Advantage program. Last year, more than $6 billion in bonuses were awarded to various types of privately run MA plans.

Obtaining a bonus is especially important as plans use that funding to sell supplemental benefits, or extra perks that can be enticing to shoppers and can attract more people to their rolls.

However, the bonus program is costly and has been pegged as an area ripe for trimming, according to a 2018 Congressional Budget Office report that suggested changes could help reduce the federal deficit.

Still, insurers take the stars program seriously and devise strategies to snag higher scores. It stokes competition among plans and promotes robust benefit offerings as issuers are forced to use some of those dollars on supplemental benefits such as dental or vision.

“There is not a silver bullet,” for a stars strategy, Dustin Grzeskowiak, an actuary for consulting firm Milliman, told Healthcare Dive.

However, highly rated plans often have a few characteristics in common, he said.

Top-rated plans tend to be part of a company with an overall culture of supporting and championing the stars program. Sophisticated data-driven strategies are also key, along with member outreach.

At Kaiser Permanente, there is a disciplined structure around star ratings, Agnes Strandberg, senior vice president of Kaiser’s Medicare program, told Healthcare Dive.

Her team is focused on reviewing data, key metrics and predictive analytics to understand emerging trends among members. The focus on analytics also helps identify best practices throughout the organization’s regions, which is a hallmark of integrated health systems, Strandberg said.

A core pillar for California-based Kaiser is ensuring a consistent member experience across all those regions, which requires a lot of training, she said.

Being an integrated health system provides an important foundation for these goals, Strandberg said.

For example, when a Kaiser member walks into a clinic for a visit, the receptionist may remind the patient they’re due for a mammogram and attempt to go ahead and schedule one. The pharmacist also is there not just to fill prescriptions but to play a role in advancing a member’s health. Staying current on screenings such as mammograms are an important metric that play into the star ratings.

The health plan and its clinicians are essentially playing for the same team and not at odds with one another, which can be the case for other non-affiliated payers and providers.

All told, Kaiser garnered five-star ratings for seven of its health plans in the most recent ranking, the most of any payer. Together the seven plans cover more than 1.5 million people.

Overall, only 23 plans out of 401 received the top grade, according to CMS.

Another top performer was Bloomfield, Connecticut-based Cigna.

Cigna’s Florida plan was one of 23 plans to earn a perfect score of five stars. The plan, Healthspring, covers more than 48,000 seniors throughout the sunshine state.




Hillary Clinton: Warren’s ‘Medicare for All’ plan would never get enacted

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Hillary Clinton said Wednesday that she does not think Sen. Elizabeth Warren’s (D-Mass.) “Medicare for All” plan could ever get enacted and that she backs a public option instead. 

“You just don’t think that that plan would ever get enacted?” interviewer Andrew Ross Sorkin asked Clinton at The New York Times DealBook Conference.

“No, I don’t. I don’t, but the goal is the right goal,” the former secretary of State responded.

“I believe the smarter approach is to build on what we have. A public option is something I’ve been in favor of for a very long time,” Clinton said. “I don’t believe we should be in the midst of a big disruption while we are trying to get to 100 percent coverage and deal with costs.”

Amid the raging health care debate among the Democratic presidential candidates, Clinton, the party’s 2016 nominee, appears to line up more with former Vice President Joe Biden and South Bend, Ind., Mayor Pete Buttigieg, who are pushing for an optional government insurance plan, rather than Warren and Sen. Bernie Sanders (I-Vt.), who are pushing government insurance for all.

Clinton, though, tried to shift the debate back to highlighting the contrast between Democrats and Republicans, pointing to the fact that the GOP is trying to repeal the Affordable Care Act, including backing a lawsuit currently in the courts to overturn the entire law. 

“Yeah, we’re having a debate on our side of the political ledger, but it’s a debate about the right issue, how do we get to health care coverage for everybody that we can afford?” Clinton said, noting the GOP is “in court right now to strike the entire law down.”