Category Archives: Health Care

Health Care Cost Containment Strategies Used In Four Other High-Income Countries Hold Lessons For The United States

Source: Mark Stabile, Sarah Thomson, Sara Allin, Seán Boyle, Reinhard Busse, Karine Chevreul, Greg Marchildon and Elias Mossialos, Health Affairs, Vol. 32 no. 4, April 2013
(subscription required)

From the abstract:
Around the world, rising health care costs are claiming a larger share of national budgets. This article reviews strategies developed to contain costs in health systems in Canada, England, France, and Germany in 2000–10. We used a comprehensive analysis of health systems and reforms in each country, compiled by the European Observatory on Health Systems and Policies. These countries rely on a number of budget and price-setting mechanisms to contain health care costs. Our review revealed trends in all four countries toward more use of technology assessments and payment based on diagnosis-related groups and the value of products or services. These policies may result in a more efficient use of health care resources, but we argue that they need to be combined with volume and price controls—measures unlikely to be adopted in the United States—if they are also to meet cost containment goals.

Some Families Who Purchased Health Coverage Through The Massachusetts Connector Wound Up With High Financial Burdens

Source: Alison A. Galbraith, Anna D. Sinaiko, Stephen B. Soumerai, Dennis Ross-Degnan, M. Maya Dutta-Linn and Tracy A. Lieu, Health Affairs, Web First, April 2013
(subscription required)

From the abstract:
Health insurance exchanges created under the Affordable Care Act will offer coverage to people who lack employer-sponsored insurance or have incomes too high to qualify for Medicaid. However, plans offered through an exchange may include high levels of cost sharing. We surveyed families participating in unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority, an exchange created prior to the 2010 national health reform law, and found high levels of financial burden and higher-than-expected costs among some enrollees. The financial burden and unexpected costs were even more pronounced for families with greater numbers of children and for families with incomes below 400 percent of the federal poverty level. We conclude that those with lower incomes, increased health care needs, and more children will be at particular risk after they obtain coverage through exchanges in 2014. Policy makers should develop strategies to further mitigate the financial burden for enrollees who are most susceptible to encountering higher-than-expected out-of-pocket costs, such as providing cost calculators or price transparency tools.

2013: What’s around the corner for the health care industry?

Source: Paul Keckley, Deloitte Center for Health Solutions, 2013

In 2013, major elements of the Affordable Care Act (ACA) are scheduled to be implemented, including health insurance exchange (HIX) open enrollment, and new rates for small groups. But health cost containment will be the central theme as the federal government tackles deficit reduction involving possible cuts to Medicare, Medicaid and other health programs, states wrestle with their portion of Medicaid funding and possible coverage expansion, and employers and consumers grapple with health inflation and increased insurance costs….

Healthcare Reform and the County Criminal Justice Systems

Source: Community Resources for Justice, April 5, 2013 and April 18, 2013

Description: Healthcare Reform and County Criminal Justice Systems, the first in a series, will provide an overview on how the upcoming changes in the California healthcare system will impact local criminal justice systems. Speakers will discuss the relationship between healthcare and the criminal justice population. There will be a comparison of healthcare today and healthcare in the years to come under the Affordable Care Act. Speakers will highlight efforts that counties can take today to further maximize existing resources and address the healthcare needs of the criminal justice population. …

Materials by session:
Health Care Reform and County Criminal Justice Systems: An introduction to health care reform and the opportunities and challenges for county criminal justice systems, April 5, 2013
Health Care Reform and County Criminal Justice Systems, April 18, 2013
Health Coverage Enrollment Toolkit, Californians for Safety and Justice
Public Health and Public Safety
Medicaid Coverage for Individuals in Jail Pending Disposition: Opportunities for Improved Health and Health Care at Lower Costs, Marsha Regenstein, PhD and Jade Christie Maples, Department of Health Policy, School of Public Health and Public Services, George Washington University. November 2012.
Who’s in Jail?, Community Oriented Correctional Health Services
Medicaid and Criminal Justice: The Need for Cross-System Collaboration Post Health Care Reform, Allison Hamblin, Stephen A. Somers, Sheree Neese-Todd and Roopa Mahadevan of the Center for Health Care Strategies, Inc.
Medicaid Expansion and The Local Criminal Justice System, Michael DuBose for American Jails MAgazine, November-December 2011
Healthcare for Today and Tomorrow
Health Care Reform & Medi-Cal: Looking to 2014, Len Finocchio, DrPH, Associate Director of California Department of Healthcare Services
Covered California Overview, David Panush Director External Affairs, Covered California
Framework Development
County Jails and the Affordable Healthcare Act: Enrolling Eligible Individuals in Health Coverage, NACo
Counties and Medi-Cal for Inmates: Current Rules/Future Considerations, Cathy Senderling-McDonald, CWDA

Retiree Healthcare Benefits: The Next Shoe to Drop?

Source: Liz Farmer, Governing, View blog, April 22, 2013

…Of course Kentucky isn’t the only state that’s patching over its retirement health payment holes with Silly Putty (although it is the only one Kim knows of that is paying off those bills today by issuing more debt for tomorrow). Most states and municipalities today are grappling with the growing cost of retiree health care, a problem highlighted now on balance sheets thanks to relatively new accounting rules that require governments to report their OPEB unfunded liabilities.

As of the end of fiscal 2012, many states’ OPEB unfunded liabilities are in the billions: California’s is more than $80 billion between its state, trial court and university system retirees; Illinois’ State Employees Group Insurance plan reports more than $33 billion in unfunded liabilities; and Maine’s three predominant plans combine for nearly $24 billion in unfunded liabilities (not including life insurance costs)….

Retirement And Medical Benefits: Who Has Both?

Source: Lindsay B. Kimbro and Michelle B. Mayfield, Beyond the Numbers, Pay & Benefits, Vol. 2 no. 10, April 2013

Employee compensation packages commonly include both wages and benefits. For decades, employee benefits have been used as part of the total compensation package to attract and retain highly qualified workers. Just as workers in various occupations receive different levels of pay, they also receive access to different types and combinations of employee benefits. This article uses March 2012 National Compensation Survey (NCS) data to examine private industry workers’ access to medical benefits, retirement benefits, and combinations of the two benefits, by major occupation group, wage category, part-time and full-time status, union and nonunion status, and establishment size. The study finds notable differences in the patterns of access to medical and retirement benefits—separately, and in combination—among the various worker groups….

…A worker’s bargaining status plays a role in access to benefits as well. Union workers generally have higher rates of access to benefits than their nonunion counterparts. Not only are employer costs for wages and salaries roughly $3 more per employee hour worked, on average, in the private sector ($23.17 per hour worked compared with $19.96 per hour worked), they also are more likely to have access to medical and retirement benefits, both separately and in combination.

Chart 4 shows the percent of workers with various benefit combinations by bargaining status. Union workers are more likely than nonunion workers to have access to both benefits. Twenty five percent of nonunion workers have no medical and no retirement, compared with only 4 percent of union workers. A study by the Employee Benefit Research Institute showed that the premiums paid for benefits “are higher in plans with union workers compared with plans that have no union workers,” and union workers “paid a smaller share of the premium through payroll deduction for family coverage in plans with at least some union workers (20 percent) as compared with plans with no union workers (31 percent).” Although union workers make up a relatively small proportion of workers in the private sector—about 7.2 percent in 2011, according to data from the Current Population Survey—through collective bargaining they generally are able to negotiate higher wages and benefits for the workers they represent….

Texas on the Brink

Source: Texas Legislative Study Group, March 2013

…In Texas today, the American dream is distant. Texas has the highest percentage of uninsured adults in the nation. Texas is dead last in percentage of high school graduates. Our state generates more hazardous waste and carbon dioxide emissions than any other state in our nation. If we do not change course, for the first time in our history, the Texas generation of tomorrow will be less prosperous than the generation of today. Without the courage to invest in the minds of our children and steadfast support for great schools, we face a daunting prospect. Those who value tax cuts over children and budget cuts over college have put Texas at risk in her ability to compete and succeed….

Mental Health, Substance Abuse, and Pregnancy: Health Spending Following the PPACA Adult-Dependent Mandate

Source: Paul Fronstin, Employee Benefit Research Institute, EBRI Issue Brief #385, April 2013

From the summary:
– The Patient Protection and Affordable Care Act (PPACA) requires group health plans that offer dependent coverage to make that coverage available to workers’ children until they reach age 26, regardless of student status, marital status or financial support by the employees.
– A number of studies found measurable increases in the percentage of young adults with employment-based coverage soon after the mandate took effect.
– It has been estimated that 3.1 million young adults have acquired health coverage as a result of this adult-dependent mandate (ADM) provision.
– Overall, 31 percent of employers enrolled adult-dependent children as a result of the mandate, although the percentage of employers enrolling adult dependents as a result of the mandate increased with firm size. Larger employers are much more likely than smaller ones to have enrolled young adults as a result of the ADM.
– With respect to the experience of the specific large employer examined in this analysis, following implementation of the mandate, health care spending increased by $2 million, representing 0.2 percent of total health care spending.
– Average spending in the ADM cohort was higher than in the comparison group. The ADM cohort used an average of $2,866 in 2011, 15 percent higher than the comparison group, which used $2,472 on average.
– The most interesting finding related to the types of health care services used by those in the ADM cohort. The ADM cohort was more likely to incur claims related to mental health, substance abuse, and pregnancy.
– The ADM cohort was more likely than the comparison group to use retail pharmacies rather than mail order. Eighty-three percent of the prescriptions filled by the ADM cohort and 74 percent of the prescriptions filled by the comparison group were filled in retail pharmacies.
– There were no notable differences between the ADM cohort and the comparison group when use of prescriptions was examined by therapeutic class. Overall, 23 percent of the prescriptions filled for the two groups were for contraceptives. Another 9 percent were for psychostimulants and antidepressants.

State-Level Trends in Employer-Sponsored Health Insurance: A State-by-State Analysis

Source: Julie Sonier, Brett Fried, Caroline Au-Yeung, Breanna Auringer, State Health Access Data Assistance Center (SHADAC), April 2013

From the Robert Wood Johnson Foundation summary:
Recent analysis of ESI coverage provides a baseline to facilitate monitoring Affordable Care Act expansions of public and private coverage in 2014.

This study from the Robert Wood Johnson Foundation-funded State Health Access Data Assistance Center (SHADAC) found that health insurance coverage from employer-sponsored insurance (ESI) “eroded substantially” from 1999/2000 to 2010/2011 (study period).

Key Findings:
– The percentage of nonelderly people with ESI declined 10.2 percentage points (PPs) from 69.7 percent to 59.5 percent over the study period while pubic coverage increased 3.1 PPs.
– While most states saw “significant declines” in ESI coverage, the range was wide—from New Hampshire (73.8% coverage) to New Mexico (48.0% coverage).
– ESI coverage varied by income. It fell less (2.8 PPs) for high-income groups (400% federal poverty level [FLP] or above) than for those with lower incomes (200 FPL or below) where the fall was 10.1 PPs.
– Nationally, the percentage of private-sector firms offering ESI fell from 58.9 percent to 52.4 percent (although the percentage of workers eligible for coverage at firms that offered ESI held steady). The take-up rate also fell from 81.8 percent to 76.3 percent. Small firms offering coverage declined (67.7% to 56.3%) while at large firms it remained essentially unchanged.
– Single-person premium costs doubled ($2,490 to $5,081); family premiums rose 125 percent ($6,415 to $14,447); employee contributions increased (17.5% to 20.8% of the total premium).