Category Archives: Health Care

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update

Source: Rachel Garfield and Anthony Damico, Kaiser Family Foundation, Issue Brief, January 2016

From the summary:
One of the major coverage provisions of the Affordable Care Act (ACA) is the expansion of Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,724 for a family of three in 20151). This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for states.

As of January 2016, 19 states were not expanding their programs. Medicaid eligibility for adults in states not expanding their programs is quite limited: the median income limit for parents in 2016 is just 44% of poverty, or an annual income of $8,840 a year for a family of three, and in nearly all states not expanding, childless adults remain ineligible.2 Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits.

Variability and Limits of US State Laws Regulating Workplace Wellness Programs

Source: Jennifer L. Pomeranz, Andrea M. Garcia, Randy Vesprey, and Adam Davey, American Journal of Public Health, e-View Ahead of Print, April 14, 2016
(subscription required)

From the abstract:
We examined variability in state laws related to workplace wellness programs for public and private employers. We conducted legal research using LexisNexis and Westlaw to create a master list of US state laws that existed in 2014 dedicated to workplace wellness programs. The master list was then divided into laws focusing on public employers and private employers. We created 2 codebooks to describe the variables used to examine the laws. Coders used LawAtlasSM Workbench to code the laws related to workplace wellness programs.

Thirty-two states and the District of Columbia had laws related to workplace wellness programs in 2014. Sixteen states and the District of Columbia had laws dedicated to public employers, and 16 states had laws dedicated to private employers. Nine states and the District of Columbia had laws that did not specify employer type. State laws varied greatly in their methods of encouraging or shaping wellness program requirements.

Few states have comprehensive requirements or incentives to support evidence-based workplace wellness programs….
Related:
State Workplace Wellness Program Laws – Public Employers Map
Source: LawAtlas, 2016

Public and private employers are increasingly providing workplace wellness programs to support employee health, reduce costs, increase productivity, and enhance the attractiveness of the organization. Many states have adopted workplace wellness program laws that distinguish between public and private employers, and specify various requirements, such as the penalties and incentives that can be used to encourage employee participation, and tax credits that can be applied for employers that participate.
Depending on the type of program, federal or state law applies. Although a complex body of law related to federal preemption of state laws applies to workplace wellness programs, state law continues to apply to certain private employer programs and those offered by state and local governments. The existing state law varies, but the majority focus on private workplace wellness programs. This map identifies state laws dedicated to public workplace wellness programs, and the characteristics of those laws in effect in 2014.

State Workplace Wellness Program Laws – Private Employers Map
Source: LawAtlas, 2016

Public and private employers are increasingly providing workplace wellness programs to support employee health, reduce costs, increase productivity, and enhance the attractiveness of the organization. Many states have adopted workplace wellness program laws that distinguish between public and private employers, and specify various requirements, such as the penalties and incentives that can be used to encourage employee participation, and tax credits that can be applied for employers that participate.
Depending on the type of program, federal or state law applies. Although a complex body of law related to federal preemption of state laws applies to workplace wellness programs, state law continues to apply to certain private employer programs and those offered by state and local governments. The existing state law varies, but the majority focus on private workplace wellness programs. On this map, laws that did not specify employer type are grouped with laws directed at private employer programs because they likely apply to private employers in specific or limited circumstances. This map identifies state laws dedicated to private workplace wellness programs, and the characteristics of those laws in effect in 2014.

Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States

Source: Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, National Bureau of Economic Research (NBER), NBER Working Paper No. 22182, April 2016
(subscription required)

From the abstract:
The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 3.0 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those with incomes below the Medicaid eligibility threshold, non-whites, young adults, and unmarried individuals. We find some evidence that the Medicaid expansion partially crowded out private coverage among low-income individuals.

Health Care for Veterans: Answers to Frequently Asked Questions

Source: Sidath Viranga Panangala, Congressional Research Service, CRS Report, R42747, April 21, 2016

The Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA), operates the nation’s largest integrated health care delivery system, provides care to approximately 6.7 million unique veteran patients, and employs more than 311,000 full-time equivalent employees. …
This report covers the following topics:
Eligibility and Enrollment
Medical Benefits
Costs to Veterans and Insurance Collections

Five evils: Multidimensional poverty and race in America

Source: Richard Reeves, Edward Rodrigue, and Elizabeth Kneebone,Brookings Institution, April 2016

From the summary:
Poverty is about a lack of money, but it’s not only about that. As a lived experience, poverty is also characterized by ill health, insecurity, discomfort, isolation, and more. To put it another way: Poverty is multidimensional, and its dimensions often cluster together to intensify the negative effects of being poor.

In a new paper, Richard Reeves, Edward Rodrigue, and Elizabeth Kneebone examine the “clustering” of five dimensions of poverty—household income, education, concentrated spatial poverty, health insurance, and employment—within a large sample of the American population.

They find that almost 50 percent of the adult population suffers from at least one of the five disadvantages and that almost 25 percent have two or more disadvantages. But importantly, black and Hispanic adults with one disadvantage are more likely than their white peers to have more than one—or many—disadvantages.
Related:
Interactive

Medicare Primer

Source: Patricia A. Davis, Scott R. Talaga, Cliff Binder, Jim Hahn, Suzanne M. Kirchhoff, Paulette C. Morgan, Congressional Research Service, CRS Report, R40425, March 31, 2016

….This report provides a general overview of the Medicare program including descriptions of the program’s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes……

Regulating Healthcare Robots: Maximizing Opportunities While Minimizing Risks

Source: Drew Simshaw, Nicolas Terry, Kris Hauser, Mary Cummings, Richmond Journal of Law and Technology, Vol. 22 No. 3, 2016

From the abstract:
Demand for healthcare robots will likely increase in the coming years due to their effectiveness and efficiency, an aging population, the rising cost of healthcare, and the trend within the industry toward personalized medicine. This paper focuses on the issues of patient and user safety, security, and privacy as they relate to healthcare robotics, and specifically the effect of medical device regulation and data protection laws on robots in healthcare.

First, it examines the demand for robots in healthcare and assess the benefits that robots can provide. Second, it looks at the types of robots currently being used in healthcare, anticipates future innovation, and identifies the key characteristics of these robots that will present regulatory issues. Third, it examines the current regulatory framework within which these robots will operate, focusing on medical device regulation and data protection laws. Because we are likely to see health-related robots appearing in both conventional healthcare and consumer spaces, there will be regulatory disruption and the opportunity for regulatory arbitrage. This paper argues that the regulation of both must change.

In order to maximize robots’ potential and minimize risks to users, regulation will need to move towards some form of premarket review of robot “safety.” Such review, likely by the Food and Drug Administration (FDA), should include broad considerations of potential harms, including security. In the data protection sphere, existing sector-based limitations that lead to gaps between, for example, Federal Trade Commission and Department of Health and Human Services’ Office for Civil Rights oversight, should be eliminated so that both patient and consumer privacy and security interests can be better protected. A foundational regulatory framework for both medical devices and consumers that is attuned to safety, security, and privacy will help foster innovation and confidence in robotics and ensure that we maximize robotic potential in healthcare.

Views on Employment-based Health Benefits: Findings from the 2015 Health and Voluntary Workplace Benefits Survey

Source: Paul Fronstin, Ruth Helmanm Employee Benefit Research Institute (EBRI), EBRI Notes, Vol. 37 no. 3, March 2016

From the summary:
This Notes article reports workers’ opinions about employment-based health coverage, based on data from the 2015 Health and Voluntary Workplace Benefits Survey (WBS). It also examines 2013-2014 WBS data, as well as 1998-2012 data from the Health Confidence Survey (HCS). Both surveys were conducted by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates.

Most workers are satisfied with the health benefits they have now. One-half of those with employment-based health insurance coverage are extremely (12 percent) or very satisfied (38 percent) with their current plans, and 41 percent are somewhat satisfied. However, one-third of workers would change the mix of wages and health benefits: 14 percent say they would trade wages to get more health benefits, and 20 percent say they would surrender some health benefits for higher wages. Nearly one-half of workers report that they would give up a wage increase to maintain their current health coverage….

The Excise Tax on High-Cost Health Plans

Source: Stephen Blakely, Employee Benefit Research Institute (EBRI), EBRI Notes, Vol. 37 No. 2, March 2016

From the abstract:
In December 2015 Congress enacted a two-year delay in the controversial excise tax on high-cost health plans under the Affordable Care Act (ACA), postponing its effective date from 2018 to 2020 and making a number of other modest changes to the tax. Nevertheless, the tax remains wildly unpopular with private-sector sponsors of employee health programs, and its potential effects are widely debated — even though the general public (and most workers in general) have little awareness that the tax has been enacted by Congress and that its potential implementation could cause major changes to how they get health coverage and how much they pay. To further public debate over the issue, the nonpartisan Employee Benefit Research Institute (EBRI) held a policy forum on Dec. 10, 2015, attended by about a hundred health experts and other benefits professionals, to discuss “The Excise Tax on High-Cost Health Plans” — both to clarify what the tax would do and how employers and health-plan sponsors are reacting to it. This paper summarizes the presentations and discussions at that forum, including a review of the purposes, goals, and key provisions of the excise tax on health plans as it was included in the Affordable Care Act; efforts to repeal the tax; the perspective and reactions to the tax by a large employer; and the broader perspective in employer options and strategies in dealing with the excise tax. As private-sector health experts pointed out at the EBRI forum, despite the delay in the effective date of the so-called “Cadillac tax” on high-cost health plans, the tax has already been causing changes, as many employers have begun reducing benefits or shifting costs now to avoid the tax if and when it later goes into effect.

Private Long-Term Care Insurance: Not the Solution to the High Cost of Long-Term Care for the Elderly

Source: Lawrence A. Frolik, University of Pittsburgh – School of Law, Legal Studies Research Paper No. 2016-09, March 8, 2016

From the abstract:
Long-term care can be extremely expensive. As older Americans plan for financing care for their golden years, one option is to purchase a Long-Term Care Insurance (LTCI) policy. However, despite the potentially steep costs of long-term care, few elderly individuals actually purchase LTCI. This decision is rational for most elderly people. First, LTCI insures a risk that may never occur, as the majority of elderly Americans only need a year or less of long-term care. Second, Medicaid provides a publicly subsidized alternative to LTCI. An elderly person can rely on his or her savings to pay for care and then qualify for Medicaid if necessary. Third, the likely benefits payout is difficult for insurers to estimate, resulting in higher premiums for policyholders. Additionally, the growth of assisted living facilities, a far more attractive living situation than nursing homes, may incentivize elderly policyholders to begin claiming benefits sooner, which also results in increased insurance rates. The elimination period of LTCI policies, coupled with the unpredictability of the need for LTCI and a daily benefit amount that is unlikely to cover the full cost of a nursing home, further renders purchasing such a policy unappealing. One possible solution is redefining long-term care costs as a social, as opposed to an individual, problem and requiring all older Americans to purchase LTCI, a measure that could reduce the burden on Medicaid while ensuring that all elderly Americans are able to afford long-term care.