Category Archives: Health Care

Medicare Advantage: Private health plans in Medicare

Source: J. Timothy Gronniger and Robert A. Sunshine, Economic and Budget Issue Brief, Congressional Budget Office, June 28, 2007

Medicare provides federal health insurance for 43 million people who are aged or disabled or who have end-stage renal disease. Most receive services through the traditional fee-for-service (FFS) part of the program, which pays providers a set fee for each covered service (or bundle of services). Participants can choose their providers and are not required to obtain prior authorization for any covered service.

Medicare beneficiaries have the option of enrolling in Medicare Advantage–the program through which private plans participate in Medicare–rather than receiving their care through the FFS program.1 They may choose to do so because such plans provide additional benefits beyond those available within traditional Medicare, including coverage for services not covered by FFS Medi- care (for instance, dental services) and cash rebates of premiums or reduced cost-sharing. As of June 2007, about 18 percent of beneficiaries are enrolled in Medicare Advantage plans.2 This brief describes how those private plans function, how they are paid, how their costs com- pare with the costs of traditional Medicare, and how those costs vary by geographic area.
See also: Testimony on the Medicare Advantage Program

Many States’ Poor Populations Lose If Cigarette Taxes Are Hiked to Pay for Health Insurance

Source: The Tax Foundation, News Release, June 29, 2007

Most states will pay more in tax than they receive in federal spending from Senator Gordon Smith’s proposal to expand federal health spending with money from a higher federal excise tax on cigarettes.

The five states that would come out furthest ahead are New Mexico, Alaska, Kansas, Arizona, and California. They combine comparatively low smoking rates with fairly large populations of households eligible for the State Children’s Health Insurance Program (SCHIP).

The five states that would fare the worst are New Hampshire, Vermont, Missouri, Massachusetts, and Iowa. Iowa and Vermont have low levels of children in poverty and above-average cigarette consumption, while Missouri has a very high smoking rate.

The study is titled “A State-by-State Estimate of the Impact of SCHIP Expansion and a 156 Percent Cigarette Tax Hike,” by Tax Foundation economist Gerald Prante. It is number 88 in the Tax Foundation Fiscal Fact series.

Medicaid Funding for Nonprofit Healthcare Organizations

Source: Courtney Burke, The Aspen Institute, June 2007

Medicaid, a publicly funded health insurance program, paid for approximately 16 percent of all healthcare delivered in the United States in 2005.1 Because nonprofit organizations comprise a notable percentage of health providers, and because many of these nonprofits disproportionately rely on Medicaid as a payment source, revenue for nonprofit organizations is inextricably linked to Medicaid. The percentage of healthcare providers that are nonprofit varies depending on the service they provide and the state in which they operate. For instance, nonprofits make up a larger percentage of all hospitals in comparison to their prevalence among all nursing homes. They are more common in Northeastern states compared with Southern and Western states. This is due to several factors, including states’ laws and regulations governing nonprofits, the competitiveness of the marketplace, and differences in states’ policies governing coverage and payment for healthcare services.

There is no doubt that the financial relationship between Medicaid and nonprofit organizations has significant implications for their missions, management and budgeting tactics. The effect of Medicaid funding on the mission of an organization is particularly striking in instances where less medically oriented social-service providers change their service delivery model to meet Medicaid reimbursement criteria. Understanding the extent of the financial affiliation between Medicaid and nonprofits is the first step in understanding the organizational effects—but doing so is difficult because the monetary relationship may vary by the type of service provided, state, or industry. Adding to the difficulty of estimating and understanding the financial relationship between Medicaid and nonprofits is the fact that there is no single database to track the flow of Medicaid money to nonprofits. The lack of a dedicated data system necessitates use of various sources to estimate the amount of Medicaid money going to nonprofits.

Each source has several caveats and only allows for imprecise estimates. Taking these caveats into account, this paper uses existing literature, analyses from industry trade organizations, and data from state officials, the Census Bureau, and Medicaid to make rough estimates of the potential amount of Medicaid money going to nonprofit healthcare providers.

The financial relationship between Medicaid and nonprofits may have additional effects on nonprofit organizations. Understanding the financial relationship between Medicaid and nonprofits can further illuminate the possible organizational effects and demonstrate Medicaid’s role in shaping the healthcare marketplace. This paper shows how and how much Medicaid funding flows to nonprofits, that Medicaid expenditures impact a significant number of nonprofits and a large portion of funds for nonprofit healthcare organizations, and that various trends and changes in the marketplace may affect nonprofit healthcare providers in different ways.

How Much Is Too Much?: A Framework for Evaluating Health Care Affordability

Source: David Carroll, California Budget Project Budget Brief, May 2007

The Governor and legislative leaders have proposed to substantially expand health coverage for uninsured Californians. These proposals would require individuals to purchase or share in the cost of coverage.1 However, these proposals may not go far enough to make health coverage affordable for California families

2005 Nationwide Inpatient Sample Data Now Available

Source: Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ), 2007

HCUPnet is a free, on-line system based on data from the Healthcare Cost and Utilization Project (HCUP). It provides access to health statistics and information on hospital inpatient and emergency department utilization. It allows users to generate tables and graphs on national and regional statistics and trends for community hospitals in the U.S. In addition, community hospital data are available for those States that have agreed to participate in HCUPnet.

Uninsured Veterans: A Stain on America’s Flag

Source: Steffie Woolhandler, Physicians for a National Health Program, Testimony Presented to the House Committee on Veterans Affairs, June 20, 2007

In 2004, 1.8 million military veterans neither had health insurance nor received ongoing care at Veterans Health Administration (VHA) hospitals. Note that the surveys asked veterans if they had health insurance, and if they had veterans or military health care. We counted them as uninsured only if they answered no to both questions. The number of uninsured veterans has increased by 290,000 since 2000. The proportion of non-elderly veterans who were uninsured rose from less then one in ten (9.9%) in 2000 to more than one in eight (12.7%) in 2004.

An additional 3.8 million members of veterans’ households were also uninsured and ineligible for VHA care.

Virtually all Korean War and World War II veterans are over age 65 and hence covered by Medicare. However, 645,628 Vietnam-era veterans were uninsured (8.5% of the 7.56 million Vietnam-era vets). Among the 8.6 million veterans who served during “other eras” including the Persian Gulf War, 12.9% (1,105,891) lacked health coverage.

Almost two-thirds (64.3%) of uninsured veterans were employed and nearly nine out of ten (86.4%) had worked within the past year. Most uninsured veterans, like other uninsured Americans were in working families. Many earned too little to afford health insurance, but too much to qualify for free care under Medicaid or VA means testing.

The Financial Health of California Hospitals

Source: California Healthcare Foundation, June 2007

From the news release:
The financial health of California hospitals improved during a five-year period, but one-third of the state’s hospitals continue to lose money, reflecting a wide disparity in their performance, according to a comprehensive new report.

The analysis by consulting firm PricewaterhouseCoopers builds upon an earlier CHCF report that warned of a looming crisis in which a large proportion of financially under-performing hospitals would face closure. The new report finds that that crisis has not materialized. Although 28 hospitals closed during 2001 to 2005, the decline was similar to the earlier five-year period. In fact, most survived in a stronger financial state than predicted.

However, a gap in financial performance between the most profitable and least profitable hospitals persists. In 2005, median operating margin for the lowest performers (bottom quartile) was negative 5.6% compared to positive 7.3% for the high performers (top quartile).
+ Report Snapshot
+ Full Text, 269 pages

New CDC Report Documents Percentage of People Without Health Insurance

Source: National Center for Health Statistics, Centers for Disease Control and Prevention, June 25, 2007

From press release:
CDC’s National Center for Health Statistics is issuing a new report today entitled “Early Release of Health Insurance Estimates Based on Data From the 2006 National Health Interview Survey.”
The study examines data collected from interviews in over 100,000 households nationwide. Some of the highlights include:
• In 2006, there were 43.6 million Americans of all ages who did not have health insurance (at the time of the interview), or 14.8 percent of the population.
• Among working-age Americans (those ages 18-64), there were 19.8 percent who did not have health insurance in 2006, a slight increase from 18.9 percent in 2005.
• Approximately 9.3 percent of children under the age of 18 did not have health insurance in 2006, a decrease from 13.9 percent in 1997.
• In 2006, the percentage uninsured at the time of interview among the 20 largest states ranged from 7.7 percent in Michigan to 23.8 percent in Texas.

Valuing the Invaluable: A New Look at the Economic Value of Family Caregiving

Source: Mary Jo Gibson and Ari N. Houser, AARP Policy & Research, June 2007

The contributions of America’s family caregivers, along with many friends and neighbors, often go unrecognized in public policy discussions about the financing and costs of health care and long-term services and supports. Yet these unpaid caregivers provide by far the majority of long-term services and supports received by persons with disabilities of all ages.

Not only are their contributions the foundation of the nation’s long-term care system, but are an important component of the U.S. economy, with an estimated economic value of about $350 billion in 2006. Public policies to alleviate stress on caregivers could be implemented at a small fraction of the value of their contributions.
+ In Brief
+ Data Digest: State Profiles

Federal Web Site Reveals Cardiac Care Mortality Rates

Source: iHealthBeat, June 22, 2007

For the first time in more than a decade, the federal government released data on how well the nation’s hospitals care for Medicare beneficiaries with heart problems, but critics say the lack of detailed information prevents consumers from making real choices. CMS said that their quality improvement officials will work with some hospitals to improve care.
Direct to Hospital Compare Database

The database contains:
– Hospital Location Information
– Hospital Quality Information
See Process of Care Measures that show how often hospitals provided recommended treatment for heart attack, heart failure, pneumonia, and surgery. Find information about hospitals’ Death (Mortality) Rates for heart attack and heart failure.
– Hospital Checklist
– Your Rights When You Are in the Hospital
Search using:
– Hospital Name
– City
– ZIP Code
– County
– State