Category Archives: Health Care

Health Care Spending Under Employer-Sponsored Insurance: A 10-Year Retrospective

Source: Amanda Frost, Eric Barrette, Kevin Kennedy, and Niall Brennan, Health Affairs, Vol. 37 No. 10, 2018
(subscription required)

From the abstract:
Using a national sample of health care claims data from the Health Care Cost Institute, we found that total spending per capita (not including premiums) on health services for enrollees in employer-sponsored insurance plans increased by 44 percent from 2007 through 2016 (average annual growth of 4.1 percent). Spending increased across all major categories of health services, although the increases were not uniform across years or categories. Growth rates for total per capita spending generally slowed after 2009 but increased between 2014 and 2016. Spending on outpatient services grew more quickly (average annual growth of 5.7 percent) compared to spending on the other types of services. However, the overall distribution of spending across categories remained largely unchanged. In the context of the dramatic economic and policy events that have taken place since 2007—including the Great Recession, the Affordable Care Act, and numerous medical innovations—this assessment of ten-year spending trends provides insights into how the largest insured population in the US contributes to health care spending growth.

2018 Employer Health Benefits Survey

Source: Kaiser Family Foundation, 2018

From the abstract:
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2018 survey included 2,160 interviews with non-federal public and private firms.

Annual premiums for employer-sponsored family health coverage reached $19,616 this year, up 5% from last year, with workers on average paying $5,547 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,573 for single coverage. Fifty-six percent of small firms and 98% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 57%.

Survey results are released in several formats, including a full report with downloadable tables on a variety of topics, a summary of findings, and an article published in the journal Health Affairs.

Related:
Health Benefits In 2018: Modest Growth in Premiums, Higher Worker Contributions at Firms with More Low-Wage Workers, More Workers Face a Deductible.
Source: Gary Claxton, Matthew Rae, Michelle Long, Anthony Damico, and Heidi Whitmore, Health Affairs, Ahead of Print, October 3, 2018
(subscription required)

From the abstract:
The annual Henry J. Kaiser Family Foundation Employer Health Benefits Survey found that in 2018 the average annual premium for single coverage rose 3 percent to $6,896 and the average annual premium for family coverage rose 5 percent to $19,616. Covered workers contributed 18 percent of the cost for single coverage and 29 percent of the cost for family coverage, on average, with considerable variation across firms. Eighty-five percent of covered workers face a general annual deductible before they use most services, including the 29 percent of covered workers who are enrolled in a high-deductible health plan with a savings option. The share of firms covering services provided via telemedicine has increased steadily over the past several years. Nearly a quarter of large employers expect the elimination of the individual mandate to result in lower take-up in plan offerings.

Mercer National Survey of Employer-Sponsored Health Plans – 2018

Source: Mercer, 2018

From the press release:
Highlighting the many ways that health technology is transforming employer-sponsored health benefit programs, Mercer unveiled early results from its industry-leading survey at this year’s HR Technology Conference & Expo in Las Vegas. Based on the first 1,566 responses to the Mercer National Survey of Employer-Sponsored Health Plans, Mercer projects that health benefit cost per employee will rise by 4.1% on average in 2019 (see Figure 1).

This increase is in line with recent low single-digit annual increases. Mercer notes that the underlying medical plan cost trend has cooled from 6.5% to 5.3% heading into 2019 (the underlying trend is the estimated increase in medical plan cost if employers made no changes). In past years, common employer cost-control tactics included raising deductibles and offering less generous plans. For 2019, however, fewer than half of the responding employers (44%) will be making these types of changes. But many employers are adopting new technology-enabled tools and solutions to address the root causes of the high cost of health care without cutting benefits or increasing the financial burden on employees. ….

Hospitals keep ER fees secret. We’re uncovering them.

Source: Sarah Kliff, Vox, 2017-2018

Each year, Americans make 141 million trips to the emergency room. In nearly all those visits, hospitals charge patients something called a facility fee: the price for walking in the door and seeking medical service. Facility fees can be big: Reporter Sarah Kliff has seen charges that range from $533 to more than $3,000. But because these fees are kept secret until you receive your bill, we can’t know how high they get — or how much they vary. We want to bring transparency to these extremely common but little-understood fees. So we have been collecting facility fee bills from our readers as part of a year-long project focused on American health care prices.

Does Socioeconomic Status Account for Racial and Ethnic Disparities in Childhood Cancer Survival?

Source: Rebecca D. Kehm, Logan G. Spector, Jenny N. Poynter, David M. Vock, Sean F. Altekruse, Theresa L. Osypuk, Cancer, Early View, First published: 20 August 2018

From the abstract:
Background:
For many childhood cancers, survival is lower among non‐Hispanic blacks and Hispanics in comparison with non‐Hispanic whites, and this may be attributed to underlying socioeconomic factors. However, prior childhood cancer survival studies have not formally tested for mediation by socioeconomic status (SES). This study applied mediation methods to quantify the role of SES in racial/ethnic differences in childhood cancer survival.

Methods:
This study used population‐based cancer survival data from the Surveillance, Epidemiology, and End Results 18 database for black, white, and Hispanic children who had been diagnosed at the ages of 0 to 19 years in 2000‐2011 (n = 31,866). Black‐white and Hispanic‐white mortality hazard ratios and 95% confidence intervals, adjusted for age, sex, and stage at diagnosis, were estimated. The inverse odds weighting method was used to test for mediation by SES, which was measured with a validated census‐tract composite index.

Results:
Whites had a significant survival advantage over blacks and Hispanics for several childhood cancers. SES significantly mediated the race/ethnicity–survival association for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non‐Hodgkin lymphoma; SES reduced the original association between race/ethnicity and survival by 44%, 28%, 49%, and 34%, respectively, for blacks versus whites and by 31%, 73%, 48%, and 28%, respectively, for Hispanics versus whites ((log hazard ratio total effect – log hazard ratio direct effect)/log hazard ratio total effect).

Conclusions:
SES significantly mediates racial/ethnic childhood cancer survival disparities for several cancers. However, the proportion of the total race/ethnicity–survival association explained by SES varies between black‐white and Hispanic‐white comparisons for some cancers, and this suggests that mediation by other factors differs across groups.

ACA subsidies cost more per person than Medicaid. Is that sustainable?

Source: Susannah Luthi, Modern Healthcare, August 8, 2018

Government spending on Obamacare premiums has raced past its per-person spending on Medicaid expansion, and the gap is poised to increase—a trend that has some policy experts shaking their heads over the long-term economic picture and at least one major insurer questioning the sustainability of the individual market….

Related:
Enrolling Americans in Medicaid Is Now Cheaper Than Subsidizing Their Obamacare Coverage
Source: Jordan Weissman, Slate, August 10, 2018

Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028
Source: Congressional Budget Office, May 2018
CBO and JCT project that the federal subsidies, taxes, and penalties associated with health insurance coverage for people under age 65 will result in a net subsidy from the federal government of $685 billion in 2018.

Federal Subsidies for Health Insurance Coverage for People Under Age 65: Tables from CBO’s Spring 2018 Projections
Source: Congressional Budget Office, May 2018

CMS’s proposed changes to outpatient services, if finalized, would hurt hospital margins

Source: Diana Lee, Daniel Steingart, Jessica Gladstone, Jonathan Kanarek, Kendra M. Smith, Peter H. Abdill, Moody’s, Sector Comment, August 8, 2018
(subscription required)

On July 25, The Centers for Medicare and Medicaid Services (CMS) proposed several changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, which, if finalized, would generally be credit negative for both not-for-profit and for-profit hospitals. Changes include: (1) site neutral clinic visits, (2) expansion of 340B policy changes to off-campus departments of hospitals, and (3) adding certain nonsurgical procedures as covered procedures at ambulatory surgical centers. While on their own, these proposed changes would not be material to overall sector credit quality, the effects would vary by hospital. In general, the proposal to move certain cardiac procedures to ASCs, if finalized and if adopted by clinicians, would likely have the broadest and most significant effect on the hospital sector. Additionally, to the extent that commercial payors follow suit, each of these changes would have more meaningful effects…..

Graying of U.S. Bankruptcy: Fallout from Life in a Risk Society

Source: Deborah Thorne – University of Idaho, Pamela Foohey – Indiana University Maurer School of Law, Robert M. Lawless – University of Illinois College of Law, Katherine M. Porter – University of California – Irvine School of Law, August 5, 2018

From the abstract:
The social safety net for older Americans has been shrinking for the past couple decades. The risks associated with aging, reduced income, and increased healthcare costs, have been off-loaded onto older individuals. At the same time, older Americans are increasingly likely to file consumer bankruptcy, and their representation among those in bankruptcy has never been higher. Using data from the Consumer Bankruptcy Project, we find more than a two-fold increase in the rate at which older Americans (age 65 and over) file for bankruptcy and an almost five-fold increase in the percentage of older persons in the U.S. bankruptcy system. The magnitude of growth in older Americans in bankruptcy is so large that the broader trend of an aging U.S. population can explain only a small portion of the effect. In our data, older Americans report they are struggling with increased financial risks, namely inadequate income and unmanageable costs of healthcare, as they try to deal with reductions to their social safety net. As a result of these increased financial burdens, the median senior bankruptcy filer enters bankruptcy with negative wealth of $17,390 as compared to more than $250,000 for their non-bankrupt peers. For an increasing number of older Americans, their golden years are fraught with economic risks, the result of which is often bankruptcy.

Prosperity Now Scorecard

Source: Prosperity Now Scorecard, 2018

The Prosperity Now Scorecard is a comprehensive resource featuring data on family financial health and policy recommendations to help put all U.S. households on a path to prosperity. The Scorecard equips advocates, policymakers and practitioners with national, state, and local data to jump-start a conversation about solutions and policies that put households on stronger financial footing across five issue areas: Financial Assets & Income, Businesses & Jobs, Homeownership & Housing, Health Care and Education.

The Scorecard assesses all states on their relative ability to provide opportunities for residents to build and retain financial stability and wealth. The state outcome rankings are a measure of financial prosperity and how that prosperity is shared and safeguarded. The Scorecard ranks the 50 states and the District of Columbia on 62 outcome measures in the five Issue Areas. Data for an additional four measures are published, but states are not ranked on these measures due to insufficient data at the state level. The overall state outcome rank is determined by the rankings each state receives for outcome measures within each issue area. The issue area grades in the Scorecard are distributed on a curve, based on how each state fares compared with all other states.

The Scorecard also separately assesses states on the strength of 53 policies to expand economic opportunity. Taken together, these 53 policies provide a comprehensive view of what states can do to help residents build and protect wealth in the issue areas described above. Unlike the outcome measures, the strength of states’ policies are assessed based on fixed criteria arrived at through consultation with issue experts and Prosperity Now’s own knowledge of policies that are promising, proven or effective in helping families build and protect financial stability and wealth.

In addition to the outcome and policy measures used to assess states, the Scorecard provides additional data to understand financial stability and prosperity in states and communities. For 44 outcome measures, trend data are available for states to track progress over time. The Scorecard also allows you to drill down to the local level—city, county, Congressional district, tribal area and metro area—on up to 26 measures. Additionally, for 21 outcome measures at the state level and 11 at the local level, the Scorecard includes outcome measure estimates disaggregated by race and ethnicity. The Scorecard also disaggregates 14 outcome measures at the state level by disability status, providing for the first time in 2018 a glimpse into the financial challenges facing people with disabilities. While these additional data do not factor into a state’s overall performance in the Scorecard, we provide the data to allow for a more meaningful analysis of financial security and stability in the United States.

Related:
Main findings
Custom reports
Methodology