Category Archives: Health Care

Job Lock, Work, and Psychological Well-being in the United States

Source: Gwenith G. Fisher, Lindsay H. Ryan, Amanda Sonnega, Megan N. Naudé, Work, Aging and Retirement, Advance Access, First published online: 19 February 2016
(subscription required)

From the abstract:
The purpose of the present study was to examine job lock in relation to well-being among workers in the United States. Job lock refers to a circumstance in which a worker would like to retire or stop working altogether, but perceives that they cannot due to needing the income, and/or health insurance. Prior to examining job lock as a potential predictor of life satisfaction we first investigated the construct validity of job lock. Results from a sample of workers obtained via MTurk indicated that job lock due to financial need was more strongly associated with continuance and affective organizational commitment and job satisfaction compared to health insurance job lock. Job lock due to health insurance needs was related to a dimension of career entrenchment. We then tested hypotheses regarding the relation between job lock at T1 and life satisfaction at T2, 2 years later. Specifically, we hypothesized that perceptions of job lock would be negatively related to life satisfaction. Using 2 independent samples from the Health and Retirement Study (HRS), we found that both types of job lock were highly prevalent among workers aged 62–65. Job lock due to money was significantly associated with lower life satisfaction 2 years later. The findings for job lock due to health insurance were mixed across the 2 samples. This study was an important first step toward examining the relation between job lock, an economic concept, in relation to workers’ job attitudes and well-being.

Newly Enrolled Members in the Individual Health Insurance Market After Health Care Reform: The Experience from 2014 and 2015

Source: Blue Cross Blue Shield and Blue Health Intelligence, Health of America Report, March 2016

From the summary:
The report, “Newly Enrolled Members in the Individual Health Insurance Market After Health Care Reform: The Experience from 2014 and 2015,” represents a comprehensive, in-depth study of actual medical claims among those enrolled in individual coverage before and after the ACA took effect. The study also compares this group to those who receive insurance through their employers.

KEY FINDINGS: Comparing health status and use of medical services among these three groups, the study finds that:
– Members who newly enrolled in BCBS individual health plans in 2014 and 2015 have higher rates of certain diseases such as hypertension, diabetes, depression, coronary artery disease, human immunodeficiency virus (HIV) and Hepatitis C than individuals who had BCBS individual coverage prior to health-care reform.
– Consumers who newly enrolled in BCBS individual health plans in 2014 and 2015 received significantly more medical care, on average, than those with BCBS individual plans prior to 2014 who maintained BCBS individual health coverage into 2015, as well as those with BCBS employer-based group health insurance.
– The new enrollees used more medical services across all sites of care—including inpatient admissions, outpatient visits, medical professional services, prescriptions filled and emergency room visits.
– Medical costs of care for the new individual market members were, on average, 19 percent higher than employer-based group members in 2014 and 22 percent higher in 2015. For example, the average monthly medical spending per member was $559 for individual enrollees versus $457 for group members in 2015.
Press Release

Funding for Housing, Health, and Social Services Block Grants Has Fallen Markedly Over Time

Source: Isaac Shapiro, Bryann DaSilva, David Reich, Richard Kogan, March 24, 2016

From the blog post:
The House Budget Committee budget plan’s proposals to convert Medicaid and SNAP (formerly food stamps) to block grants have raised once again the issue of block-granting key safety net programs. As our updated paper explains, history shows that this would likely lead to large cuts in these programs over time (see graph). ….

Individual Block Grant Programs, 2000-2016, Year-by-Year Figures (Excel)

Trends in Employer-Sponsored Insurance Offer and Coverage Rates, 1999-2014

Source: Michelle Long, Matthew Rae, Gary Claxton, and Anthony Damico, Kaiser Family Foundation, Issue Brief, March 2016

From the summary:
The majority of nonelderly people get their health coverage through an employer-based plan. This issue brief uses data from the National Health Interview Survey (NHIS) to examine trends in employer-sponsored health insurance (ESI) for different types of people and households.1 While ESI remains the leading source of coverage for nonelderly people (those under age 65), the percentage covered by an employer plan has declined over the last fifteen years. A similar pattern exists with firm offer rates; fewer workers were offered health insurance from their employer in 2014 than in 1999. The decrease in offer and coverage rates has not been universal; families with low and modest incomes have been most affected by the decline. While coverage rates have declined over time, the percentage of the nonelderly population covered by ESI is similar between 2013 and 2014.

Both the percentage of employers who offer insurance and the percentage of people covered will be important to watch as the changes brought about by the Affordable Care Act (ACA) continue to unfold. New coverage provisions and financial assistance provided in the ACA affect employers’ decision to offer coverage and employees’ decisions to take up any coverage they are offered at work. The employer shared responsibility provision, for example, requires employers with 50 or more full-time equivalent employees to offer coverage to full-time employees and their dependent children or face a financial penalty. This provision should tend to expand the number of workers offered coverage in these firms, and, because most individuals are required to have health insurance or pay a penalty (the individual responsibility provision), more workers may take up the coverage offered at work. At the same time, new coverage options and financial assistance available through health insurance marketplaces may encourage some small employers (who are exempt from the employer shared responsibility provisions) to stop offering health benefits if they feel that their employees would be better off getting coverage through the marketplaces.2 Larger employers may also reconsider who they offer coverage to; some may stop offering coverage to part-time workers so those workers are eligible to receive a subsidy on the marketplaces. The percentage of people who received coverage through an employer sponsored plan in 2014 remained similar to the coverage rates in 2010, the year of the ACA’s passage.

Access to Affordable Care through Public Libraries

Source: Jenny S. Bossaller, The Library Quarterly: Information, Community, Policy, Volume 86 Number 2, April 2016
(subscription required)

From the abstract:
This article presents a study of activity that occurred in public libraries during early implementation of the Affordable Care Act (ACA). Data were collected through telephone interviews, using open-ended questions, with 72 public library employees between November 2013 and February 2014. The article is not a comprehensive or statistical study; rather, it demonstrates different ways that librarians were or were not helping people find out about ACA health-care coverage options in large and small libraries across the United States. The research found that library involvement was related to perceived community need and to activities of other groups in the city. Anomalies and various problems suggested during the interviews point to areas for future research.

Worker Opinions About Employee Benefits: Differences Among Millennials, Baby Boomers, and Generation X Have Implications for Plan Sponsors

Source: Paul Fronstin and Ruth Helman, Employee Benefit Research Institute, EBRI notes, Vol. 36 No. 12, December 2015

From the press release:
• Millennials are less likely than Baby Boomers and Gen Xers to report health insurance as the most important benefit they receive at work. Millennials are more likely than Baby Boomers or Gen Xers to report that they value life insurance and paid time off as the most important benefit.

• Millennials are less likely than Baby Boomers and Gen Xers to report that the benefits a potential employer offers are extremely important in their decision to accept or reject a job. Millennials are also more likely than Baby Boomers and Gen Xers to be open to non-traditional ways of obtaining benefits.

• Millennials are more likely than other workers to respond that they do not know about their benefits. Participation in various employee benefit programs is generally lower among Millennials than among Baby Boomers and Gen Xers.

Subsidies and Structure: The Lasting Impact of the Hill-Burton Program on the Hospital Industry

Source: Andrew P Chung, Martin S. Gaynor, Seth Richards-Shubik, National Bureau of Economic Research (NBER), NBER Working Paper No. w22037, February 2016
(subscription required)

From the abstract:
The hospital industry is one of the most important industries in the U.S., and industry structure can have profound effects on the functioning of markets. Using county-level panel data, we study the effect of public subsidies from the Hospital Survey and Construction Act of 1946, known as the Hill-Burton program, on hospital capacity, organization of the hospital industry, and utilization. We find that the program generated substantial increases in capacity and these changes were highly persistent, lasting well beyond twenty years. However the increases in capacity at non-profit and public hospitals were partially offset by reductions in capacity at for-profit hospitals. Nonetheless, we estimate that the Hill-Burton program accounted for a net increase of over 70,000 beds nationwide, which is roughly 17 percent of the total growth in hospital beds in the U.S. from 1948 to 1975. We also show that differences across counties in the number of hospital beds per capita were greatly reduced over this period. Differences between high and low income counties, rural and urban counties, and the South and the rest of the country fell substantially. We conclude that the program largely achieved its goals, and had substantial and long lasting effects on the hospital industry in the U.S..

Long-Term Care Insurance: Less Bang, More Buck

Source: Barbara Feder Ostrov, Kaiser Health News, March 17, 2016

….. Long-term care insurance was supposed to help the middle class ease the financial burden of expensive in-home or nursing home care that now can top $90,000 a year. Consumers were urged to buy policies in their 50s, because premiums rose the longer they waited. About 4.8 million people were covered by long-term care policies in 2014. But insurers botched just about every aspect of the policies they sold in the early days of the industry, said Joseph Belth, a retired professor of insurance at Indiana University known as one of the insurance industry’s toughest critics. They underestimated how long people would live and how long they’d need nursing home care — but overestimated how many people would drop their policies and how much interest insurers could earn on the premiums they banked. Hemorrhaging money, many insurers left the business. Those that remain are in financial trouble on their long-term care policies. They’re charging far more for new policies, and sharply raising the premiums of old ones. ….. As a result, many seniors nationwide face the same unpleasant choices as Klimenko: paying rising costs, scaling back coverage or dropping it altogether. ….

How Much Do Marketplace and Other Nongroup Enrollees Spend on Health Care Relative to Their Incomes?

Source: Linda J. Blumberg, John Holahan, Matthew Buettgens, Urban Institute & Robert Wood Johnson Foundation, Timely Analysis of Immediate Health Policy Issues, In Brief, December 21, 2015

From the abstract:
Despite the Affordable Care Act improving health insurance coverage and affordability for many, an increasing number of voices have drawn attention to high out-of-pocket costs and the affordability of marketplace insurance. High financial burdens relative to income can lower enrollment levels and compromise the ability of the ACA to reach its ultimate goals. We examine premiums and out-of-pocket costs, as well as total financial burdens for individuals with different characteristics enrolled in ACA-compliant nongroup coverage. We show that despite the financial assistance available, individuals across the income distribution who are ineligible for Medicaid can still face very high expenditures.

The Health Coverage Tax Credit (HCTC): In Brief

Source: Bernadette Fernandez, Congressional Research Service, CRS Report, R44392, February 18, 2016

Certain workers who have experienced job loss and retirees whose private pension plans were taken over by the Pension Benefit Guaranty Corporation (PBGC) may be eligible for the Health Coverage Tax Credit (HCTC). The tax credit’s purpose is to make the purchase of health insurance more affordable for eligible individuals. The HCTC has a sunset date of January 1, 2020. This report describes the eligibility criteria for the HCTC and the types of health insurance to which the tax credit may be applied. It briefly describes the administration of the HCTC program and receipt of the credit by eligible taxpayers. The report concludes with a summary of the HCTC’s statutory history.