Category Archives: Health Care

Medicaid and Financial Health

Source: Kenneth Brevoort, Daniel Grodzicki, Martin B. Hackmann, National Bureau of Economic Research (NBER), NBER Working Paper No. 24002, November 2017
(subscription required)

From the abstract:
This paper investigates the effects of the Medicaid expansion provision of the Affordable Care Act (ACA) on households’ financial health. Our findings indicate that, in addition to reducing the incidence of unpaid medical bills, the reform provided substantial indirect financial benefits to households. Using a nationally representative panel of 5 million credit records, we find that the expansion reduced unpaid medical bills sent to collection by $3.4 billion in its first two years, prevented new delinquencies, and improved credit scores. Using data on credit offers and pricing, we document that improvements in households’ financial health led to better terms for available credit valued at $520 million per year. We calculate that the financial benefits of Medicaid double when considering these indirect benefits in addition to the direct reduction in out-of-pocket expenditures.

Are Zero Tolerance Drug Testing Policies About to Go Up in Smoke?

Source: Nathaniel M. Glasser, Employee Benefit Plan Review, Vol. 72 no. 2, October 2017
(subscription required)

In an important recent decision, the Massachusetts Supreme Judicial Court recently held that a qualifying patient who has been terminated from employment for testing positive for marijuana as a result of her lawful medical marijuana use may state a claim of disability discrimination under that state’s anti-discrimination statute. Much like a similar decision in Rhode Island, this holding has significant implications for employers that drug test for marijuana use because 29 states plus the District of Columbia have enacted legislation legalizing medical or recreational marijuana use, or both.

2017 Employer Health Benefits Survey

Source: Kaiser Family Foundation, September 2017

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, and employer practices. The 2017 survey included more than 2,100 interviews with non-federal public and private firms. Annual premiums for employer-sponsored family health coverage reached $18,764 this year, up 3% from last year, with workers on average paying $5,714 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Education Trust 2017 Employer Health Benefits Survey. The 2017 survey includes information on the use of incentives for employer wellness programs, plan cost sharing, and firm offer rates. Survey results are released in a variety of ways, including a full report with downloadable tables on a variety of topics, summary of findings, and an article published in the journal Health Affairs.
Related:
Press Release
Summary of Findings
Survey Design and Methods
Health Affairs
The peer-reviewed journal Health Affairs has published an article with key findings from the 2017 survey: Health Benefits In 2017: Stable Coverage, Workers Faced Considerable Variation in Costs.

Web Briefing
On Tuesday, September 19, 2017, the Kaiser Family Foundation and the Health Research & Educational Trust (HRET) held a reporters-only web briefing to release the 2017 Employer Health Benefits Survey.

Interactive Graphic
This graphing tool allows users to look at changes in premiums and worker contributions for covered workers at different types of firms over time: Premiums and Worker Contributions Among Workers Covered by Employer-Sponsored Coverage, 1999-2017.

Key Exhibits-Chartpack
Over twenty overview slides from the 2017 Employer Health Benefits Survey are available as a slideshow or PDF.

Additional Resources
Standard errors for selected estimates are available in the Technical Supplement here.
Employer Health Benefits Surveys from 1998-2016 are available here. Please note that historic survey reports have not been revised with methodological changes.
Researchers may request a public use dataset by going to Contact Us and choosing “TOPIC: Health Costs.”

Graham-Cassidy Legislation Threatens Affordable Coverage for Older Americans

Source: Lina Walker, Jane Sung, Claire Noel-Miller, and Olivia Dean, AARP Public Policy Institute, Fact Sheet, September 2017

The Graham-Cassidy (GC) bill, as proposed on September 13, 2017, threatens to make health care unaffordable and inaccessible for millions of older Americans. The bill eliminates two sources of financial assistance—premium tax credits and cost-sharing reductions—critical to ensuring that low- to moderate-income older adults are able to afford the coverage they need. For a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year if they wanted to keep their current coverage. The bill may also allow states to charge older adults age 50–64 significantly higher premiums than under current law on the basis of their age by waiving federal protections that limit the practice known as age rating…..

Graham-Cassidy ACA Repeal Bill Would Cause Huge Premium Increases for People with Pre-Existing Conditions

Source: Sam Berger and Emily Gee, Center for American Progress, September 18, 2017

With only two weeks left to move forward with a partisan health care repeal bill, some Senate Republicans are trying one last time to rip coverage from millions of Americans. Their latest effort, introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), would make devastating cuts to Medicaid and cut and eventually eliminate funding that helps people in the individual insurance market afford coverage, leading to at least 32 million fewer people having coverage after 2026.

Those who did not lose coverage would see their premiums increase significantly. In the first year, premiums would increase by 20 percent. But the increases would be even greater for people with pre-existing conditions because the bill would let insurers in the individual market charge a premium markup based on health status and history, which could increase their premiums by tens of thousands of dollars…..

Organizational Restructuring in US Healthcare Systems: Implications for Jobs, Wages, and Inequality

Source: Eileen Appelbaum and Rosemary Batt, Center for Economic and Policy Research (CEPR), September 2017

From the summary:
The healthcare sector is one of the most important sources of jobs in the economy. Healthcare spending reached $3.2 trillion in 2015 or 17.8 percent of GDP and accounted for 12.8 percent of private sector jobs. It was the only industry that consistently added jobs during the Great Recession. In 2016, the private sector healthcare industry, which is the focus of this report, added 381,000 private sector jobs, the most of any industry. It is a particularly important source of employment for workers without a college degree, most of whom, as we document in this report, earn low wages.

This report describes how organizational restructuring is affecting the job opportunities and wages of healthcare workers. We focus on changing employment and wages in hospitals and outpatient clinics, where the most profound restructuring is occurring. Over the last decade or more, hospitals have restructured the organization of care delivery in response to major technological advances, regulatory changes, and financial pressures. This restructuring has occurred at two levels: the consolidation of hospitals and providers into larger healthcare systems on the one hand; and the decentralization of services and the movement of jobs to outpatient facilities on the other. Outpatient care facilities include a wide range of services — from primary care centers to specialized units such as urgent care centers, ambulatory surgery centers, free-standing emergency rooms, dialysis facilities, trauma and burn units, and other specialty clinics. These organizational changes began before the 2010 passage of the Patient Protection and Affordable Care Act (ACA), but have accelerated considerably since then, and are likely to continue even as the ACA is revamped in the future.

This shift to outpatient care centers offers benefits to patients — convenience as well as opportunities for preventative care — and most healthcare providers and unions have supported the move to more community-based care. But in this report, we show that workers are bearing the costs of this organizational restructuring.

Related:
Supplement
Press release

Cassidy, Graham State Estimates Irrelevant to Assessing Their Health Bill’s Effects

Source: Aviva Aron-Dine, Edwin Park, Matt Broaddus, Center on Budget and Policy Priorities, September 18, 2017

From the summary:
In rolling out their revised bill to repeal the Affordable Care Act (ACA), Senators Bill Cassidy and Lindsey Graham released estimates purporting to show that most states would see large funding gains under their proposal. But these estimates do not compare states’ funding under the proposal to what states would receive under current law, the relevant comparison. Instead, they show how each state’s funding under the proposed block grant would change over time. In reality, the Cassidy-Graham plan would cut federal funding for coverage programs by about $80 billion in 2026 compared to current law, leading to cuts in most states, and would cut federal funding by about $300 billion in 2027, with funding cuts in all states.

Income, Poverty and Health Insurance Coverage in the U.S.: 2016

Source: U.S. Census Bureau, Press Release, Release Number: CB17-156, September 12, 2017

Real median household income increased by 3.2 percent between 2015 and 2016, while the official poverty rate decreased 0.8 percentage points. ….

….These findings are contained in two reports: Income and Poverty in the United States: 2016 and Health Insurance Coverage in the United States: 2016. This year’s income and poverty report marks the 50th anniversary of the first poverty estimates released by the Census Bureau in the Current Population report series.

Another Census Bureau report, The Supplemental Poverty Measure: 2016, was also released today. The supplemental poverty rate in 2016 was 13.9 percent, a decrease from 14.5 percent in 2015. With support from the Bureau of Labor Statistics, the Supplemental Poverty Measure shows a different way of measuring poverty in the United States and serves as an additional indicator of economic well-being. The Census Bureau has published poverty estimates using the supplemental poverty measure annually since 2011.

The Current Population Survey, sponsored jointly by the Census Bureau and Bureau of Labor Statistics, is conducted every month and is the primary source of labor force statistics for the U.S. population; it is used to calculate the monthly unemployment rate estimates. Supplements are added in most months; the Annual Social and Economic Supplement questionnaire is designed to give annual, national estimates of income, poverty and health insurance numbers and rates. The most recent Annual Social and Economic Supplement was conducted nationwide and collected information about income and health insurance coverage during the 2016 calendar year. ….

Growth in Health Hiring and Hospital Spending Decline

Source: Altarum Institute Center for Sustainable Health Spending, Press Release, September 8, 2017

Hiring in the health sector moderated in August after rising over the last few months, while July spending growth slowed, according to analysis of health economic indicators released today by Altarum’s Center for Sustainable Health Spending. Driving low overall spending growth is historically low hospital spending, which, at a revised .8% June growth rate, is the lowest year-over-year monthly growth rate recorded in more than 25 years. After 2 months of unexpectedly robust growth (41,000 in July and 36,000 in June), the health sector only added 20,000 jobs in August, consistent with the slower level of growth seen in the first 5 months of the year. … Hospital hiring is continuing to grow at about two-thirds the 2015 and 2016 pace (6,000 versus 10,000-11,000 new jobs per month). With indications of declining hospital utilization and reports of potential job losses at individual hospitals, further declines in hospital job growth are expected in coming months. …

Related:
Health Sector Trend Report
Source: Altarum Institute Center for Sustainable Health Spending

Obamacare in Alaska: Cost-Control Plan Is Challenging But Working

Source: Erin Mershon, CQ Weekly, Vol. 75 no. 17, June 6, 2017
(subscription required)

It’s hard to get excited about a health insurance premium spike.

But for Lori Wing-Heier, Alaska’s blunt but friendly state insurance commissioner, the decision by the state’s Blue Cross Blue Shield plan to raise its rates by just 7 percent was a moment of joy. …. That 7 percent increase — finalized last August — was the first sign that her plan had worked. After a grueling slog with a state legislature of reluctant Republicans throughout the spring, Wing-Heier had put in place a program designed to prevent Alaska’s only remaining Obamacare insurer from raising its rates a whopping 42 percent, one of the highest projected hikes in the country…..