Category: Health Insurance

Employer-Based Coverage Does Not Equalize Workers’ Access to Health Care

InsFormSmallOne reason public policy favors employer-based health benefits instead of individually owned health insurance is the former is supposed to equalize access to health care among workers of all income levels. Insurers usually demand 75 percent of workers be covered, which leads to benefit design that attracts almost all workers to be covered.

Employers do this by charging the same premium for all workers but only having workers pay a small share of the premium through payroll deduction. Most is paid by the firm. Last year, the average total premium for a single worker in an employer-based plan was $6,435, but the worker only paid $1,129 directly while the employer paid $5,306.

Although this suppresses workers’ wages, workers cannot go to their employers and demand money instead of the employers’ share of premium. The tax code also encourages this, by exempting employer-based benefits from taxable income.

Does this equal access to care? Not at all, according to new research:

Fixed-Dollar Tax Credits Would Reduce Individual Health Insurance Premiums

UntitledghgSonia Jaffe and Mark Shepard of the National Bureau of Economic Research (NBER) have written a new paper, which compares the effects of fixed-dollar subsidies for health insurance to subsidies that are linked to premiums. They conclude fixed-dollar subsidies reduce taxpayers’ costs and improve access. Unfortunately, the structure of subsidies in U.S. health insurance has moved in the other direction.

Tax credits that subsidize health insurance offered in Obamacare’s exchanges are based on the second-lower cost Silver-level plan in a region. Intuitively, this implies insurers will not compete too much because that would drive down subsidies. As long as subsidies chase insurance premiums, premiums will be higher than otherwise.

Jaffe and Shepard examine evidence from Massachusetts’ health reform (“Romneycare”), which dates to 2006. Its costs are still spiraling, and Jaffe estimates one factor is its design of subsidies, which is similar to Obamacare’s:

American Health Insurance Is Upside Down

Writing in The Week, Ryan Cooper shares a chilling story about an Obamacare Gold-level health insurance policy that let its beneficiary down when he needed it most:

Stewart is 29 years old, and was pursuing his Ph.D in American history at Texas Christian University until ill health forced him to withdraw. He lives in Ft. Worth, Texas, with his wife of six years, who is a junior high school teacher in a low-income district. They own their home. Before he came down with complications from cirrhosis caused by autoimmune hepatitis, he says he led a scrupulously healthy lifestyle — he does not drink or do any other non-medical drugs, he says, and was a devoted hiker before disaster struck. And he was insured — indeed, he had a gold plan from the ObamaCare exchanges, the second-best level of plan that you can get.

But now he faces imminent bankruptcy and possibly death.

(Ryan Cooper, “This is How American Health Care Kills People,” The Week, January 14, 2017.)

Trump Disembowels Obamacare… Slowly and Painfully

InsFormSmallOn the day of his inauguration, President Trump took time out to issue an executive order directing his administration to drag its feet enforcing provisions of the Patient Protection and Affordable Care Act (ACA). Regulators were instructed to “waive, defer, grant exemptions from, or delay…” whenever possible to the “maximum extent of the law.” Many believe this move was intended to destabilize the ACA and hasten its demise without Republicans getting blamed.

Obamacare’s Bureaucracy: The Amazing Rise in Health Insurance Jobs

health-insuranceAs Congress and President Trump debate how to repeal and replace Obamacare, the obsession with health insurance, rather than actual access to health care, has dominated the debate. It invites the question: How have jobs in health insurance fared before and after Obamacare?

They have boomed, growing over one quarter since the pre-recession January 2008 employment high-water mark.

Obamacare IS Socialized Medicine!

Caduceus with First-aid KitHave you ever stopped and considered why the government wants you to have health insurance? The Affordable Care Act (ACA) was supposedly designed to make health care affordable for millions of individuals who could otherwise not afford health coverage or would choose not to enroll due to costs. Worse yet, the ACA was designed to make medical care “affordable” for many individuals by foisting the costs on others who are not at risk of health problems. Obamacare was premised on the idea that benefits one person would never expect to use should be subsidized for others who may need them. That is the very definition of socialized medicine!

Health Coverage The Same As Ten Years Ago

NHISThe best measurement of people who lack health insurance, the National Health Interview Survey published by the Centers for Disease Control and Prevention (CDC), has released early estimates of health insurance for all fifty states and the District of Columbia in the first half of 2016. There are three things to note.

First: 69.2 percent of residents, age 18 to through 64, had “private health insurance” (at the time of the interview) in the first half of this year, which is which is the same rate as persisted until 2006 (page 1, Figure 1; and page A5, Table III). Obamacare has not achieved a breakthrough in coverage. It has just restored us to where we were a decade ago.

Health, Wealth and Personal Responsibility

How much is Obamacare really worth? This is an important question as we approach the incoming Trump Administration. Should he backtrack on his campaign promise to repeal Obamacare on Day One? If Trump merely instructed his HHS Secretary to drop the appeal of House v Burwell most insurers would probably bail out of the market and it would collapse. If Congress uses a Budget Reconciliation process to repeal Obamacare provisions, such as the individual mandate, employer mandate, the Obamacare taxes and the subsidies, the health insurance exchange would probably collapse.

What Holds Back Consumer-Driven Health Plans?

health-insuranceA previous entry discussed new evidence that so-called consumer-driven health plans (CDHPs) reduce health spending one eighth among employer-sponsored group plans run by national health plans.

CHDPs are defined as High-Deductible Health Plans coupled with Health Savings Accounts or Health Reimbursement Arrangements). These plans became available in 2005. However, they only appear to cover a little over one quarter of employed people or their dependents who are enrolled in their benefits.

The case for CDHPs is that consumers (patients) will spend their health dollars more prudently than insurers or employers will. So: How can such a small proportion of people be enrolled in CDHPs after over a decade of evidence supporting the case that they cut the rate of growth of health spending?

Consumer-Driven Health Plans Reduce Health Spending One Eighth

credit-card-2The Health Care Cost Institute has released its analysis of claims data for the years 2010 through 2014, examining consumer-driven health plans (CDHPs, which HCCI defines as High-Deductible Health Plans coupled with Health Savings Accounts or Health Reimbursement Arrangements). HCCI examines a database of claims submitted by Aetna, Humana, Kaiser Permanente, and UnitedHealthcare for their employer-sponsored group plans.

CDHPs shift payment from third-party bureaucracies (that is, insurers) back to patients directly. The results continue to impress: