Category Archives: Health Care

The Uninsured in America: Estimates of the Percentage of Non-Elderly Adults Uninsured throughout Each Calendar Year, by Selected Population Subgroups and State Medicaid Expansion Status: 2013 and 2014

Source: Jessica P. Vistnes and Brandy J. Lipton, Agency for Healthcare Research and Quality, Statistical Brief #488, June 2016

Highlights:
The percentage of non-elderly adults ages 18-64, uninsured for the entire calendar year (“the uninsured rate”) declined from 18.8 percent (35.6 million adults) to 14.4 percent (27.4 million adults) between 2013 and 2014.
The uninsured rate declined between 2013 and 2014 for adults ages 18-35, 36-54, and 55-64 in both Medicaid expansion and non-expansion states. In states that expanded Medicaid, the decline was larger for adults ages 18-35, than for adults ages 55-64, narrowing the percentage point difference in the uninsured rates between these two age groups in 2014.
Uninsured rates declined between 2013 and 2014 for Hispanic, white, black and Asian non-elderly adults ages 18-64. The percentage point difference in the uninsured rates for Hispanic non-elderly adults and white non-Hispanic adults decreased between 2013 and 2014, overall and in Medicaid expansion states.

Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults

Source: Emily R. Adrion, Andrew M. Ryan, Amanda C. Seltzer, Lena M. Chen, John Z. Ayanian, Brahmajee K. Nallamothu, JAMA internal Medicine, Online First, June 27, 2016
(subscription required)

From the abstract:
Importance: Patients’ out-of-pocket spending for major health care expenses, such as inpatient care, may result in substantial financial distress. Limited contemporary data exist on out-of-pocket spending among nonelderly adults.

Objectives: To evaluate out-of-pocket spending associated with hospitalizations and to assess how this spending varied over time and by patient characteristics, region, and type of insurance.

Design, Setting, and Participants: A retrospective analysis of medical claims for 7.3 million hospitalizations using 2009-2013 data from Aetna, UnitedHealthcare, and Humana insurance companies representing approximately 50 million members was performed. Out-of-pocket spending was evaluated by age, sex, type of insurance, region, and principal diagnosis or procedure for hospitalized adults aged 18 to 64 years who were enrolled in employer-sponsored and individual-market health insurance plans from January 1, 2009, to December 31, 2013. The study was conducted between July 1, 2015, and March 1, 2016.

Main Outcomes and Measures: Primary outcomes were total out-of-pocket spending and spending attributed to deductibles, copayments, and coinsurance for all hospitalizations. Other outcomes included out-of-pocket spending associated with 7 commonly occurring inpatient diagnoses and procedures: acute myocardial infarction, live birth, pneumonia, appendicitis, coronary artery bypass graft, total knee arthroplasty, and spinal fusion.

Results: From 2009 to 2013, total cost sharing per inpatient hospitalization increased by 37%, from $738 in 2009 to $1013 in 2013, after adjusting for inflation and case-mix differences. This rise was driven primarily by increases in the amount applied to deductibles, which grew by 86% from $145 in 2009 to $270 in 2013, and by increases in coinsurance, which grew by 33% over the study period from $518 in 2009 to $688 in 2013. In 2013, total cost sharing was highest for enrollees in individual market plans and consumer-directed health plans. Cost sharing varied substantially across regions, diagnoses, and procedures.

Conclusions and Relevance: Mean out-of-pocket spending among commercially insured adults exceeded $1000 per inpatient hospitalization in 2013. Wide variability in out-of-pocket spending merits greater attention from policymakers.

PHI State Data Center

Source: Paraprofessional Healthcare Institute, 2016

From the blog post:
PHI recently updated the PHI State Data Center, the first web-based tool to provide comprehensive, state-by-state profiles of the direct-care workforce — one of the largest and fastest-growing workforces in the nation.

Using Current Population Survey (CPS) data collected from 2012 to 2014 and Occupational Employment Statistics (OES) from 2015, PHI released updates to the following areas:
– trends in wages for home health aides, personal care aides, and nursing assistants
– information on health insurance coverage rates
– worker reliance on public assistance

Key Findings
According to the most recent OES data, 4.4 million direct-care workers were employed nationwide in 2015, an increase of over 125,000 workers from the previous year. Despite increasing demand for paid caregivers, inflation-adjusted wages have fallen by 4 percent over the past 10 years, from an average of $11.60 per hour in 2005 to $11.08 per hour in 2015.

There is some good news, however. The downward trend in wages, which began in 2009, finally ended in 2014. Due in part to successful wage initiatives in some states — including increases to the minimum wage — inflation-adjusted wages rose on average $0.27 from 2014 to 2015.

Still, nearly half (48 percent) of direct-care workers rely on public assistance, including Medicaid (39 percent) and nutrition assistance (31 percent), according to the CPS…..

“Who is a Veteran?” — Basic Eligibility for Veterans’ Benefits

Source: Scott D. Szymendera, Congressional Research Service, R42324, May 25, 2016

The U.S. Department of Veterans Affairs (VA) offers a broad range of benefits to U.S. Armed Forces veterans and certain members of their families. Among these benefits are various types of financial assistance, including monthly cash payments to disabled veterans, health care, education, and housing. Basic criteria must be met to be eligible to receive any of the benefits administered by the VA.

This report examines the basic eligibility criteria for VA administered veterans’ benefits, including the issue of eligibility of members of the National Guard and reserve components….

2016 Employee Benefits: Looking Back at 20 Years of Employee Benefits Offerings in the U.S.

Source: Society for Human Resource Management (SHRM), 2016

From the overview:
This is the 20th anniversary edition of SHRM’s annual Employee Benefits research report, which looks at benefits prevalence and trends in the U.S. Comparisons were made with the 1996 data where possible, as well as over the past five years.
– 88% of organizations offered professional membership benefits in 2016, a 23 percentage point increase compared with 1996.
– Over the past year, the percentage of organizations offering health savings accounts increased from 43% to 50%.
– Compared with five years ago, more organizations are offering monetary bonus benefits such as employee referral bonuses, spot/bonus awards, sign-on bonuses for executives and nonexecutives, as well as retention bonuses for nonexecutives.
– Telecommuting benefits have seen a threefold increase over the past two decades, from 20% in 1996 to 60% in 2016.
Related:
Executive Summary
Overview of Paid Leave Benefits

New Estimates of Offer and Take-up of Employer-Sponsored Insurance

Source: Joelle Abramowitz, Brett O’Hara, U.S. Census Bureau, Working Papers, June 2016

These research files on offer and take-up of employer-sponsored health insurance coverage are based on new questions asked in the 2014 & 2015 CPS ASEC. …. This analysis uses new questions in the Current Population Survey Annual Social and Economic Supplement to examine rates of offer and take-up of employer-sponsored health insurance over early 2014 and early 2015, as well as reasons reported for why individuals did not enroll. We find increases in offer and eligible rates of 0.5 and 0.9 percentage points, respectively, and a decrease in the take-up rate of 1.5 percentage points, while the coverage rate remained stable. We further find an increase in the proportion of workers covered by another plan and decreases in the proportions eligible for coverage but having a pre-existing condition, employed as contract or temporary employees not allowed in the plan, and who have not yet worked for an employer long enough…

Medicaid Expansion Producing State Savings and Connecting Vulnerable Groups to Care

Source: Jesse Cross-Call, Center on Budget and Policy Priorities, June 15, 2016

From the summary:
Health reform’s Medicaid expansion has produced net budget savings for many states, new data show, and states such as Arkansas, Kentucky, Louisiana, and New Jersey expect continued net savings in coming years, even after they begin paying a modest part of the expansion’s cost. In part, this is because the expansion has lessened the burden on a patchwork of largely state-funded programs that connect people who are experiencing homelessness, have substance use disorders, or have other serious needs with critical health care services.

Medicaid expansion is a good deal for states financially, as the federal government pays the entire cost of covering the new Medicaid enrollees through this year and no less than 90 percent of the cost thereafter. In expansion states there is now less demand for targeted Medicaid programs that serve low-income people with specific health conditions (such as certain women with breast and cervical cancers) but are funded at the state’s regular, lower matching rate, and for health programs that are entirely state-funded such as mental and behavioral health programs. Expansion states also are collecting more revenue from their existing taxes on health plans and providers, such as the managed care plans that serve Medicaid beneficiaries in many states, which have experienced a surge in enrollment due to expansion. The combination of these factors has produced savings for many state budgets.

Women And The Zika Virus: Smart Questions And A Few Solid Answers

Source: Shefali Luthra, Kaiser Health News, June 13, 2016

….. What’s the danger? A lot is up in the air, since there’s not a ton of research on the virus. Here’s a quick breakdown of the smart questions to ask and what we do actually know.
• I’m a woman of childbearing age. What if I get Zika? …..
• I am pregnant. What steps should I take to protect myself? …..
• I went somewhere where Zika-carrying mosquitoes have been detected, but I feel fine. Can I carry on as normal? …..
• I have Zika, and I’m pregnant. What do I do? …..
• This is scary, and it’s a lot of information. How else can I stay up to date? …..

Related:
Gaps In Women’s Health Care May Derail Zika Prevention In Texas, Florida
Source: Shefali Luthra, Kaiser Health News, June 14, 2016

The Cost of ACA Repeal

Source: Matthew Buettgens, Linda J. Blumberg, John Holahan, and Siyabonga Ndwandwe, Urban Institute & RWJF, In Brief, June 2016

Six years after its enactment, many are still calling for the repeal of the Affordable Care Act (ACA). In January 2016, Congress passed a bill for the first time, repealing the ACA without a replacement, but this was vetoed by the president. Because considerable controversy exists among ACA opponents on what should replace the ACA, the prospect of repeal without replacement is real and merits analysis. In this brief, we compare future health care coverage and costs with the ACA in place and with the law repealed.

We find that ACA repeal would reduce federal government spending on health care for the nonelderly, which appears to be one of the goals of those advocating repeal, by $90.9 billion in 2021 and $927 billion between 2017 and 2026. That represents a decrease of 21.1 percent. However, that reduction comes at a cost in other areas:

• The number of uninsured people would rise by 24 million by 2021, an increase of 81 percent.
• 81 percent of those losing coverage would be in working families, around 66 percent would have a high school education or less, 40 percent would be young adults, and about 50 percent would be non-Hispanic whites.
• There would be 14.5 million fewer people with Medicaid coverage in 2021.
• Approximately 9.4 million people who would have received tax credits for private health coverage would no longer receive assistance.
• State spending would increase by $68.5 billion between 2017 and 2026 as reductions in Medicaid spending would be more than offset by increases in uncompensated care.
• Many states have reported net budget savings as a result of expanding Medicaid and would experience budget shortfalls if the ACA were repealed.
• Significantly less health care would be provided to modest- and low- income families

Medicaid Expansion Can Have Impacts Beyond State Borders

Source: Mattie Quinn, Governing, June 10, 2016

One state’s rejection of Medicaid expansion can hurt health-care systems in another state, according to a new study. ….

….One FQHC reported having an end-of-year loss of $2.5 million before its state expanded Medicaid. The very next year, after expansion, it had a surplus of $2.5 million. This extra money can be the difference between investing in health infrastructure projects or being forced to lay people off, according to Paul Taylor, CEO of Ozarks Community Hospital system, a safety-net provider with clinics in both Arkansas (an expansion state) and Missouri (a nonexpansion state).

In the case of Ozarks Community Hospital systems, Missouri’s rejection of Medicaid expansion hurt Arkansas.

“I had to cut 100 full-time employees in both states because of the losses in Missouri. If I hadn’t done that, the whole system would be endangered,” said Taylor. “Missouri is benefitting from Arkansas’ expansion simply because we’ve been able to continue operations. It’s been a very real, horrific experiment to live through. But at least we are holding on.”

There’s also a medical brain-drain occurring in states that chose not to expand. According to the report, doctors are increasingly worried about layoffs and cuts in nonexpansion states and moving to places with more opportunities.

According to the Georgetown researchers, this is an example of two health-care systems existing in America…..
Related:
Beyond the Reduction in Uncompensated Care: Medicaid Expansion Is Having a Positive Impact on Safety Net Hospitals and Clinics
Source: Adam Searing and Jack Hoadley, Georgetown University Center for Children and Families, June 2016

From the summary:
More than two years after the onset of expanded Medicaid coverage, significant differences are emerging between states that opted to expand Medicaid and those that did not. This report contains the findings of telephone interviews with eleven leaders of hospital systems and federally qualified health centers (FQHCs) in seven states. Three of the states where we conducted interviews had not expanded Medicaid (Missouri, Tennessee, and Utah) while the other four states had expanded Medicaid effective in 2014 (Arkansas, Colorado, Kentucky, and Nevada). The authors picked expansion and non-expansion states with common borders in order to better compare state experiences. They found the benefits of Medicaid expansion have been felt beyond the walls of the health care facilities and have had positive ripple effects throughout the community.