Category Archives: Health Care

National Health Spending In 2013: Growth Slows, Remains In Step With The Overall Economy

Source: Micah Hartman, Anne B. Martin, David Lassman, Aaron Catlin, Health Affairs, published online before print December 2014
(subscription required)

From the abstract:
In 2013 US health care spending increased 3.6 percent to $2.9 trillion, or $9,255 per person. The share of gross domestic product devoted to health care spending has remained at 17.4 percent since 2009. Health care spending decelerated 0.5 percentage point in 2013, compared to 2012, as a result of slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care also contributed to the low overall increase.

Michigan: Baseline Report – State-Level Field Network Study of the Implementation of the Affordable Care Act

Source: Center for Healthcare Research & Transformation (CHRT) at the University of Michigan, Rockefeller Institute of Government, Brookings Institution, Fels Institute of Government, ACA Implementation Research Network, December 2014

The Center for Healthcare Research & Transformation (CHRT) at the University of Michigan has released a baseline report on Michigan’s implementation of the Affordable Care Act (ACA), which shows that the alternative approach to passing and implementing Medicaid expansion in Michigan — a state led by a Republican governor — can be a model for other states with bipartisan or Republican-led governments seeking Medicaid expansion. This is the most recent of the state reports of the 36-state ACA implementation network, a collaborative endeavor of the Nelson A. Rockefeller Institute of Government, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.
Press release

Immigrant Health Care Access and the Affordable Care Act

Source: Sanjay K. Pandey, Joel C. Cantor and Kristen Lloyd, Public Administration Review, Vol. 74 no. 6, November/December 2014
(subscription required)

From the abstract:
In spite of major coverage expansions under the Patient Protection and Affordable Care Act (ACA), a large proportion of immigrants will continue to remain outside the scope of coverage. Because various provisions of the ACA seek to enhance access, advancing knowledge about immigrant access to health care is necessary. The authors apply the well-known Andersen model on health care access to two measures—one focusing on perceptions of unmet health care needs and the other on physician visits during the last year. Using data from the New Jersey Family Health Survey, the authors find that prior to implementation of the ACA coverage expansions, immigrants in New Jersey reported lower levels of unmet health care needs despite poorer self-rated health compared with U.S.-born residents. The article concludes with a discussion of the use of Andersen model for studying immigrant health care access and the broader implications of the findings.

Local Government Strategies to Address Rising Health Care Costs

Source: Elizabeth Kellar, Christine Becker, Christina Barberot, Ellen Bayer, Enid Beaumont, Bonnie Faulk, Joshua Franzel, Mark Ossolinski, and Danielle Miller Wagner, Center for State and Local Government Excellence (SLGE) and University of Tennessee, December 2014

From the abstract:
Rising costs over the last decade have prompted many local governments to make changes to their health plans and strategies. Cost sharing, wellness program, and disease management initiatives are widely reported. Other changes cited include increased reliance on high-deductible plans, dependent eligibility audits, and altering retiree benefits.

Key findings:
– The top cost drivers of local government health care increases were increased claim costs (64 percent); prescription drugs (57 percent); an aging workforce (46 percent); insurance company price increases (45 percent) and federal health care policy (45 percent).
– Fifty-seven (57) percent of respondents increased cost sharing of premiums paid by employees and nearly half of respondents reported that their local governments changed the way health insurance is provided.
– Nineteen (19) percent of those reporting health plan changes shifted employees to a high-deductible plan with a health savings account and 14 percent established a health reimbursement arrangement.
– Disease management programs, on-site clinics, dependent eligibility audits, and regular review and rebidding of health care vendor contracts have achieved significant savings.
– Respondents reported that providing easy access to health services at work sites not only supports employee wellness, but also reduces employee absenteeism and health care costs.

State Expenditure Report (Fiscal 2012-2014 Data)

Source: National Association of State Budget Officers, 2014

This annual report examines spending in the functional areas of state budgets: elementary and secondary education, higher education, public assistance, Medicaid, corrections, transportation, and all other. It also includes data on the State Children’s Health Insurance Program and on revenue sources in state general funds.

The latest edition of NASBO’s State Expenditure Report finds that total state spending in fiscal 2014 is estimated to have grown at its fastest pace since before the recession, largely due to an increase in federal Medicaid funds as a majority of states chose to expand enrollment under the Affordable Care Act. Total state spending growth in fiscal 2013 was more modest; however, total state expenditure did return to positive growth following declines in fiscal 2012.

Assessing Alternative Modifications to the Affordable Care Act – Impact on Individual Market Premiums and Insurance Coverage

Source: Christine Eibner, Evan Saltzman, RAND Corporation, Research Reports, Document Number: RR-708-DHHS, 2014

From the abstract:
The goals of the Affordable Care Act (ACA) are to enable all legal U.S. residents to have access to affordable health insurance and to prevent sicker individuals (such as those with preexisting conditions) from being priced out of the market. The ACA also instituted several policies to stabilize premiums and to encourage enrollment among healthy individuals of all ages. The law’s tax credits and cost-sharing subsidies offer a “carrot” that may encourage enrollment among some young and healthy individuals who would otherwise remain uninsured, while the individual mandate acts as a “stick” by imposing penalties on individuals who choose not to enroll.

In this report, the authors use the COMPARE microsimulation model, an analytic tool that uses economic theory and data to predict the effects of health policy reforms, to estimate how eliminating the ACA’s individual mandate, eliminating the law’s tax credits, and combined scenarios that change these and other provisions of the act might affect 2015 individual market premiums and overall insurance coverage. Underlying these estimates is a COMPARE-based analysis of how premiums and insurance coverage outcomes depend on young adults’ propensity to enroll in insurance coverage.

The authors find that eliminating the ACA’s tax credits and eliminating the individual mandate both increase premiums and reduce enrollment on the individual market. They also find that these key features of the ACA help to protect against adverse selection and stabilize the market by encouraging healthy people to enroll and, in the case of the tax credit, shielding subsidized enrollees from premium increases. Further, they find that individual market premiums are only modestly sensitive to young adults’ propensity to enroll in insurance coverage, and ensuring market stability does not require that young adults make up a particular share of enrollees.

Moving the Needle: The Impact of the Affordable Care Act on LGBT Communities

Source: Kellan Baker, Laura E. Durso, Andrew Cray, Center for American Progress, November 2014

From the summary:
…..Under the Affordable Care Act, or ACA, however, financial assistance is available to help make coverage more affordable, and plans are not allowed to discriminate against people living with HIV or people who are lesbian, gay, bisexual, or transgender, or LGBT. ….

….. In order to better understand the degree to which the Affordable Care Act affects LGBT communities—particularly those who are potentially eligible either for Medicaid coverage or for financial assistance to purchase a plan through a health insurance marketplace—the Center for American Progress conducted research in 2013 that focused on the experiences of LGBT people with incomes less than 400 percent of the federal poverty level, or FPL. Among other findings, this research shows that one in three LGBT people with incomes less than 400 percent of the FPL were uninsured in 2013.

The research survey was updated and refielded in summer 2014 to assess the law’s success in reaching LGBT people who most need help to get coverage. The findings were astounding: By 2014, uninsurance among LGBT people with incomes less than 400 percent of the FPL had dropped from the 2013 rate of one in three—34 percent—to one in four—26 percent—uninsured. In short, over the single year that encompassed the first open enrollment period under the Affordable Care Act, the rate of uninsurance among LGBT people fell 24 percent.

This report looks in detail at the health insurance experiences of LGBT people with incomes less than 400 percent of the FPL in 2014, the first year after the full implementation of the ACA’s coverage expansion began with the start of open enrollment through the health insurance marketplaces in October 2013. Overall, the survey findings show that LGBT people in this income range have had enormous success in gaining access to new coverage options under the ACA. They also indicate, however, lingering issues that must be priorities for policy and advocacy activities in the 2014 open enrollment period and beyond, including:
· Enforcing LGBT nondiscrimination in access to insurance coverage
· Ensuring quality and comprehensiveness of coverage, especially for transgender people
· Raising awareness of the health reform law in LGBT communities
· Requiring LGBT inclusion in consumer outreach and education activities
· Providing regular LGBT cultural competency training for navigators and other enrollment assisters
· Collecting voluntary LGBT data collection in enrollment
· Strengthening the link between coverage and culturally appropriate care for LGBT people

Using Medicaid to Prevent Recidivism in States’ Corrections Systems

Source: Debra Miller, Council of State Governments, E-newsletter Issue #145, October 9, 2014

Since 1997, states have been able to bill for Medicaid-enrolled inmates who leave prisons or jails longer than 24 hours for health treatment in a hospital or nursing facility. That provision is an important but little-known exception to the federal prohibition on spending Medicaid funds for health services to inmates of state prisons and local jails, according to Dr. Nicole Jarrett, who spoke at September’s CSG Medicaid Leadership Policy Academy.

Open Enrollment 2 (OE2): What to Expect

Source: Mara Youdelman, National Health Law Program (NHeLP), Health Advocate, Vol. 31, November 2014

From the summary:
The second open enrollment period begins Nov. 15, 2014. While we are leaps and bounds from the road bumps experienced during the first enrollment period, we still have work to do. This edition of the Health Advocate walks through many of the challenges and concerns as we head into the second enrollment period.

San Francisco’s Pioneering Health Program Shows That Local Governments Can Help All Working Families

Source: Jake Martín Grumbach, Scholars Strategy Network, Basic Facts, November 2014

In an era of polarized politics and a deadlocked U.S. Congress, reformers determined to help working families are shifting efforts toward lower levels of government. This is what led to the passage and implementation of a local public health program called “Healthy San Francisco.” Financed in part by fees charged to employers who do not insure their workers, the San Francisco program has provided care to over 60,000 residents, about three quarters of the city’s uninsured population. Seeing it as a viable model, officials in Los Angeles have begun to replicate some aspects of this approach. In the past, conventional wisdom has assumed that cities cannot act alone to help working families but, along with urban minimum wage laws, universal urban health programs show what can be done.