Tag: "consumer driven health care"

Where Does Your Insurance Premium Go?

InsFormSmallAHIP, the trade association for health insurers, has a nifty infographic answering the question: “Where does your premium dollar go?”

Obviously designed to defray accusations that health insurers earn too much profit, the infographic shows “net margin: of only three percent. A full 80 percent of our premium dollar goes to paying medical, hospital, and prescription claims.”

Fair enough. However, the elephant in the infographic is the 18 percent of premium that goes to “operating costs.” Lest you think that’s a synonym for “overhead” or “bureaucracy,” AHIP helpfully explains: “Operating costs include consumer-centric activities such as communicating with members, running customer service operations, quality reviews, and data analysis, among other activities.”

Well, readers have to judge how “consumer-centric” those operations are.

Health Insurance A Cause Of Past-Due Debt?

credit-card-2A study of past-due medical debt by Michael Karpman and Kyle J. Kaswell of the Urban Institute demonstrates the expansion of coverage subsequent to the Affordable Care Act is associated with a reduction in the proportion of adults with past-due medical debt.

In 2012, 29.6 percent of U.S. adults had past-due medical debt, versus just 23.8 percent in 2015. The study does not define “past-due,” nor the average amount of medical debt that is past-due. However, it cites research that almost half of debt in collections is owed to hospitals and other providers.

Although health insurance is supposed to protect us from such a situation, it often does not. Among insured people, 26.6 percent had past-due medical debt in 2012, versus 22.8 percent in 2015. However, among uninsured people it declined more: 39.8 percent in 2012, versus 30.5 percent in 2015. What to make of this?

Bernie Sanders’ Single-Payer Utopia

Back in October I wrote “Is Obamacare’s Failure Intentional, to Promote Medicaid-for-All?”  In it I discussed how Bernie Sanders famously advocated for single-payer socialized medicine during his campaign. In 2011, the Vermont legislature passed a bill to create a single-payer initiative known as Green Mountain Care. In 2014 it was abandoned by Vermont’s governor — a Democrat — as being too costly. Green Mountain Care was going to require an 11.5 percent payroll tax and an additional sliding-scale income tax that topped out at 9.5 percent. Despite the heavy tax burden, a single-payer system in Vermont was projected to run deficits by 2020.

Obamacare Repeal Has Begun For Small Firms

Businessman Sitting at His Desk(A version of this Health Alert was published by Forbes.)

My previous Health Alert suggested the 21st Century Cures Act, which President Obama signed on December 13 demonstrated Republicans can lead on health reform. Promoted as a pro-innovation bill, the new law will improve the Food and Drug Administration’s regulatory processes; as well as fund Vice-President Biden’s Cancer Moonshot, the National Institutes of Health, and steps to reduce the opioid epidemic.

However, the final version of the bill also included an important payment reform, which takes a small but significant bite out of Obamacare. Tacked onto the end of the bill, section 18001of the 21st Century Cures Act expands the use of Health Reimbursement Arrangements (HRAs) by small businesses. This is a win for small businesses which were harmed by Obamacare. Indeed, given the overwhelming bipartisan support for the 21st Century Cures Act, section 18001 could be defined as Democrat politicians’ first real step towards conceding Obamacare needs to be repealed and replaced.

The Health Care Costs Quandary: What Can Be Done About It?

yuI recently attended a roundtable discussion that included Human Resource (HR) executives, chief financial officers (CFOs), benefits brokers, consultants and providers who discussed ways self-insured employer plans can lower their health care costs. The meeting was hosted by a state-of-the-art hospital that is part of a small chain of medical facilities, including emergency rooms, imagine, clinics, orthopedic hospitals.

Health Savings Accounts Continue To Grow

credit-card-2One of Donald Trump’s campaign promises is to make Health Savings Accounts more widely used. The purpose of HSAs is to give patients more directly control over health spending, and reducing the share of spending controlled by insurers. Unfortunately, the 2003 law which established HSAs requires they be linked with a highly regulated type of health insurance policy.

These policies, like all health insurance today, give insurers power to dictate prices instead of allowing prices to be formed through interactions between patients and providers (that is, a normal market process). So, these health insurance policies are not as popular as truly consumer-driven plans should be.

Nevertheless, HSAs (which are bank accounts, not health insurance policies) are growing like gangbusters, according to new research from the Employee Benefits Research Institute (EBRI). As I wrote previously, EBRI is a rock-solid member of the health-benefits establishment. If Trump wants to expand the use of HSAs, EBRI’s evidence suggests he is pushing on an open door.

FDA Backs Selling Hearing Aids Over the Counter

UntitledghgThe U.S. Food and Drug Administration (FDA) just announced it is taking steps to make hearing aids available over the counter. The FDA plans to immediately stop enforcing a requirement that patients must have a medical evaluation prior to obtaining a hearing aid. The Agency also hopes its move will stimulate a new category of OTC hearing aid products that cost less.  In this regard, hearing aids will function in a manner similar to reading glasses. The move was likely due to prodding by Senators Elizabeth Warren (D-MA) and Chuck Grassley (R-IA), who recently introduced legislation along these lines.

How Long Should You Have to Wait to See a Doctor?

dogvetwait

How long should you have to wait to see a doctor? Why not just call a doctor?

The patient in the photo was able to get a same-day appointment within 15 minutes of the request and was seen within 10 minutes after arriving. But that is an exception in the United States. A recent article in the American Journal of Managed Care estimated the average physician visit takes two hours (121 minutes). That includes travel time (37 minutes), waiting time (about an hour) and treatment time (10 to 20 minutes). Of course, that’s once you get an appointment.

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?

EpiPen Maker Lobbied U.S. Preventive Services Task Force

According to a report in the Washington Examiner, drug maker Mylan lobbied the U.S. Preventive Services Task Force to require insurers to pay the full price of EpiPens by deeming the drug delivery device a preventative measure. Under the Affordable Care Act, health plans must cover preventive services 100% without cost-sharing regardless of whether deductibles have been met. EpiPens are used by people with severe allergies who go into anaphylactic shock.  They are not used to prevent anaphylaxis, they treat the symptoms once it occurs. For example, under ACA regulations, a flu shot is a preventive medicine. Once you have the flu, seeing your doctor for Tamiflu would be a treatment, not a prevention.