Two thirds of voters (66%), including large shares of Democrats, Republicans, and independents, identify access and affordability of health care and the future of Medicare, an issue not being widely discussed on the campaign trail, as top priorities for the presidential candidates to talk about during the campaign. Smaller majorities of voters say the same about Medicaid’s future (54%), prescription drug costs (53%), and the future of the 2010 health care law (52%).
http://blogs.wsj.com/washwire/2016/06/30/the-next-big-debate-in-health-care/
Source: Kaiser Family Foundation analysis of Truven Health Analytics Market Scan Commercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).
With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer.
As the chart above shows, payments toward deductibles by consumers who have insurance through large employers rose 256% from 2004 to 2014; over the same period, wages increased 32%. The chart shows what people actually paid toward their deductibles and other forms of cost-sharing, not just their exposure as deductibles climbed (which is more typically what studies and data report). Deductibles accounted for 47% of cost-sharing payments in 2014, up from 24% in 2004. During the same period some other forms of cost-sharing fell. Payments for co-pays declined by 26%. It’s no wonder that consumers say in polls that deductibles are their top health-cost concern.
Rising payments for deductibles cause people to use less health care and have played a role in the moderation we have seen in recent years in the growth of health spending. That rate of growth has begun to tick up but remains moderate by historical standards. Ever larger deductibles may dampen growth in spending but can also be a significant burden for many family budgets and a barrier to care for the chronically ill.
So far Medicare has not been one of the major health-care issues in the presidential campaign. Neither Hillary Clinton nor Donald Trump has talked about it much. The former secretary of state has discussed the idea of a Medicare buy-in for the near-elderly, but that’s been mentioned more as a way of strengthening the Affordable Care Act, not reforming Medicare. Meanwhile, Medicare faces serious long-term challenges, including how to finance care for an aging population, ensure its solvency in the future, fill gaps in coverage, and address cost-sharing burdens that can be onerous for its mostly lower- and moderate-income beneficiaries.
An estimated 11 million young adults ages 19 to 34 currently lack health insurance. Health insurers covet this age group as enrollees for their generally healthy status and lower cost risk. Bringing more of these uninsured young people into the Affordable Care Act (ACA) marketplaces would bring more balance to the marketplace risk pools, which some insurers complain are dominated by less healthy people.
One option for attracting young people being floated in policy circles is lowering premiums for this group by raising the limit on how much more insurers can charge older people relative to young people. The ACA bans insurers from charging people higher premiums on the basis of health or gender, but insurers are allowed to charge older adults up to three times what they charge young adults. This provision helps protect insurers from the greater potential health costs of older adults. Some have suggested that insurers be allowed to increase this so-called age band from 3:1 to 5:1 or higher, or allowing states to set their own age bands.
http://www.nj.com/politics/index.ssf/2016/08/christie_medicaid_expansion_report.html
Gov. Chris Christie on Monday boasted the success of expanding the Medicaid program in the state, arguing the “naysayers” have been “proven wrong” and that 566,000 additional New Jerseyans have insurance coverage.
It’s been three years since Christie announced he planned to buck his party and embrace President Obama’s Medicaid expansion under the Affordable Care Act. He was one of only a handful of GOP governors to embrace the changes.
“There were many naysayers,” Christie said during a Statehouse news conference.
“We made a deal with the federal government. If they keep their deal, we’ll keep our part of the deal,” he said. “I am for Medicaid expansion … but I am not for Medicaid expansion at any price.”
http://www.vox.com/2016/8/18/12520820/public-option-health-care-obamacare
THE REALITY IS THAT COMPETITION AMONG PRIVATE INSURERS HAS NEVER LIVED UP TO THE RHETORIC PUT FORTH BY THE INDUSTRY OR FREE MARKET FUNDAMENTALISTS
This week, Aetna announced it would stop selling insurance plans in all but four Obamacare exchanges, the state-run markets set up under the 2010 Affordable Care Act. Aetna, which now covers more than 800,000 people in 15 exchanges, said it had been hemorrhaging money on the plans. (A fight with the government over an acquisition of the insurance company Humana may have played a role, too.)
Aetna’s exit, following similar departures by UnitedHealth and Humana, means that a growing number of US counties — 20 to 25 percent, according to the Kaiser Family Foundation — now have only a single private insurer offering coverage on the exchanges, a development that essentially eliminates consumer choice. One county in Arizona now has no insurers. Even before Aetna’s decision, more than half of state exchanges had four or fewer insurers, with DC, Vermont, Connecticut, and Rhode Island having only two.
It’s enough to make a frazzled health care consumer in one of those feeble markets wish there were another option — perhaps even (dare one say it?) a public option. Does the phrase ring a bell? That’s the health care policy that some policymakers pushed to include in the 2010 law.
Uwe E. Reinhardt, PhD, is the James Madison professor of political economy and of economics at Princeton University, where he teaches health economics, comparative health systems, general microeconomics, and financial management. Dr Reinhardt is also the codirector of the Griswold Center for Economic Policy Studies at Princeton University. The bulk of his research has been focused on health economics and policy, both in the United States and abroad. He is a member of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) and served on its Governing Council in the 1980s. He is past president of AcademyHealth, the Foundation for Health Services Research, and the International Health Economics Association. He is also a member of JAMA‘s editorial board.
The contributions individuals make out of their paychecks toward employer-sponsored health insurance are community rated, which means that they are the same for all employees of the firm, regardless of their health status and even age. So healthy employees are forced to subsidize less healthy colleagues through the premiums they pay. With the ACA, the Obama administration sought to provide the same deal for US individuals purchasing health insurance in the individual market.
For health insurers, however, this approach can be called an unnatural act, because it forces them knowingly to issue policies to very ill people at premiums evidently far below these individuals’ likely claims on the insurer’s overall risk pool. Actuaries and health policy analysts understand that this approach can work only if all individuals, healthy and ill, are mandated to purchase coverage for a defined, basic package of benefits, at the community-rated premium—thereby forcing young and healthy individuals to subsidize with their premiums the health care of individuals with medical conditions in the insurer’s risk pool.
However, for purely political reasons, the ACA mandate for all person in the United States to be insured was rather weak, leading many younger or healthier individuals simply to forgo purchasing health insurance and paying the relatively low fines for doing so. Over time, this practice naturally will drive up the community-rated premiums, inducing even greater numbers of young and healthy individuals to forgo insurance coverage, leaving private insurers with ever-more expensive risk pools.
The result of this adverse risk selection (the scenario in which sicker-than-average people purchase insurance while young and healthy people do not) has been that some private health insurers underpriced their policies on the ACA exchanges, perhaps to gain market share early on or because they simply did not anticipate quite the adverse risk selection that occurred.
http://www.healthcaredive.com/news/uwe-reinhardt-adverse-risk-selection-crippling-obamacare/425182/
Fewer than one-third of Accountable Care Organizations qualified for bonuses from Medicare in 2015.
And just 31 percent of ACOs generated savings of $466 million, according to a CMS announcement released Thursday.
CMS and Congress must “take swift and decisive action to solidify the foundation of the Medicare ACO program,” Clif Gaus, CEO of the National Association of ACOs, said in a response (.pdf) to the findings.
The savings were accumulated from 392 Medicare Shared Savings Program participants and 12 Pioneer ACO participants, according to CMS. Total savings grew 13 percent from 2014, when ACOs recognized $411 million in total savings.
The National Association of ACOS “was disappointed not to find stronger financial results that reflect the extensive financial and personal contributions invested by ACOs,” Clif Gaus told FierceHealthcare via email, adding, “the ACO program has strong, bipartisan support and is considered a model for the transition from fee-for-service to value-based payment.”
http://www.fiercehealthcare.com/payer/obamacare-ceo-kevin-counihan-counterstrikes-aetna-s-aca-exit
In the aftermath of Aetna’s ACA exchange exit, which leaves places like Pinal County, Arizona, with no insurers scheduled to offer plans in 2017, Obamacare CEO Kevin Counihan says HHS has already revved up its efforts to recruit insurers to fill in the gaps, according to an interview with Politico.
Insurers, including most recently the Dallas-based insurer Scott & White Health Plan, say sicker, more expensive populations mean they’re losing money on government-created marketplaces. Aetna, Scott & White, UnitedHealth and Humana have all said they can’t afford to keep offering the plans.
This week, Aetna dropped out of 68 percent of the exchanges in which it was operating.
But the insurance market–a market based in risk, after all–will always be dynamic. That was the case even before healthcare reform. “This is the nature of the industry,” Counihan toldPolitico.
According to University of Chicago economist Robert Kaestner, these exits are entirely normal.
“I don’t think it’s a particularly unusual situation where the firms are leaving the market,” Kaestner told Salon. “The fact that firms can leave and enter markets means the markets are, in fact, quite competitive.”
HENRY KOTULA 