Tag: Affordable Care Act

Americans’ Challenges with Health Care Costs

Mary Pat Campbell

Link: https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

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Excerpt:

  • About half of U.S. adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months. Younger adults, those with lower incomes, adults in fair or poor health, and the uninsured are particularly likely to report problems affording health care in the past year.
  • The cost of health care can lead some to put off needed care. One in four adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably six in ten uninsured adults (61%) say they went without needed care because of the cost.
  • The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share say they have instead opted for over-the-counter alternatives. About one in ten adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost.
  • Those who are covered by health insurance are not immune to the burden of health care costs. About four in ten insured adults worry about affording their monthly health insurance premium, and 48% worry about affording their deductible before health insurance kicks in. Indeed, large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor.
  • Health care debt is a burden for a large share of Americans. About four in ten adults (41%) report having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.
  • Notable shares of adults still say they are worried about affording medical costs such as unexpected bills, deductibles, and long-term care services for themselves or a family member. Additionally, about half of adults would be unable to pay an unexpected medical bill of $500 in full without going into debt.

Author(s): Lunna Lopes, Marley Presiado, and Liz Hamel

Publication Date: 21 Dec 2023

Publication Site: Kaiser Family Foundation

Electronic Health Records in the Age of Coronavirus: The Covid Crisis Has Accelerated Real-World Adoption

Mary Pat Campbell

Link:https://www.soa.org/sections/technology/technology-newsletter/2021/october/att-2021-10-timmins/

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As with most things in the world, early 2020 seems like ancient history. In late January last year, I had just finished a white paper for the SOA[1], stating confidently that Electronic Health Records, or EHRs, were not likely to have a major impact for several years amid slow adoption by executives—with significant strategic differences among stakeholders and little signs of compromise.

Then in February came COVID-19, and the urgent need to move rapidly to telemedicine for both COVID and non-COVID afflictions. Government authorities moved quickly to relax restrictions on interstate telehealth, allowing payer coverage for the transfer of sensitive material online and over mobile networks—including Facebook Messenger, Apple Facetime, and Zoom.[2] Although not permanent while a public health emergency, this created an unexpected precedent for interoperability, the Holy Grail of seamless cross-talk of health data between HIPAA-regulated IT systems.

….

Much remains unknown about the secondary effects of COVID-19, beyond respiratory failure and immune system overload. However, there is likely a significant spike in claims related to COVID-19 building within the insurance industry. It may be important for the insurance industry to monitor these secondary afflictions, at minimum through the claims process (see Figure 3), although the best digital approach to obtain that evolving health information remains unclear at this time. Genomics and epigenetic vulnerability could be a rich data area here.

If insureds would be willing (or mandated) to provide their immunization history to payors, directly or indirectly, this could be a significant asset for actuaries in evaluating this ongoing phenomenon. Claims data also can include non-prescription drug information, which could provide additional clues of COVID exposure.

Author(s): James Timmins

Publication Date: October 2021

Publication Site: Actuarial Technology Today

Actuaries project future virus surges, end of regulatory flexibility key drivers in 2022 rates

Mary Pat Campbell

Link: https://www.fiercehealthcare.com/payer/actuaries-project-future-virus-surges-end-regulatory-flexibility-key-drivers-2022-rates

Excerpt:

Uncertainty over future surges of COVID-19 and the end of regulatory flexibilities are going to be major drivers for 2022 premiums on the individual and small group markets, a new actuary report finds.

The report, released Thursday (PDF) by the American Academy of Actuaries, finds insurers face major uncertainties like the end of the public health emergency and the fate of enhanced subsidies for coverage on the Affordable Care Act’s (ACA’s) insurance exchanges.

“Greater degrees of uncertainty could lead to more conservative assumptions and risk margins for some insurers,” the report said. “Alternatively, carriers might lower risk margins, seeing an opportunity to capitalize on the increased enrollment due to the [American Rescue Plan Act] subsidies.”

Author(s): Robert King

Publication Date: 2 September 2021

Publication Site: Fierce Healthcare

Biden Budget Boosts Health Subsidies, Broadens Net Investment Income Tax

Mary Pat Campbell

Link: https://www.thinkadvisor.com/2021/06/01/biden-budget-boosts-health-subsidies-broadens-net-investment-income-tax/

Excerpt:

The current, emergency health insurance premium tax credit subsidy levels would become permanent.

Either the net investment income tax or self-employment tax would apply to all individual income over $400,000.

The definition of net investment would expand.

Author(s): Allison Bell

Publication Date: 1 June 2021

Publication Site: Think Advisor

Reforming Health Insurance: Competition Across State Lines

Mary Pat Campbell

Link: https://www.manhattan-institute.org/reforming-health-insurance-across-states?utm_source=mailchimp&utm_medium=email

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State governments often operate with limited administrative and technical resources and are highly vulnerable to lobbying by interest groups. Medical providers—physicians and hospitals—are well represented in state capitols, and they frequently push legislatures to mandate that insurers pay for services that they provide, as a way to increase the sales (and prices) of these services.

The typical state had fewer than one benefit mandate in 1970; by 2017, the average was 37. James Bailey of Temple University has estimated that each benefit mandate enacted by states tends to increase health-insurance premiums by 0.4%–1.1% and that new mandates were responsible for 9%–23% of premium increases during 1996–2011. Benefit mandates may have added value to insurance coverage by preventing insurers from leaving gaps in coverage, in order to deter sicker individuals from enrolling.[9] Still, in a study of the period 1989–94, Frank Sloan and Christopher Conover of Duke University estimated that 20%–25% of Americans without health insurance were deterred from purchasing coverage because of the added costs resulting from benefit mandates.[10]

Lobbyists for hospitals and physicians have similarly pushed states to enact laws that increase their pricing power, by making it hard for insurers to exclude them from networks of covered providers. When HMOs began to squeeze hospital costs in the late 1990s, more than 1,000 bills were introduced in state legislatures. Most states enacted laws requiring insurers to reimburse “any willing provider” for treatment according to their standard payment arrangements. A study by Maxim Pinkovskiy of the Federal Reserve Bank of New York found that anti-HMO state laws drove up the incomes of medical providers, increased service use, slowed reduction in hospital lengths of stay, and caused U.S. health-care spending to increase by 2% of GDP—accounting for much of the growth in health-insurance costs in the early 2000s.[11]

Author(s): Chris Pope

Publication Date: 8 June 2021

Publication Site: Manhattan Institute

Will States Resist Fresh Billions for Medicaid Expansion?

Mary Pat Campbell

Link: https://www.governing.com/now/Will-States-Be-Able-to-Resist-Billions-for-Medicaid-Expansion.html

Excerpt:

As part of the most recent federal stimulus, states that haven’t expanded Medicaid under the Affordable Care Act can receive additional matching funds. Rather than paying 10 percent of the cost for new recipients, they’d only have to pay 5 percent over the next two years. Additional subsidies mean they would actually cost themselves money by refusing to expand. Florida, for instance, would come out ahead by $1.25 billion, even after paying its share of expanded coverage. Still, Gov. Ron DeSantis and legislative leaders remain opposed.

….

It’s true that the 95 percent match rate will only last for two years. But plenty of states have put in place triggers that would end their expansion programs if the federal share ever dipped below 90 percent, notes Trish Riley, executive director of the National Academy for State Health Policy.

Author(s): Alan Greenblatt

Publication Date: 31 March 2021

Publication Site: Governing

Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap.

Mary Pat Campbell
Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap.

Excerpt:

The reliance on private plans — a hard-fought compromise in the 2010 health law that was designed to win over industry — already costs taxpayers tens of billions of dollars each year, as the federal government picks up a share of the insurance premiums for about 9 million Americans.

The ACA’s price tag will now rise higher because of the recently enacted $1.9 trillion covid relief bill. The legislation will direct some $20 billion more to insurance companies by making larger premium subsidies available to consumers who buy qualified plans.

Author(s): Noam N. Levey

Publication Date: 24 March 2021

Publication Site: Kaiser Health News