Cartoon – Whose getting deep into my pockets?
Tag Archives: High Deductible Health Plans
Studies: Employer Costs Slow As Consumers Use Less Care, Deductibles Soar
Employer health insurance expenses continued to rise by relatively low amounts this year, aided by moderate increases in total medical spending but also by workers taking a greater share of the costs, new research shows.
Average premiums for employer-sponsored family coverage rose 3.4 percent for 2016, down from annual increases of nearly twice that much before 2011 and double digits in the early 2000s, according to a survey by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
But 3.4 percent is still faster than recent economic growth, which determines the country’s long-run ability to afford health care.
And the tame premium increases obscure out-of-pocket costs that are being loaded on employees in the form of higher deductibles and copayments. Another new study suggests those shifts have prompted workers and their families to use substantially fewer medical services.
For the first time in Kaiser’s annual survey, more than half the workers in plans covering a single person face a deductible of at least $1,000. Deductibles for family plans are typically even higher.
How companies are quietly changing your health plan to make you pay more
How the ACA’s Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums
Abstract
Issue: One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law’s individual mandate also protect from high health spending.
Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket.
Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds.
Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.
While uninsured rate hits historic low, young adults still not sold
A survey found adults in states with a federally facilitated marketplace more likely to be uninsured than those in states operating a state-based marketplace or a partnership marketplace. This indicates another way in which states’ support (or lack thereof) for the ACA has impacted their uninsurance rates.
High-Risk Pools For Uninsurable Individuals
In the debate over the future of the Affordable Care Act (ACA), proposals have emerged that would repeal or weaken rules prohibiting health insurance discrimination based on health status, instead offering high-risk pools as a source of coverage for people who would be uninsurable due to pre-existing conditions.
In Congress, HR 2653 was introduced by members of the House Republican Study Committee to repeal the ACA and replace it with other changes, including state high-risk pools. This bill would authorize $50 million for seed grants to help states establish high-risk pools, and $2.5 billion annually for 10 years to help states fund high-risk pools. Recently, House Republicans released their proposal to replace the ACA, entitled A Better Way. This plan would significantly modify ACA insurance market rules to provide a one-time open enrollment opportunity; thereafter, only individuals who maintain continuous coverage would be guaranteed access to insurance without regard to their health status. This plan also would provide $25 billion over 10 years in state grants to help fund high-risk pools. Pools would be required to cap premiums (at unspecified levels) and would be prohibited from imposing waiting lists.
For more than 35 years, many states operated high-risk pool programs to offer non-group health coverage to uninsurable residents. The federal government also operated a temporary high-risk pool program established under the ACA to provide coverage to people with pre-existing conditions in advance of when broader insurance market changes took effect in 2014. This issue brief reviews the history of these programs to provide context for some of the potential benefits and challenges of a high-risk pool.
The Next Big Debate in Health Care
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.
Prices soar for some popular drugs despite insurer discounts
Three out of four medicines with $1 billion or more of yearly global sales increased prices by more than double the rate of inflation between 2009 and 2015, even when insurer- and pharmacy benefit manager-negotiated discounts were factored in, a Bloomberg analysis shows.
Insurers can easily require patients to switch to alternatives, the analysis notes, giving them leverage to negotiate lower prices.
But drug costs are still putting significant pressure on payers’ margins, rising from less than 10 percent of care-cost expenditures years ago to 13 percent in 2010 and 17 percent in 2015. Insurers and state lawmakers have tried pushing back, with Virginia among severalstates trying to legislate better price transparency. Insurers also are experimenting with negotiating deals with drug manufacturers that link prices to how well the drugs work.
Bloomberg looked at 39 drugs for its analysis. Only six increased in price at the rate of inflation or below, the news agency found. Discounted prices rose significantly as well. The discounted prices for 27 of the 39 drugs rose by 25 percent or more over six years; the consumer price index rose just 9.5 percent during the same period, according to the article. Prices doubled or more for seven drugs.
States eye health insurance regulations to control drug costs
Healthcare insurance companies are actively fighting to keep drug costs low for their members and for their own bottom lines. Now a new policy brief offers state policymakers tips on how to shift more of the costs to payers in an effort to protect consumers.
The brief (.pdf) from the National Association of Insurance Commissioners outlines several regulations policymakers can adopt to ease consumers’ cost burdens, including:
Consumerism and RCM: 3 challenges posed by high deductibles & how to meet them
As high deductible health plans become more common, patients are becoming the new payers. This puts responsibility back in the hands of the provider to provide a consumer-friendly billing experience and collection strategy to maintain the speed of the revenue cycle management process.
At the Becker’s 2nd annual CIO/HIT + Revenue Cycle Conference in Chicago, the following five panelists discussed the top three challenges of consumerism and how RCM can meet those challenges: Steve Collins, vice president of business development at Zotec Partners; J. Wade Shields, owner and managing partner of Practice Partners; Susan Hawkins, executive director of revenue cycle at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif.; Amanda Cancelliere, vice president of operations and business performance services at McKesson Technology Solutions; and Brooke Murphy, writer/reporter with Becker’s Healthcare.
HENRY KOTULA 