Category Archives: Health Care

Employer and Worker Contributions to Health Savings Accounts and Health Reimbursement Arrangements, 2006-2011

Source: Paul Fronstin, Employee Benefit Research Institute, EBRI Notes, Vol. 33, No. 2, February 2012

Enrollment in health savings accounts (HSAs) and heath reimbursement arrangements (HRAs) continues to grow, but contribution patterns to these account-based health plans are changing, according to a new report from EBRI. Annual contributions from employer have fallen since 2008, while contributions from individuals have gone up.
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The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System

Source: Sara R. Collins, Ruth Robertson, Tracy Garber, and Michelle M. Doty, Commonwealth Fund, Issue Brief, February 2012

The new Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults finds nearly three of five adults in families earning less than 133 percent of the federal poverty level were uninsured for a time in 2011; two of five were uninsured for one or more years. Low- and moderate-income adults who were uninsured during the year were much less likely to have a regular source of health care than people in the same income range who were insured all year. In addition, uninsured lower-income adults were more likely than insured adults in the same income group to cite factors other than medical emergencies as reasons for going to the emergency room. These included needing a prescription drug, not having a regular doctor, or saying that other places cost too much. The Affordable Care Act will substantially narrow these inequities through an extensive set of affordable coverage options starting in 2014.
See also:
Chartpack (PDF)
Chartpack (PPT)
News Release (PDF)

Benefits Design and Delivery – A New Era

Source: Don Heilman, IPMA-HR News, Vol. 78 no. 1, January 2012
(subscription required)(scroll down)

Governmental employers are faced with many challenges in managing benefits in today’s environment. Among those challenges: static/decreasing revenues, increasing costs, future/unfunded liabilities, workforce planning and health care reform–not to mention increasing public scrutiny….[T]he benefits configuration creating many of the challenges is most valued by the baby boomers that are both contributing to the costs and who are entering their retirement phase. These employees in turn will be replaced with an employee population with a different level of expectations and values elated to benefits, and for that matter, total compensation.

Viewpoint: Lessons learned while adjusting retiree health benefits

Source: Lynna Soller and Steve Burrows, American City and County, Vol. 127 no. 1, January 2012

For many years, Tempe, Ariz., provided active and retired employees — about 2,450 individuals — with a generous health plan at little or no cost. But recently, the city faced up to a hard reality: that plan simply was not sustainable.

Tempe officials had to figure out how to make good on retiree medical benefit promises in a sluggish economy marked by staggering deficits, relentless health care inflation and growing numbers of retirees. It was a huge challenge to design a plan that would stem the fiscal bleeding, be fair to all parties and that could be communicated in a clear, concise way. We had our ups and downs along the way. In the end, however, by working with retirees and unions, we achieved a consensus and achieved a long-term solution.

Here are seven lessons we learned that may be instructive to other cities and counties contemplating reform of their retiree benefits plans:

A Fatter Butt Equals a Skinnier Wallet: Why Workplace Wellness Programs Discriminate Against the Obese and Violate Federal Employment Law

Source: Steven C. Sizemore, Wyoming Law Review, 2011
(subscription required)

This comment examines the complicated nature of obesity in America to ascertain whether workplace wellness programs requiring the disclosure of legally protected genetic information discriminate against the obese and violate federal employment law. To accomplish this, the background section discusses the facts behind America’s alleged obesity epidemic in an attempt to address some of the societal issues underpinning America’s growing concern with obesity and the workplace wellness program solution. Following a discussion of the relevant sections of the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), this comment analyzes whether the ADA and GINA permit employers to provide discounts to the non-obese which results in charging the obese more for the same insurance benefits. This comment concludes Patient Protection and Affordable Care Act’s (PPACA) sanction of workplace wellness programs discriminates against the obese and violates the ADA and GINA by unequally allocating health insurance benefits among employees and requiring the disclosure of statutorily protected genetic information.

While workplace wellness programs provide a multitude of benefits for employers and their employees, ultimately such programs discriminate against the obese through the unequal distribution of health insurance premiums and violate federal employment law by compelling the disclosure of legally protected information. As a result, PPACA’s endorsement of workplace wellness through awarding grants to implement workplace wellness programs discriminates against the obese and violates federal employment law.

The Impact of PPACA on Employment-Based Health Coverage of Adult Children to Age 26

Source: Paul Fronstin, Employee Benefit Research Institute, EBRI Notes, Vol. 33, No. 1, January 2012

From the press release:
The new federal insurance law has increased the health insurance coverage of adult children between 2009 and 2011…

…To determine whether the coverage mandate had an effect, EBRI examined data from two U.S. Census Bureau surveys (the Current Population Survey, CPS, and the Survey of Income and Program
Participation, or SIPP), as well as from the National Health Interview Survey (NHIS) by the Centers for Disease Control.

The data indicated:
– The percentage of persons ages 19‒ 25 with employment-based coverage as a dependent increased from 24.7 percent in 2009 to 27.7 percent in 2010, according to the CPS.
– The percentage of individuals ages 19‒ 25 with employment-based health coverage as a dependent averaged 26.9 percent during January ‒ September 2010, and increased to an average 27.1 percent during October and November, per SIPP.
– The percentage with private insurance increased from 51 percent to 55.8 percent, and the percentage uninsured fell from 33.9 percent during 2010 to 28.8 percent during the first half of 2011 among those ages 19 ‒ 25, according to data from the NHIS.

Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012

Source: Martha Heberlein, Tricia Brooks, and Jocelyn Guyer, Samantha Artiga and Jessica Stephens, Kaiser Commission on Medicaid and the Uninsured, Publication Number: 8272, January 2012

From the summary:
The annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices, conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, found that, despite continued fiscal pressures on states, eligibility policies remained stable in nearly all state Medicaid and Children’s Health Insurance Programs during 2011. Moreover, many states used technology to increase program efficiency and streamline enrollment. The “maintenance of eligibility” requirement in the Affordable Care Act (ACA) played a key role in preserving coverage levels. Without it, more states likely would have limited eligibility or tightened enrollment procedures.

Growth In US Health Spending Remained Slow In 2010; Health Share Of Gross Domestic Product Was Unchanged From 2009

Source: Anne B. Martin, David Lassman, Benjamin Washington, Aaron Catlin and the National Health Expenditure Accounts Team, Health Affairs, Vol. 31 no.1, 2012
(subscription required)

From the abstract:
Medical goods and services are generally viewed as necessities. Even so, the latest recession had a dramatic effect on their utilization. US health spending grew more slowly in 2009 and 2010–at rates of 3.8 percent and 3.9 percent, respectively — than in any other years during the fifty-one-year history of the National Health Expenditure Accounts. In 2010 extraordinarily slow growth in the use and intensity of services led to slower growth in spending for personal health care. The rates of growth in overall U S gross domestic product (GDP) and in health spending began to converge in 2010. As a result, the health spending share of GDP stabilized at 17.9 percent.

Medicaid Spending

Source: Debra Miller, Council of State Governments, January 18, 2012

Per capita health care spending and Medicaid spending per enrollee vary widely by state. According to 2009 data, the highest Medicaid spending state, Alaska, spent more than twice the lowest spending state, California. State spending for Medicaid continues to grow, consuming one third of the Missouri state budget, but just 7 percent of the Wyoming state budget in 2010. Regional and state data are provided in this brief on per capita health spending, Medicaid spending, and Medicaid enrollment.
See also:
National Analysis
– Regional Analysis: Midwest, East, South, West