Category: Health Insurance

Number of Uninsured Americans Aged 18-64 Down 2 Percentage Points

The number of uninsured Americans, aged 18-64 has dropped by two percentage points from the first quarter of 2013 to the first quarter of this year, according the Centers for Disease Control (CDC).

As shown in figure 2, that brings the proportion of uninsured down to where it was about ten years ago. In other words, Obamacare has not managed to overcome the results of the recession that began in December 2007. Plus, much of the reduction in uninsured is a result of more people becoming dependent on Medicaid, which is welfare, so should not be viewed as the same type of benefit as individually owned or employer-based health insurance.

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Employer-Based Health Insurance Costs Up 3 Percent, Share of Covered Workers in High-Deductible Health Plans Steady

The annual Kaiser Family Foundation/Health Research Education Trust Employer Health Benefits Survey has been released. As many expected, the increase in employer-based health costs from 2013 to 2014 was moderate:

In 2014, the average annual premiums for employer-sponsored health insurance are $6,025 for single coverage and $16,834 for family coverage. The average family premium rose 3% over the 2013 average premium. Single coverage premiums rose 2% in 2014 but are not statistically different than the 2013 premium amounts. During the same period, workers’ wages increased 2.3% and inflation increased 2%. Over the last ten years, the average premium for family coverage has increased 69% (Exhibit A).  Premiums have increased less quickly over the last five years (2009 to 2014), than the preceding five year period (2004 to 2009) (26% vs. 34%).

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Only 2 Percent of Small Businesses Have Checked Out Obamacare’s Small Business Exchanges

business-dealAs well as health insurance exchanges for individuals, which have suffered much criticism for their failings, Obamacare created exchanges especially for small businesses: Small Business Health Options Program (SHOP).

SHOP is a bigger failure than the exchanges for individuals. SHOPs were supposed to open up nationwide on October 1, 2013, alongside those exchanges. However, the deadline was deferred, and only 15 states currently have SHOPs.

People Are Not Very Satisfied with Their Health Plans

The Employee Benefit Research Institute (EBRI) has just released a survey of beneficiaries in traditional health plans, high-deductible health plans (HDHPs), and consumer-driven health plans (CDHPs). EBRI defines a CDHP as a HDHP with a Health Savings Account or Health Reimbursement Arrangement. What is interesting about the results is that satisfaction in traditional plans dropped significantly in 2010 and has never recovered. Although satisfaction with HDHPs and CDHPs is worse than with traditional plans (because of higher out-of-pocket payments), they have not suffered the same drop. However, having an HSA or HRA really improves satisfaction: Last year, 47 percent of CDHP beneficiaries were satisfied, versus only 40 percent of HDHP beneficiaries. On the other hand, only 58 percent of beneficiaries in traditional plans were satisfied.

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Direct Primary Care Has Exploded Since Obamacare

doctor-with-patientThe goal of Obamacare is to increase the number of people with health insurance. Remarkably, its passage has coincided with an explosion in the number of primary care physicians who do not take health insurance, according to Daniel McCorry of the Heritage Foundation:

W‌ith new concerns over the effects of the Affordable Care Act (ACA) on access to care and continued frustration with third-party reimbursement, innovative care models such as direct primary care may help to provide a satisfying alternative for doctors and patients. Doctors paid directly rather than through the patients’ insurance premiums typically provide patients with same-day visits for as long as an hour and offer managed, coordinated, personalized care. Direct primary care — also known as “retainer medicine” or “concierge medicine” — has grown rapidly in recent years. There are roughly 4,400 direct primary care physicians nationwide, up from 756 in 2010 and a mere 146 in 2005.

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The Health Insurance Bureaucracy Lives!

You know it never died. But in the health policy world, it is so easy to get caught up in the lingo used at conferences and in journals — Accountable Care Organizations, Pay-For-Performance, Population Health Management — that it’s easy to delude yourself into thinking that things have actually improved for the doctors and patients. So, it is valuable to get kicked back into reality by an actual practicing physician who takes the time to put pen to paper and write about her experience. Here’s Dr. Danielle Ofri:

The letter in my hand concerned one of my patients, Mr. V., who suffers from stubborn hypertension. His chart is a veritable tome, documenting the years of effort it took to find the combination of four different blood-pressure medications that controls his hypertension without upsetting his diabetes, kidney disease and valvular heart disease or making his life miserable from side effects. We’ve been on stable ground for a few years now, a state neither of us takes for granted.

But Mr. V. had changed insurance companies, and now one of his medications required a prior authorization. The last thing I wanted was for him to be turned away at his pharmacy and have his blood pressure spiral out of control, so I called right away to sort things out.

Obamacare’s Newly Insured Can’t Use It

Even though Obamacare will spend billions of taxpayer dollars subsidizing health insurers to enroll more people, many of the newly insured can’t use their new policies, according to the New York Times:

“I’ve had one doctor appointment since I got this insurance, and I had to pay $60,” Ms. Shabazz told Daniel Flynn, a counselor with the health network, the Health Federation of Philadelphia. “I don’t have $60.”

Mr. Flynn spent almost two hours going over her Independence Blue Cross plan, which he explained had a “very complicated” network that grouped doctors and hospitals into three tiers. Ms. Shabazz, who has epilepsy, had not understood when she chose the plan that her doctors were in the most expensive tier.

“None of that was explained when I signed up,” she said. “This is the first I’m hearing it.”

Obamacare Insurer Bailout: Budget Neutrality Would Lead to 20 Percent Rate Hikes

Last month, I had the privilege of testifying in person at a hearing of the House Oversight Committee on Obamacare’s risk corridors, an unlimited taxpayer liability that protects health insurers’ profits in Obamacare’s health insurance exchanges. The Administration has suggested that the risk-corridor payments will be budget neutral, a claim which I and others find unconvincing. I advised that budget neutrality of risk-corridor payments can be insured by amending Obamacare to make budget neutrality statutory.

The Committee has investigated the Administration’s claims of budget neutrality further, and found that they are bunk. In a recently released staff report, the Committee noted that:

At least one insurance company appealed directly to Valerie Jarrett, Senior Advisor to President Obama and Assistant to the President for Public Engagement and Intergovernmental Affairs, after the Administration signaled its intent in March 2014 to implement the Risk Corridor program in a budget neutral manner. Chet Burrell, the President and CEO of Care First Blue Cross Blue Shield, wrote to Ms. Jarrett that insurers would likely require Risk Corridor payments on net and that budget neutrality would lead insurers “to increase rates substantially (i.e., as much as 20% or more…)”

Why Can’t Health Insurers Criticize the Government?

This blog has recently given the health insurance industry a hard time for its fight against Gilead, an innovative pharmaceutical company, and drug-makers generally. So, it may be time to clarify that we approve of private health insurance and wish health insurers the best of success in a healthcare system that is consumer-driven and suffers little government control. We are not going to get there if health insurers cannot support others’ criticism of the government.

Eric Lipton of the New York Times has discovered that America’s Health Insurance Plans (AHIP), the health-insurers’ trade association, gave $1.593 million to the Voice of Free Enterprise, a project of the National Federation of Independent Business, to advertise against U.S. Senator Mark Pryor’s support for Obamacare in Arkansas. AHIP made this grant anonymously. Lipton and his sources would prefer that the trade association be forced to disclose its contribution to the advertising campaign.

Why are Health Insurers Persecuting Innovative Drug-Makers, Instead of Bloated Hospitals?

One constant refrain heard in national health policy circles is the need for “integrated” or “coordinated” care. To be sure, I have never heard anyone speak favorably of “disintegrated” or “un-coordinated” care. While there are many good-faith practitioners who do want to integrate and coordinate care for patients, these terms are often used to camouflage a more straightforward way to raise prices. Here’s an example from Bloomberg BusinessWeek:

money-burdenFor the past four years, Pennsylvania insurance company Highmark has watched its bills for cancer care skyrocket. The increase wasn’t because of new drugs being prescribed or a spike in diagnoses. Instead, the culprit was a change that had nothing to do with care: Previously independent oncology clinics and private practices have been acquired by big hospital systems that charge higher rates, sometimes three times as much, for chemotherapy drugs. “The site of care and the type of service provided does not change at all,” says Tom Fitzpatrick, Highmark’s vice president of contracting. “The only significant difference that we primarily see is the [patient] gets a wristband placed on them.”