Healthcare Triage News: Many with Employer Insurance Still Need CHIP to Insure Their Kids
As employer-sponsored insurance becomes more expensive for children, public programs are picking up the slack. This is Healthcare Triage News.
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3 Truths About Trust
Virtually everyone agrees that trust is a vital ingredient for healthy and successful relationships. Unfortunately, most people don’t think about trust until it’s been broken. That’s the worse time to realize its importance because by then it may be too late to fix the damage that’s been done. Instead of leaving trust to chance, we need to have an intentional focus on proactively building it. When our attention is focused on a specific goal, our energy will flow in that direction to help us accomplish it. There are three truths about trust we should keep in mind as we strive to build high-trust relationships.
Cartoon – Improving your Communication Skills
Cartoon – We all make mistakes
Cartoon – Leadership Experiments
Cartoon – The Power of the Committee
Covering the Coming Battle Over the ACA: What You Need to Know
Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA
Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA
Brief
Before private insurance market rules in the Affordable Care Act (ACA) took effect in 2014, health insurance sold in the individual market in most states was medically underwritten.1 That means insurers evaluated the health status, health history, and other risk factors of applicants to determine whether and under what terms to issue coverage. To what extent people with pre-existing health conditions are protected is likely to be a central issue in the debate over repealing and replacing the ACA.
This brief reviews medical underwriting practices by private insurers in the individual health insurance market prior to 2014, and estimates how many American adults could face difficulty obtaining private individual market insurance if the ACA were repealed or amended and such practices resumed. We examine data from two large government surveys: The National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS), both of which can be used to estimate rates of various health conditions (NHIS at the national level and BRFSS at the state level). We consulted field underwriting manuals used in the individual market prior to passage of the ACA as a reference for commonly declinable conditions.
Discussion
The Affordable Care Act guarantees access to health insurance in the individual market and ends other underwriting practices that left many people with pre-existing conditions uninsured or with limited coverage before the law. As discussions get underway to repeal and replace the ACA, this analysis quantifies the number of adults who would be at risk of being denied if they were to seek coverage in the individual market under pre-ACA rules. What types of protections are preserved for people with pre-existing conditions will be a key element in the debate over repealing and replacing the ACA.
We estimate that at least 52 million non-elderly adult Americans (27% of those under the age of 65) have a health condition that would leave them uninsurable under medical underwriting practices used in the vast majority of state individual markets prior to the ACA. Results vary from state-to-state, with rates ranging around 22 – 23% in some Northern and Western states to 33% or more in some southern states. Our estimates are conservative and do not account for a number of conditions that were often declinable (but for which data are not available), nor do our estimates account for declinable medications, declinable occupations, and conditions that could lead to other adverse underwriting practices (such as higher premiums or exclusions).
While most people with pre-existing conditions have employer or public coverage at any given time, many people seek individual market coverage at some point in their lives, such as when they are between jobs, retired, or self-employed.
There is bipartisan desire to protect people with pre-existing conditions, but the details of replacement plans have yet to be ironed out, and those details will shape how accessible insurance is for people when they have health conditions.
California’s Projected Economic Losses under ACA Repeal
Click to access Californias-Projected-Economic-Losses-under-ACA-Repeal.pdf
If Congress follows through on President-elect Trump’s campaign promise to repeal the Affordable Care Act (ACA), 3.7 million Californians enrolled in the Medi-Cal expansion would lose that coverage,1 and another 1.2 million individuals enrolled through California’s health benefit exchange, Covered California, would lose federal subsidies to make private health insurance more affordable.2 These two ACA provisions are the largest drivers of the historic reduction in the state’s uninsured rate from 17.2% in 2013 to 8.6% in 2015.
Not only would repeal of the ACA reverse much of these coverage gains, but California would lose approximately $20.5 billion in annual federal funding for the Medi-Cal expansion and Covered California subsidies. The economic losses associated with these lost federal dollars would be partially offset by limited economic gains from other provisions that may be included as part of the repeal of the ACA, which could yield $6.3 billion in tax cuts to California insurers and high-income households and nearly $1.3 billion in eliminated penalties for uninsured individuals and employers not offering affordable coverage.
In this brief, we estimate the effects on employment, gross domestic product (GDP), and state and local tax revenue in California with the elimination of the major health insurance expansions, reduction in taxes, and removal of penalties under a partial repeal of the ACA. A summary of these estimates is shown in Exhibit 1. We also estimate losses for select medium and large counties that would be especially harmed economically by ACA repeal because of their high share of population (more than 10%) enrolled in the Medi-Cal expansion: Fresno, Kern, Los Angeles, San Bernardino, San Joaquin, Stanislaus, and Tulare Counties.
CONCLUSION
The ACA not only significantly expanded access to health insurance in California, but it also provided economic stimulus at a time when the state was still recovering from the Great Recession. As California is one of the states that made the greatest gains in health coverage under the ACA,16 it is also one of the states with the most to lose economically if key components of the ACA are repealed. The partial repeal of the ACA would not only lead to a substantial decline in health coverage in California, but it would also lead to significant economic losses, including more than 209,000 lost jobs, $20 billion in lost GDP, and $1.5 billion in lost state and local tax revenue. Some medium and large California counties’ economies – Fresno, Kern, San Bernardino, San Joaquin, Stanislaus, and Tulare – would be especially harmed due to their residents’ high level of reliance on the Medi-Cal expansion and above-average unemployment rates.
ACA Repeal in California: Who Stands to Lose?
Click to access ACA-Repeal-in-California.pdf
California has a lot to lose if the Affordable Care Act (ACA) is repealed. The state made significant investments in implementing the law successfully, and under the ACA cut the number of uninsured residents in half, from 6.5 million in 2013 to 3.3 million in 2015—the largest decline in the uninsured rate of any state.1 The two major reasons for this drop in uninsurance were the expansion of Medicaid and the provision of financial assistance for purchasing coverage through the state health insurance marketplace, Covered California. As a result of these policies, California experienced a significant reduction in health coverage disparities: the biggest drops in the uninsurance rate were among those least likely to have coverage before the ACA, namely those with the lowest income, young adults, part-time workers, and Latinos.2 Repealing the ACA threatens not only to leave millions without health insurance, but also to undo the progress California has made in reducing inequality of health insurance access. This brief focuses on Californians enrolled in expanded Medi-Cal (the state’s Medicaid program) and those who receive subsidized coverage through Covered California, the two groups most immediately affected if the ACA is repealed. However, many more Californians could see diminished health coverage under various Congressional Republicans’ proposals to repeal and replace the ACA.
