Category Archives: Health Care

The Cost of Employer Insurance Is a Growing Burden for Middle-Income Families

Source: Sara R. Collins and David C. Radley, Commonwealth Fund, December 7, 2018

Recent national surveys show health care costs are a top concern in U.S. households. While the Affordable Care Act’s marketplaces receive a lot of media and political attention, the truth is that far more Americans get their coverage through employers. In 2017, more than half (56%) of people under age 65 — about 152 million people — had insurance through an employer, either their own or a family member’s. In contrast, only 9 percent had a plan purchased on the individual market, including the marketplaces.

In this brief, we use the latest data from the federal Medical Expenditure Panel Survey–Insurance Component (MEPS–IC) to examine trends in employer premiums at the state level to see how much workers and their families are paying for their employer coverage in terms of premium contributions and deductibles. We examine the size of these costs relative to income for those at the midrange of income distribution. The MEPS–IC is the most comprehensive national survey of U.S. employer health plans. It surveyed more than 40,000 business establishments in 2017, with an overall response rate of 65.8 percent…..

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Lone Medicaid Expansion Defeat Offers Lessons for Other States

Source: Michael Ollove, Stateline, December 17, 2018

Perhaps the chief takeaway from the rejected citizen initiative to expand Medicaid in Montana last month is this: Be careful when you poke a giant.

Montana was one of four red states with Medicaid expansion on the ballot, and the only one where it failed. And the reason why, many close observers both inside and outside of the state agree, almost certainly came down to a tactical decision to link expansion to an increase in the state’s tobacco tax.

Supporters thought that strategy would boost their effort with voters, but it attracted Big Tobacco into the fight, along with the $17.2 million it spent, much of it on a television advertising blitz. Opponents raised nearly $19 million to defeat the measure, finance reports filed with the state show.

Proponents, with about $9.7 million to spend, simply couldn’t keep up….

Health Care Providers’ Credit Quality To Suffer If ACA Lawsuit Ruling Is Not Overturned

Source: S&P Global Ratings, December 17, 2018
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Last week a federal judge in Texas struck down the Affordable Care Act as unconstitutional in a lawsuit brought by 20 state attorneys general. In S&P Global Ratings’ view, if this ruling is not overturned the credit quality of many health care providers, insurers, and states could be hurt….

State and Local Governments’ Fiscal Outlook: 2018 Update

Source: U.S. Government Accountability Office, GAO-19-208SP, December 13, 2018

From the summary:
What’s the prognosis for the fiscal health of state and local governments across the nation?

Our annual outlook suggests the sector will have an increasingly tough time covering their bills over the next 50 years. Our model shows both revenue and spending will increase; however, spending will rise faster. Revenues may be insufficient to sustain the amount of government service currently provided.

Our model also suggests health care costs will largely drive the spending increases—in particular, Medicaid spending and spending on health benefits for state and local government employees and retirees.
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Did California Paid Family Leave Impact Infant Health?

Source: Ariel Marek Pihl, Gaetano Basso, Journal of Policy Analysis and Management, Volume 38 Issue 1, Winter 2019
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From the abstract:
The effects of paid parental leave policies on infant health have yet to be established. In this paper we investigate these effects by exploiting the introduction of California Paid Family Leave (PFL), the first program in the U.S. that specifically provides working parents with paid time off for bonding with a newborn. We measure health using the full census of infant hospitalizations in California and a set of control states, and implement a differences‐in‐differences approach. Our results suggest a decline in infant admissions, which is concentrated among those causes that are potentially affected by closer childcare (and to a lesser extent breastfeeding). Other admissions that are unlikely to be affected by parental leave do not exhibit the same pattern.

Chronic Medical Conditions in Criminal Justice Involved Populations

Source: Amy J. Harzke and Sandi L. Pruitt, Journal of Health and Human Services Administration, Vol. 41 No. 3, 2018
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From the abstract:
Nationally representative data collected by the Bureau of Justice Statistics (BJS) have shown increasing and elevated prevalence of a number of non-infectious chronic medical conditions in criminal justice populations relative to the non-institutionalized population. Prevalence of these conditions, including hypertension and arthritis, are especially high among elderly and female prisoners and jail inmates. State- and site- specific prevalence estimates, however, have revealed patterns that are somewhat inconsistent with BJS national data. We summarize the extant literature regarding prevalence of chronic medical conditions in U.S. prison and jail settings, determinants of these conditions across the phases of criminal justice involvement, and potential opportunities for reducing and managing the burden of chronic medical conditions in criminal justice populations. We provide research and policy recommendations for improving measurement of the burden of chronic medical conditions in criminal justice populations, provision of healthcare in correctional settings, and post-release continuity of care and community reentry.

Institutional Design of the ACA Health Insurance Exchanges: Factors Affecting Policy Implementation In State Administration

Source: Shihyun Noh and Christian L. Janousek, Journal of Health and Human Services Administration, Vol. 41 No. 2, Fall 2018
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From the abstract:
In state implementation of the Affordable Care Act (ACA) health insurance exchanges, sixteen states decided to create and administer their own exchanges, determining the institutional location of the exchanges. This institutional design of implementing organizations affects aspects of state policy implementation of the health exchanges, reflecting the intentions of state officials to exert control over the administration of operations and other decisions such as funding sources. This research examines whether state decisions regarding agency assignment of the ACA health exchanges were associated with political, economic, and historical-cultural explanations. This study provides evidence that, in the decision of the location of health insurance exchanges, state officials were influenced by the factors of state budget shortfalls and state histories of creating independent agencies, but not by divided government, compound divided government and state personnel capacity.

Rising U.S. States’ OPEB Liabilities Signal Higher Costs Ahead

Source: S&P Global Ratings, November 28, 2018
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Other postemployment benefit (OPEB) liabilities, which consist primarily of retiree health care plans, are a growing concern for certain states’ credit quality and require attention to control higher future costs. Total unfunded state OPEB liabilities have increased significantly for the third year in a row, according to S&P Global Ratings’ latest survey of U.S. states.