A defense of narrow networks. (A weak defense in my opinion.)
Based on data available for about 85 percent of exchange plans, about 77 percent have deductibles of more than $1,250 and qualify under Internal Revenue Service rules for a health savings account. For a 27-year-old purchasing coverage, the median HSA-eligible plan costs about $238 a month and typically comes with a deductible of about $3,600. The median plan without a high deductible, however, costs almost 30 percent more ($310) for a 27-year-old, though it has a significantly lower deductible (about $600). (More)
This is something the Bush Administration never was willing to even consider
The Obama administration loosened rules governing health-care savings accounts known as flexible-spending arrangements, or FSAs, allowing consumers to roll over as much as $500 in unused funds each year. (WSJ)
This means the accounts will partially function just like Health Saving Accounts. Employers potentially will be able to put up to $500 in an account for every employee and let that integrate with an overall health plan with none of the restrictions that hamper HSAs.
This is 35 million people, in addition to the 30 or so million that already have an HSA or HRA.
But why only $500? Why not the full amount? $2,500 is the new allowable contribution.
They’re sending their employees to private exchanges, armed with HSAs and HRAs:
Employers are raising deductibles, giving workers health savings accounts that look like 401(k) plans, mimicking the health law’s online insurance marketplaces and nudging patients to compare prices and shop around for treatments. Together the moves could eventually affect far more consumers than the law’s Medicaid expansion or health exchanges aimed at the uninsured and scheduled to open Oct. 1. (Kaiser Health News)
See Walgreen and others.
Aaron Carroll and Austin Frakt relate the problem:
Over the past decade, the number of reimbursed eyelid-lift procedures has tripled. The cost to taxpayers has quadrupled, to $80 million from $20 million.
Medicare traditionally avoids coverage for cosmetic procedures such as Botox or breast augmentation (except after medically necessary breast removal). So why cover eyelid lifts? It’s possible that more of the elderly are suffering real vision problems in need of corrective surgery.
But is it likely that a disproportionate number of these patients live in one state? More than half of the 20 highest-billing physicians were in Florida, where one doctor submitted for 2,200 eyelid lifts in 2008 alone.
Their solution: better Medicare oversight.
My solution: Get Medicare completely out of the business of eyelid lifts. Let patients pay for all such procedures from their Health Savings Accounts.
Senators Orrin Hatch (R-UT) and Marco Rubio (R-FL) have introduced legislation to eliminate many of the restrictions currently placed on HSAs and FSAs. For instance, the bill would allow HSA accounts to be used to pay health insurance premiums. The bill allows eligible spouses 55 and older to make HSA catch-up contributions to the same HSA account and it allows Medicare beneficiaries to contribute to HSAs after age 65. Also, Medicare beneficiaries in an MSA plan will be able to contribute their own tax-deductible money to their MSAs.
Across-the-board deductibles don’t make a lot of sense. In Priceless, I argued that whole categories of care should be transferred to the patient in some cases and there should be first-dollar coverage for other kinds of services. Austin Frakt seems to agree, reproducing this graph from the book, and remarking:
LASIK is an elective procedure, the purpose of which is well understood by the patient. I’m on board with the idea that insurance shouldn’t cover such things, or if it does, not the full cost and certainly not the marginal cost. All health procedures just like this are good candidates for the purview of John Goodman’s “New HSA.”
The issue is not whether the procedure is like LASIK surgery, however. The issue is whether choices by the individual will create costs for other members of the insurance pool. Where there are no “financial externalities,” the case for individual decision-making is strong.