Category Archives: Health Care

Health Care Spending and Efficiency in the U.S. Department of Veterans Affairs

Source: David I. Auerbach, William B. Weeks, Ian Brantley, RAND Corporation, RR-285-MTF, 2013

From the abstract:
In its 2013 budget request, the Obama administration sought $140 billion for the U.S. Department of Veterans Affairs (VA), 54 percent of which would provide mandatory benefits, such as direct compensation and pensions, and 40 percent of which is discretionary spending, earmarked for medical benefits under the Veterans Health Administration (VHA). Unlike Medicare, which provides financing for care when its beneficiaries use providers throughout the U.S. health care system, the VHA is a government-run, parallel system that is primarily intended for care provision of veterans. The VHA hires its own doctors and has its own hospital network infrastructure. Although the VHA provides quality services to veterans, it does not preclude veterans from utilizing other forms of care outside of the VHA network — in fact, the majority of veterans’ care is received external to the VHA because of location and other system limitations. Veterans typically use other private and public health insurance coverage (for example, Medicare, Medicaid) for external care, and many use both systems in a given year (dual use). Overlapping system use creates the potential for duplicative, uncoordinated, and inefficient use. The authors find some suggestive evidence of such inefficient use, particularly in the area of inpatient care. Coordination management and quality of care received by veterans across both VHA and private sector systems can be optimized (for example, in the area of mental illness, which benefits from an integrated approach across multiple providers and sectors), capitalizing on the best that each system has to offer, without increasing costs.

2013 National Health Insurer Report Card

Source: American Medical Association, 2013

From the press release:
Patients are responsible for nearly one-quarter of the medical bill, according to the findings released today from the AMA’s sixth annual check-up of health insurers and their patterns for processing and paying medical claims. For the first time, the AMA’s National Health Insurer Report Card examined the portion of health care expenses that patients are responsible for through copays, deductibles and coinsurance. During Feb. and March of this year, patients paid an average 23.6 percent of the amount that health insurers set for paying physicians.

Private Health Insurance: The Range of Base Premiums in the Individual Market by State in January 2013

Source: U.S. Government Accountability Office, GAO-13-712R, July 23, 2013

From the summary:
GAO reported the range of base premiums prior to underwriting for health insurance in the individual market that were displayed on the Plan Finder in the month of January 2013 for each of the 50 states and the District of Columbia. The base premiums displayed on the Plan Finder reflected information from data submitted by insurers to the Center for Consumer Information and Insurance Oversight (CCIIO) within the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS). Included were ranges for six different types of consumers: 1) 30-year-old, single, nonsmoking male; 2) 30-year-old, single, smoking male; 3) 30-year-old, single, nonsmoking female; 4) 30-year-old, single, smoking female; 5) a family of 4 with 2 parents, aged 40; and 6) a couple, aged 55. GAO also reported on base premiums prior to underwriting for an urban and rural zip code in four select states, one from each census region. The states included: Illinois, Nevada, Pennsylvania, and Texas.

Update: State Action Round-Up on Affordable Care Act Implementation

Source: Tracy Garber and Sara Collins, Commonwealth Fund blog, July 19, 2013

In less than six months, the major health insurance provisions of the Affordable Care Act will go into effect. This is the second post in a series that offers an overview of action on the new state health insurance marketplaces, or exchanges, and expansion in eligibility for the Medicaid program.

Insurance Marketplace Updates:
Beginning on October 1, 2013, Americans who do not have affordable health benefits through a job will be able to go to a new health insurance marketplace in their state and enroll in a private health plan. Adults with annual incomes up to 400 percent of poverty ($45,960 for an individual and $94,200 for a family of four) will be eligible for premium tax credits to help reduce the cost of coverage. In most states, companies with 50 or fewer employees will also be able to select plans through their state’s small-business marketplaces.

Currently, 16 states and the District of Columbia intend to operate a state-based marketplace, while the remaining 34 states will have a federally facilitated marketplace. Seven of these 34 states will conduct plan management activities and/or consumer assistance and outreach functions in a state–federal partnership model. Another seven of the 34 will conduct plan management activities only, and one, Utah, will operate the small-business marketplace while the federal government operates the individual marketplace.

Here is a list of recent state and federal activity. …

Coverage of Medicaid Preventive Services for Adults – A National Review

Source: Sara Wilensky, Elizabeth Gray, George Washington University, November 2012

There was significant variation among states in which services were covered under Medicaid for non‐elderly, non‐pregnant adults. While some research has been published examining Medicaid coverage of select preventive services, there has not been a comprehensive look at state‐level Medicaid coverage of preventive services for adults. This study is intended to provide a better understanding of Medicaid coverage of preventive services for adults in the current state programs, help guide federal policymakers as they make decisions about the criteria qualifying a state for the FMAP increase, and inform state policy makers as they consider the level of preventive benefits and services to offer should they expand Medicaid in 2014….
Existing Medicaid Beneficiaries Left Off The Affordable Care Act’s Prevention Bandwagon
Source: Sara E. Wilensky, Elizabeth A. Gray, Health Affairs, Vol. 32 no. 7, July 2013
(subscription required)

Delay in Implementation of Potential Employer Penalties Under ACA

Source: Janemarie Mulvey, Bernadette Fernandez, Annie L. Mach, Congressional Research Service, CRS Report for Congress, R43150, July 16, 2013

…On July 2, 2013, the Obama Administration announced that it is going to delay, until 2015, enforcement and associated reporting requirements relating to potential employer penalties under ACA. On July 11, 2013, the IRS released Notice 2013-45, which provided more detailed information on this transitional relief. According to the IRS notice, this transition relief will provide additional time for input from employers and other reporting entities in an effort to simplify information reporting consistent with effective implementation of the law.

This delay may have implications for an individual’s health insurance coverage and eligibility for tax assistance provided through the exchanges. One potential impact of a delay in the enforcement of potential employer penalties may be a lower than projected number of “large” employers offering health insurance coverage. This may result in a larger than projected increase in the number of workers eligible for premium tax credits in the exchanges in 2014 and an increase in the number of uninsured. However, while measurement of the magnitude of this effect is beyond the scope of this paper, one recent study found that a delay may not have a significant effect on the employer-sponsored health insurance coverage. The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) have not yet completed an analysis of the impact that the Administration’s announcement and other recently issued final rules will have on spending and revenues under current law…

At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint

Source: Diana Scully, Eunhee (Grace) Cho, John Michael Hall, Kelsey Walter, Jenna Walls, Wendy Fox-Grage, Kathleen Ujvari
AARP Public Policy Institute, #2013-16, July 2013

From the abstract:
Tight fiscal budgets and increasing demand for publicly funded long-term services and supports (LTSS) are putting pressure on states to transform their systems of care for older people and adults with disabilities. Many states are beginning to implement Affordable Care Act LTSS options that increase access to Medicaid home and community-based services, but non-Medicaid aging and disability funding has either decreased or remained flat in most states.
See also:
In Brief

Monetary Costs of Dementia in the United States

Source: Michael D. Hurd, Paco Martorell, Adeline Delavande, Kathleen J. Mullen, and Kenneth M. Langa, New England Journal of Medicine, Vol. 368 No. 14, April 4, 2013

From the abstract:
Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase…. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers…. The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost…

State Decisions on Health Insurance Exchanges and the Medicaid Expansion, as of June 20, 2013

Source: Kaiser Family Foundation, State Health Facts, June 20, 2013

United States:
– Status of State Exchange Decision: 17 Declared State-based Exchange; 7 Planning for Partnership Exchange; 27 Default to Federal Exchange
– Current Status of Medicaid Expansion Decision: 24 Moving Forward at this Time; 21 Not Moving Forward at this Time; 6 Debate Ongoing

Data are as of June 20, 2013. It is important to note that per CMS guidance, there is no deadline for states to implement the Medicaid expansion. Requirements for legislation to implement the Medicaid expansion vary across states; some state will require authorizing language and/or budgetary authority to implement the expansion while others will not.

Coverage through the exchanges will begin in every state on January 1, 2014, with enrollment beginning October 1, 2013. States can elect to build a fully state-based exchange, enter into a state-federal partnership exchange, or default into a federally-facilitated exchange. The Affordable Care Act (ACA) directs the Secretary of Health and Human Services (HHS) to establish and operate a federally-facilitated exchange in any state that is not able or willing to establish a state-based exchange. In a federally-facilitated exchange, HHS will perform all exchange functions. States entering into a state-federal partnership exchange may administer plan management functions, in-person consumer assistance functions, or both, and HHS will perform the remaining exchange functions.

The ACA expands Medicaid coverage for most low-income adults to 138% of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012). Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. For additional information on the cost and coverage implications of the Medicaid expansion click here.

Health Reform: What Next?

Source: Alice M. Rivlin, Public Administration Review, Early View, Article first published online: 6 June 2013
(subscription required)

From the abstract:
The political rhetoric of the 2012 election suggested that Americans are deeply split over how to deliver and pay for health care. In fact, however, the election may have cleared the way for substantial reforms in health care delivery that will gradually enable the United States to finance effective health care for almost everyone at a sustainable cost. The election affirmed for the first time that almost everyone in the United States will have health insurance coverage and put to rest the idea that voters will tolerate radical change in the complex patchwork of health care financing that has evolved in the United States. The tasks remaining are improving the quality of health care delivered by increasing care coordination and reducing the growth of costs by moving away from fee-for-service delivery toward rewarding quality and value. These challenges are daunting but less ideologically fraught than health coverage expansion.