Tag Archives: Underinsured

Employers shift costs with 12% surge in deductibles

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http://www.healthcaredive.com/news/employers-shift-costs-with-12-surge-in-deductibles/426292/

  • The average deductible for employer-sponsored health plans has risen 12% this year to $1,478 annually, and has exceeded $2,000 at small businesses, according to a new Kaiser/HRET survey, which looked at more than 1,900 small and large employers to analyze the trends around employer-sponsored health insurance.
  • The rapid increase in deductibles, which puts more healthcare costs on the shoulders of employees, has been a significant factor in helping employer-sponsored plans slow down their premium increases to “historically low rates,” the study found. It noted that since 2011 the average family premium has gone up just 20%, compared to 31% from 2006 and 2011, and 63% from 2001 to 2006.
  • The analysis illustrates the shift between plan types, showing 29% of all employees are now in high-deductible plans compared to 20% in 2014, while those employees in higher cost PPO plans have gone down from 58% in 2014 to 48% in 2016.

This is how the presidential election is shaping the ongoing drug price debate

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This is how the presidential election is shaping the ongoing drug price debate

Change Capsule Pill Filled with Word on Balls

In this year’s presidential campaign, health care has taken a back seat. But one issue appears to be breaking through: the rising cost of prescription drugs.

The blockbuster drugs to treat hepatitis C as well as dramatic price increases on older drugs, most recently the EpiPen allergy treatment, have combined to put the issue back on the front burner.

Democrat Hillary Clinton just issued a lengthy proposal to address what her campaign calls “unjustified price hikes for long-available drugs.” That’s in addition to a broader proposal to address high drug prices the campaign put out last fall.
Republican Donald Trump, meanwhile, has said little about health care since announcing his candidacy in 2015, but he has several times called for a change in law to allow Medicare to negotiate drug prices for the population it serves.

Here are five reasons why this issue is back — and why it is so difficult to solve.

Studies: Employer Costs Slow As Consumers Use Less Care, Deductibles Soar

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http://khn.org/news/studies-employer-costs-slow-as-consumers-use-less-care-deductibles-soar/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=34365867&_hsenc=p2ANqtz-8KEto_GP9_uQqUz3i-mPzdbfQDEppu8jP4OnWeCEXc0J1QCOvNd0hi84YGIhj1horx7qHfq8_4658aqWRUhtoQ9n9XQQ&_hsmi=34365867

Pocketbook pain: Workers’ contributions to health-plan premiums have been rising faster than their pay. Deductibles have risen even more. (Courtesy of Kaiser Family Foundation)

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.

Failure to Improve Is Still Being Used, Wrongly, to Deny Medicare Coverage

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For months, physical therapists worked with Mrs. Kirby, a retired civil servant who is now 75, trying to help her regain enough mobility to go home. Then her daughter received an email from one of the therapists saying, “Edwina has reached her highest practical level of independence.”

Translation: Mrs. Kirby wouldn’t receive Medicare coverage for further physical therapy or for the nursing home. If she wanted to stay and continue therapy, she’d have to pay the tab herself.

Medicare beneficiaries often hear such rationales for denying coverage of skilled nursing, home health care or outpatient therapy: They’re not improving. They’ve “reached a plateau.” They’re “stable and chronic,” or have achieved “maximum functional capacity.”

Deanna Kirby wasn’t buying it. “I knew they couldn’t refuse you, even if you’re not improving,” she said.

She’s right. A federal judge last month ordered the federal Centers for Medicare and Medicaid Services to do a better job of informing health care providers and Medicare adjudicators that the so-called improvement standard was no longer in effect.

 

While uninsured rate hits historic low, young adults still not sold

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http://www.healthcaredive.com/news/while-uninsured-rate-hits-historic-low-young-adults-still-not-sold/425890/

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.

Cleveland Clinic details hits to operating margin

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http://www.healthcaredive.com/news/cleveland-clinic-details-hits-to-operating-margin/425703/

  • The Cleveland Clinic’s latest financials show the hospital system ended the first half of 2016 with a significantly lower operating margin than at the same time in 2015, landing at 1.2% after the six-month period that ended June 30, 2016 vs. 5.6% in June 2015.
  • Although the system’s revenue went up 17% during this period compared to last year, reaching $3.93 billion, that revenue failed to keep pace with a 23% increase in expenses.
  • The system had anticipated a smaller margin this year, Cleveland Clinic chief financial officer Steve Glasstold Modern Healthcare, partly as a result of increased investments in new care-delivery models and consultants to manage those projects, as well as providing raises to medical and other employees to retain in-demand clinicians.

States that resisted the ACA face the biggest hurdles in 2017

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http://www.fiercehealthcare.com/payer/states-resisted-aca-face-biggest-hurdles-2017?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWmpJMlpEZzFZbVV3WXpSaSIsInQiOiI0dCs1NW9kd0ord0VnTUpDWkgzcUp6VmpOV09JNUpldnBqcTh3eUJNTithQUs5QWc0N1JBbjJRYWZmRVJRN216MjNHQ2tFNGhrQWNON2NwR0dLSkdiVTZTSGxDVEZkNVwvejNoRitlVFpGblU9In0%3D

Document titled "Patient Protection and Affordable Care Act"Document titled "Patient Protection and Affordable Care Act"

States that are set to experience reduced competition in their health insurance exchanges also appear to be the ones that were unwilling to lay the groundwork to create a robust marketplace.

The issues that many states are now facing regarding consumer choice and premium pricingwere predicated by resistance from Republican politicians, who failed to expand Medicaid or conduct the necessary outreach to enroll healthy individuals into marketplace plans, according to the Los Angeles Times. In fact, eight of the nine states that have the fewest plan options next year refused to expand Medicaid and failed to engage in outreach.

“It’s the same basic lesson I tell my kids,” Joel Ario, a former insurance commissioner in Oregon and Pennsylvania, told the newspaper. “If you put the work into something, you will get results. If you just sit on the sidelines and complain, you shouldn’t be surprised if things don’t work out.”

Uncovered California: Why Millions Have Fallen Into Health Care Gaps

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Uncovered California: Why Millions Have Fallen Into Health Care Gaps

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“Right now, I have a medicine sitting at Wal-Mart pharmacy that I can’t purchase till payday,” Jacqueline, a 55-year-old San Diegan told me during a telephone interview in mid-April. She asked that her last name not be used for this story. “I’ll go without, eight or nine days till payday. It’s for my high cholesterol.”

Five years after the Affordable Care Act became law, and more than three years after California began moving aggressively to implement its provisions, upwards of three million Californians remain without health care coverage; and millions more, like Jacqueline, have basic coverage but continue to be grievously under-insured.This is the story of how so many Californians continue to fall through the ACA’s cracks.

“Uncovered California” is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

Uncovered California: Community College Students’ Quest for Mental Health Services

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Uncovered California: Community College Students’ Quest for Mental Health Services

Mental Health infographic

On April 19, 35-year-old Sacramento City College student Rachel Wilson testified before the state Assembly’s higher education committee. A survivor of sexual assault and multiple suicide attempts, she described the lack of mental health support services available to her at school. Wilson was followed by an American River College professor, whose own son had killed himself while studying at a community college. The professor talked about three students who had recently committed suicide at her school, and of the lack of mental health services to help troubled individuals. When faculty members saw someone in crisis, she said, they were instructed to call campus police and have them take the student away.

“Mental illness is not a crime,” she told legislators. Then she repeated it: “Mental illness is not a crime.”

 Both women wanted the legislators to support Kevin McCarty’s (D-Sacramento) Assembly Bill 2017, which would significantly expand mental health services across California’s vast community college system.

Roughly two million Californians attend classes in one or another of the 113 community campuses dotted around the state. Surveys suggest that somewhere in the region of one in four of these students will experience a diagnosable mental health problem at some point, but approximately 40 percent of them won’t seek timely help. And too often, the institutions at which they study won’t be proactive in linking them up with vital services. As a result, they go untreated.

“Uncovered California” is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

High-Risk Pools For Uninsurable Individuals

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High-Risk Pools For Uninsurable Individuals

Figure 1: Concentration of Health Care Spending in U.S. Population, 2011

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.