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Health plan costs - misc


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ACA Has Little Impact on Reducing ER Visits
"Emergency department visits in Maryland fell by 1% statewide in the months after Medicaid expanded. The number of Medicaid ED visits increased 6%, with a corresponding 6% drop in the number of uninsured emergency department visits." (HealthLeaders Media)
Premiums Are the Big Factor in Health Plan Enrollment
"After eliminating employee premiums for all coverage tiers, HSA-eligible health plan enrollment increased from 4 percent to 25 percent among individuals with employee-only coverage and from 2 percent to 31 percent among individuals with family coverage.... Offering coverage with no payroll deduction attracted individual enrollees who were marginally healthier than those who would have enrolled without this financial incentive in place, therefore not mitigating adverse selection as anticipated." (Wolters Kluwer Law & Business)
Cost-Sharing Reductions: What Are They and Why Do They Need to Be Funded? (PDF)
"Decisions not to pay the reimbursements or even uncertainty about the reimbursements could result in 2018 premium increases averaging nearly 20 percent for silver plans, over and above premium increases due to medical inflation and other factors.... Although those who receive premium subsidies would be insulated from the full increase in premiums, nonsubsidized enrollees would face the full increase, potentially reducing their enrollment, increasing the uninsured population, and deteriorating the risk pool." (American Academy of Actuaries)
[Official Guidance] Text of IRS Final Regs: Health Insurance Premium Tax Credit
44 pages. "These regulations affect individuals who enroll in qualified health plans through Affordable Insurance Exchanges ... and claim the premium tax credit and Exchanges that make qualified health plans available to individuals.... After consideration of all the comments, the proposed regulations are adopted by this Treasury decision, with one technical correction that was not identified in the comments." (Internal Revenue Service [IRS])
Small Businesses Split Over Republican Health Plans
"With so many forces aligned in opposition to the Senate's proposed changes, the views of small-business owners have not been a decisive factor. But the enthusiasm that a growing number are voicing for the health care law weakened the argument, often cited by Republicans, that small businesses had been harmed by it and need a rollback." (The New York Times; subscription may be required)
Employee Benefits in the United States: March 2017
"Retirement and medical care benefits were available to 70 percent of civilian workers in March 2017 ... Ninety-four percent of union workers had access to employer-sponsored retirement and medical care benefits. For nonunion workers, 66 percent had access to retirement benefits and 67 percent to medical care benefits.... For civilian workers, the shares employers paid of medical care premium costs were 80 percent for single coverage and 68 percent for family coverage.... Employers assumed 87 percent of the premium for single coverage for union workers and 79 percent for nonunion workers." (U.S. Bureau of Labor Statistics [BLS])
CBO Cost Estimate for the Better Care Reconciliation Act of 2017 (Amendment in the Nature of a Substitute, July 20, 2017)
"CBO and JCT estimate that enacting this legislation would reduce federal deficits by $420 billion over the 2017-2026 period ... [In] 2018, 15 million more people would be uninsured under this legislation than under current law. The increase in the number of uninsured people relative to the number under current law would reach 19 million in 2020 and 22 million in 2026. In 2026, an estimated 82 percent of all U.S. residents under age 65 would be insured, compared with 90 percent under current law." (Congressional Budget Office [CBO])
Medicare's Financial Condition: Beyond Actuarial Balance (PDF)
"The projected [hospital insurance (HI)] deficit over the next 75 years is 0.64 percent of taxable payroll. Eliminating this deficit would require an immediate 22 percent increase in standard payroll taxes or an immediate 14 percent reduction in expenditures -- or some combination of the two. Delaying action would require more severe changes in the future." (American Academy of Actuaries)
CBO Cost Estimate for the Obamacare Repeal Reconciliation Act of 2017
"The number of people who are uninsured would increase by 17 million in 2018, compared with the number under current law. That number would increase to 27 million in 2020 ... Average premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by roughly 25 percent -- relative to projections under current law -- in 2018. The increase would reach about 50 percent in 2020, and premiums would about double by 2026.... In CBO and JCT's estimation, under this legislation, about half of the nation's population would live in areas having no insurer participating in the nongroup market in 2020 because of downward pressure on enrollment and upward pressure on premiums." (Congressional Budget Office [CBO])
[Opinion] How Not to Lower Healthcare Costs
"With national healthcare expenditures topping $3.2 trillion annually, legislators on Capitol Hill are looking to root out the kind of wasteful spending that has flattened American wages and sent health insurance premiums soaring. At the same time, Congress is under pressure from voters not to sacrifice the quality or accessibility of medical care. What few seem to realize, however, is that financial disincentives in healthcare rarely work and, more often, carry unintended consequences." (Robert Pearl, M.D. in Forbes)
Health Care Spending Today and in the Future: Impacts on Federal Deficits and Debt
"CBO projects that federal spending on the major health care programs would grow larger than spending in any other category if current laws generally remained unchanged. Driven particularly by growth in Medicare outlays, spending on those programs would account for 40 percent of federal noninterest spending in 2047, compared with 28 percent today. Two factors explain the projected growth in spending on major health care programs: aging of the population and rising health care costs per person (that is, excess cost growth)." (Congressional Budget Office [CBO])
Medical Claims Spending Requirement Not Cutting Premiums
"Prior to the ACA requirement, insurers were less afraid to be more competitive some years because 'they knew if they made a mistake they could take a rate increase the next year, to maybe offset losses and replenish their surplus,' [Maryland Insurance Commissioner Al Redmer Jr.] said. But with the MLR, 'if a carrier loses a lot of money in one year they can't make it up in the next year.' As a result, particularly in the small group market, carriers are less likely to be more competitive, Redmer said." (Bloomberg BNA)
Risk Pooling: How Health Insurance in the Individual Market Works (PDF)
"What is risk pooling? ... What is 'adverse selection'? ... Why is adverse selection a problem? ... Why do premiums depend on who buys coverage? ... How does risk pooling currently work in the individual market? ... How does the ACA protect against adverse selection? ... What if more flexibility were allowed in the ACA market rules? ... What if some plans were allowed to avoid ACA rules altogether?" (American Academy of Actuaries)
Whichever Way 'Repeal and Replace' Blows, Pharma Is Due for Windfall
"The pharmaceutical industry could see windfall profits from a little-noticed tweak to the insurance market tucked into the Trump administration's draft executive order on drug prices ... The short, technical paragraph calls for the [IRS] to allow patients with high-deductible health plans to receive care for chronic diseases, including drugs, before meeting their deductibles." (Kaiser Health News)
[Official Guidance] Text of CMS MLR Annual Reporting Form Instructions for the 2016 MLR Reporting Year (PDF)
61 pages. "[S]ignificant changes [include]: ... [1] ICD-10 expenses may no longer be included in quality improvement activity expenses.... [2] allow an issuer to defer reporting of experience of all policies newly issued in 2016 ... if 50% or more of the issuer's total earned premium for 2016 is attributable to such policies; ... [3] provide issuers the option of limiting the total rebate payable with respect to a given calendar year.... [4] Clarified instructions for reporting the experience of newly issued policies and Basic Health Plans, taxes on Part 1, and claims liabilities and cost-sharing reductions on Part 2." [Also issued: Revised MLR 2016 Calculator and Formula Tool (XLSM)] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
The Impact of Offering Free Coverage on Enrollment Choice and Risk Selection in an HSA-Eligible Health Plan (PDF)
20 pages. "After eliminating employee premiums for all coverage tiers, HSA-eligible health plan enrollment increased from 4 percent to 25 percent among individuals with employee-only coverage and from 3 percent to 28 percent among individuals with family coverage.... Offering coverage with no payroll deduction attracted individual enrollees who were marginally healthier than those who would have enrolled without this financial incentive in place, therefore adverse selection was not mitigated as anticipated." (Employee Benefit Research Institute [EBRI])
Fewer Issuers Apply to Participate in Exchanges for 2018
"141 individual market qualified health plan (QHP) issuers submitted initial applications to offer coverage using the Federally-facilitated Exchange eligibility and enrollment platform in 2018. At the initial filing deadline last year, 227 issuers submitted an application compared to 141 this year, a 38 percent drop in filings." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Drivers of 2018 Health Insurance Premium Changes (PDF)
"Key drivers of 2018 premium changes include: [1] Medical trend, which is the underlying growth in health care costs; [2] Legislative and regulatory uncertainty regarding cost-sharing reduction subsidies and enforcement of the individual mandate; [3] Whether risk-sharing programs for high-cost enrollees are provided; [4] Changes in the risk pool composition and insurer assumptions from 2017; and [5] Resumption of the health insurer fee." (American Academy of Actuaries)
Obamacare Marketplaces Just Had Their Most Profitable First Quarter Ever
"Insurers in the [ACA] marketplaces earned an average of nearly $300 per member in the first quarter of 2017, more than double what they earned in a similar period in the marketplaces' previous three years ... Insurers' newfound profitability seems to stem from increased premiums and steady costs, a suggestion the markets are stabilizing[.]" (The Washington Post; subscription may be required)
Individual Insurance Market Performance in Early 2017
"Loss ratios began to decline in 2016, suggesting improved financial performance. In 2017, following relatively large premium increases, individual market insurers saw significant improvement in loss ratios, averaging 75% in the first quarter.... Though 2017 annual loss ratios are therefore likely to end up higher than 75%, this is nevertheless a sign that individual market insurers on average are on a path toward regaining profitability in 2017." (Henry J. Kaiser Family Foundation)
The Implications of Cutting Essential Health Benefits: An Analysis of Nongroup Insurance Premiums Under the ACA (PDF)
"[T]he largest shares of ACA-compliant nongroup insurance premiums can be attributed to the costs of office-based care (30%), prescription drugs (22%), outpatient facility care (17%), and inpatient care (15%). Coverage for these services is generally seen as fundamental to insurance.... Maternity and newborn care accounts for just 6 percent of total premium dollars, habilitative/rehabilitative care for 2 percent, and pediatric dental and vision care for 1 percent.... [T]he per-person costs of insuring essential benefits are reasonably low when the costs are spread broadly across a large population with diverse health care risks." (Urban Institute)
Value-Based Insurance Design: Some Health Plans Nudge Patients to Do the Right Thing
"What would happen if, instead, health plans offered more generous coverage of high-value care, but less generous coverage of those services that provide little or no health benefit? ... Many large employers and state governments are ... reducing cost-sharing for high-value care and medications to treat chronic illnesses, like depression and heart disease. This year, [CMS] began a five-year test of value-based design that permits Medicare Advantage plans in seven states to reduce cost-sharing and enhance benefits for enrollees with designated chronic conditions." (The New York Times; subscription may be required)
House Passes Medical Malpractice Tort Reform Bill
"The House passed the Protecting Access to Care Act by a vote of 218 to 210 ... [T]he bill would: [1] Cap noneconomic damage awards at $250,000 and set sliding-scale limits on the contingency fees that lawyers can charge; [2] Create a safe harbor from product liability litigation for health care providers who prescribe or dispense FDA approved products; [3] Establish a three-year statute of limitations for medical malpractice claims, with certain exceptions, from the date of an injury; and [4] Create a fair-share rule, under which a defendant would be liable only for the percentage of the final award that was equal to his or her share of responsibility for the injury." (HR Policy Association)
The Hidden Subsidy That Helps Pay for Health Insurance
"As Republican senators work to fix their troubled health care bill, there is one giant health insurance subsidy no one is talking about. It is bigger than any offered under the [ACA] -- subsidies some Republicans loathe as handouts -- and costs the federal government $250 billion in lost tax revenue every year. The beneficiaries: everyone who gets health insurance through a job, including members of Congress." (The New York Times; subscription may be required)
Senate Health Care Stabilization Funds Could Offset Premium Hikes
"The Better Care Reconciliation Act [BCRA] allocates $15 billion in both 2018 and 2019, and $10 billion in both 2020 and 2021, for short-term stabilization funding to cover high-cost claims in a reinsurance program ... The health insurance industry is calling for greater subsidies for low-income people to help them pay their out-of-pocket expenses. It also wants a continuation of the ACA's reinsurance program as a way of stabilizing the market in the short term." (Bloomberg BNA)
2016 Employer Stop-Loss Market (PDF)
12 pages. "Approximately 58% of respondents achieved over 6% premium growth from January 1, 2016, to January 1, 2017 ... Loss ratios (net of commissions) increased from 75% in 2015 to 77% in 2016.... Third-party carriers are more willing to pay supplemental commissions to brokers for stop-loss placements than health plan carriers.... Sixty percent of total premium is concentrated in deductibles of less than $150,000 per individual (60%). Seventy-five percent of total premium is derived by employers who have 1,000 or fewer subscribers." (Milliman)
Tax Breaks Promised In GOP Healthcare Plans Go Mostly To Top 1%
"[B]oth the House and the Senate plan would change or eliminate more than a dozen taxes that were levied to help pay for the [ACA's] insurance subsidies and to bolster Medicare and expand Medicaid. Republicans and other ACA critics have argued the taxes are onerous on businesses and families. The [CBO] estimated that the Senate proposal would result in $700 billion in lost revenue from the federal Treasury over the next 10 years." (Kaiser Health News)
CMS Releases 2016 ACA Marketplace Reinsurance and Risk Adjustment Data
"Insurers in the lowest quartile of claims costs were assessed on average a risk adjustment charge of 18 percent of total collected premiums, while insurers in the highest quartile of claims received risk adjust payments of 27 percent of total premiums. Risk adjustment transfers averaged 11 percent of premiums in the individual market, up from 10 percent in 2015, while small group transfers remained steady at 6 percent of premiums." (Timothy Jost, in Health Affairs)
Stabilizing Risk Pools to Drive Individual Market Stability and Promote Affordable Coverage (PDF)
"A recent study estimated that insurers would have t o increase premiums by 34% in 2018 to compensate both for the lack of CSR payments and enforcement of the mandate.... [R]einsurance programs are a proven method to protect consumers and promote stability in the market.... In the short term, the most effective option would be to leverage best practices from proven programs, utilizing existing administrative processes and procedures and avoiding unnecessary complexity in administration and financing." (America's Health Insurance Plans [AHIP])
CBO Report: Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending
"In CBO's assessment, Medicaid spending under the Better Care Reconciliation Act of 2017 would be 26 percent lower in 2026 than it would be under the agency's extended baseline, and the gap would widen to about 35 percent in 2036 ... [O]verall Medicaid spending would grow 5.1 percent per year during the next two decades, in part because prices for medical services would increase. Under this legislation, such spending would increase at a rate of 1.9 percent per year through 2026 and about 3.5 percent per year in the decade after that." (Congressional Budget Office [CBO])
Obamacare Premiums Will Be Officially 'Unaffordable' for Many in 2018
"eHealth's analysis shows that projected costs for 2018 health insurance plans would be officially unaffordable for 29% of individuals and 54% of families who bought their health insurance at eHealth during the 2017 open enrollment period. The ACA deems health insurance to be unaffordable if it costs more than 8.13% of a person's modified adjusted gross income (MAGI or household income) to pay for the lowest cost plan available." (eHealth)
[Guidance Overview] July 31 PCORI Filing Deadline Is Quickly Approaching
"The PCORI fee generally applies only to major medical plans and health reimbursement arrangement (HRAs).... However, the PCORI rules provide an exception to the fee requirement for an HRA where it is offered along with a self-insured major medical plan that has the same plan year as the HRA. This avoids the need to pay the PCORI fee for both the HRA and the self-insured major medical plan (i.e., each person covered by both plans is counted only once for purposes of determining the PCORI fee). There is no exception from the PCORI fee for an HRA offered along with fully insured major medical coverage." (ABD Insurance & Financial Services)
Understanding How Health Care Costs Can Impact Your Retirement Readiness (PDF)
13 pages. "Medicare data put spending per capita at age 70 at about $7,566, increasing at 80 to $11,618 and more than doubling from ages 70 to 96 to $16,145.... 77 percent of baby boomers and 75 percent of retirees have never estimated the amount of health care expenses they expect to incur throughout retirement.... This lack of preparedness is exacerbated by expectations that national health care spending will grow by 5.8 percent on an average annual rate basis from 2012 to 2022." (Voya Financial)
Employers See Consumer Directed Healthcare as the Future
"For both employers and brokers, the rising cost of healthcare was still the biggest factor driving them to seek CDH adoption.... The utilization of technology to drive employee adoption of CDHs was also cited as a critical component for success.... The importance of working with the right payer in offering a CDH was also cited as key by both groups.... Finally, over half of employers reported they need support from insurers to address organizational issues vital for driving employee participation in CDHs." (HealthPayer Intelligence)
The Senate Takes a Crack at a Healthcare Reform Replacement Bill (PDF)
A summary of the provisions of the Senate's Better Care Reconciliation Act (BCRA) that would affect group health plans, along with a description of the likely effect of each provision, and how it differs from the American Health Care Act. (Trucker Huss)
Senate Delays Vote on Health Bill Amid Mounting GOP Opposition
"Senate Majority Leader Mitch McConnell on [Tuesday, June 27] delayed a planned vote this week on Senate Republicans' health care bill, amid mounting opposition from moderate and conservative members over central aspects of the plan to repeal and replace the [ACA]." (Morning Consult)
[Opinion] Senate Republicans' Obamacare Repeal and Replace Bill Will Not Reduce the Cost of Health Insurance
"Here's the key question: Given that only 40% of the subsidy eligible signed up under Obamacare, will the proposed Senate actions make that 40% take-up rate better or worse? For the life of me, I can't see how it can't be a lot worse. And, if we have an even worse sign-up rate than 40% we can only have relatively fewer healthy people in the pool to pay the claims of the sick. That means costs would be even higher under the proposed Senate bill than what we now have in Obamacare." (Bob Laszewski's Health Care Policy and Marketplace Review)
CBO Presentation: An Analysis of Private-Sector Prices for Physician Services
"Physicians' services account for a substantial portion of health care spending in the United States, but research on the prices private insurers pay for those services has been limited. Using 2014 claims data from three major insurers, we analyzed the prices paid for 21 common services and compared them with the estimated amounts that Medicare's fee-for-service (FFS) program would pay. Consistent with other studies, our results showed that commercial prices were higher than Medicare FFS prices, on average, and that prices for a given service varied as much as twofold across areas and providers, even after adjusting for differences in input costs. Out-of-network prices that insurers paid in commercial plans were as much as three times their in-network prices." (Congressional Budget Office [CBO])
[Opinion] Senate Bill Would Raise Premiums, Deductibles, or Both for Most Marketplace Consumers
"[T]he bill's defenders are either mischaracterizing or misunderstanding what CBO says -- which is that most marketplace consumers would pay more in premiums, deductibles, or both, with older consumers facing the highest cost increases. And in many cases, they'd be buying insurance that covered fewer benefits and offered fewer protections." (Center on Budget and Policy Priorities)
CBO and JCT Cost Estimate for Senate's 'Better Care Reconciliation Act of 2017'
"CBO and JCT estimate that enacting this legislation would reduce the cumulative federal deficit over the 2017-2026 period by $321 billion. That amount is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House of Representatives. The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation. By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law." (Congressional Budget Office [CBO])
[Opinion] Winners and Losers in the Senate Healthcare Bill, and Four Themes Not Addressed at All
"Four themes have been missed in the rhetoric on both sides: [1] Access to insurance coverage is not the same as access to care.... [2] There's plenty of money in the system, but much is wasted and it's not spent in the most productive ways.... [3] The Medicaid program needs transformation: budget cuts without program re-design does nothing to fix it long-term.... [4] Affordability has not been addressed." (Paul Keckley)
Exclusive Agreement Between Hospital and Insurance Plan Does Not Violate Sherman Act
"Judge Posner, writing for a unanimous panel, held that the procompetitive benefits of the exclusive deal arguably outweighed the anticompetitive effects, finding the vertical exclusivity agreement to be economically efficient. An insurance company or plan can get better rates from a hospital in exchange for exclusive contracts, benefiting the plan and its customers. The court took considerable comfort in the short duration of the agreement as well." [Methodist Health Serv. Corp. v. OSF Healthcare System d/b/a Saint Francis Medical Center, No. 16-3791 (7th Cir. June 9, 2017)] (Sheppard Mullin)
[Opinion] Senate Health Care Bill Will Reduce Costs for Employers and Employees
"Most importantly, the Senate's health care bill lays out a path to fully repeal the 40 percent 'Cadillac' excise tax on employer-sponsored health insurance. The 'Cadillac' tax ... forces employers to scale back benefits and increasingly shift rising health care costs to employees. Full and final repeal of the Cadillac tax is essential to ensuring a healthy future for the employer-sponsored health insurance system." (The ERISA Industry Committee [ERIC])
Discussion Draft: Senate Republican Health Care Bill
"The discussion draft will: [1] Help stabilize collapsing insurance markets that have left millions of Americans with no options. [2] Free the American people from the onerous Obamacare mandates that require them to purchase insurance they don't want or can't afford. [3] Improve the affordability of health insurance, which keeps getting more expensive under Obamacare. [4] Preserve access to care for Americans with pre-existing conditions, and allow children to stay on their parents' health insurance through age 26. [5] Strengthen Medicaid for those who need it most by giving states more flexibility while ensuring that those who rely on this program won't have the rug pulled out from under them." (U.S. Senate Committee On The Budget)
Senate Healthcare Draft Relies on Subsidies GOP Has Faulted
"Senate Republicans' proposal to replace Obamacare would provide an additional $50 billion over four years to stabilize insurance exchanges ... The plan, ... includes $15 billion a year in market-stabilizing funds over the next two years and $10 billion a year in 2020 and 2021. These payments would come in addition to cost-sharing subsidy payments, which would be extended through 2019.... The draft bill also would provide $62 billion allocated over eight years to a state innovation fund, which can be used for coverage for high-risk patients, reinsurance and other items. The draft bill would phase out Obamacare's expansion of Medicaid over three years, starting in 2021." (Bloomberg)
CalPERS Moves to Adopt 2018 Health Plan Premiums
"The California Public Employees' Retirement System Board of Administration today approved health care rate and plan changes for 2018 that include an average 2.33 percent overall premium increase. Individual plan increases may vary, but the overall Medicare and Basic (non-Medicare) increase is the lowest in 20 years." (CalPERS)
Cigna Stays in Obamacare for Now; Anthem Reduces Participation
"U.S. healthcare insurer Cigna Corp said on [June 21] it will continue to offer individual coverage under Obamacare for now while rival Anthem announced it was shrinking its participation, amid uncertainty over the fate of the government-subsidized program. [June 21] was the deadline for insurers to submit to the government their 2018 rates for individual plans sold on the HealthCare.gov website[.]" (Reuters)
Massachusetts Scales Back Plan for Health Care Fee on Employers
"Governor Charlie Baker's administration has scaled back a plan to assess a controversial new fee on employers to cover more of the state's health care costs and asked lawmakers Tuesday to allow an increase to an existing fee that could raise $200 million per year.... Baker initially proposed a $300 million new fee that would have charged businesses $2,000 per worker to help pay the costs of MassHealth, the state Medicaid program." (The Boston Globe)
Sole ACA Insurer in Most Iowa Counties to Hike Premiums by 43.5 Percent
"Medica's decision means every county in Iowa will have at least one insurer on the exchanges next year.... Because of the uncertainty surrounding ObamaCare, Medica will ask for 43.5 percent increases in its premiums, however. 'Rate increases of 43 percent are not sustainable long-term,' [Georff Bartsh, Medica's vice president of individual and family business] said." (The Hill)
[Opinion] Savings Reported by CMS Do Not Measure True ACO Savings
"While we can observe actual spending for ACO beneficiaries, ... it's very hard to know what would have been spent if ACOs did not exist. It is important to avoid using the [CMS] benchmarks to evaluate ACO savings because benchmarks are constructed with policy goals in mind.... Using the benchmark as the measure of success, analysts have concluded, for example, that CMS actually lost money (on the order of $200 million) in the ACO program and that it was a bad deal for CMS. Contrast this with a conclusion based on the use of a counterfactual designed for research purposes (and based on regional spending trends):" (Health Affairs)
State Efforts to Lower Cost-Sharing Barriers to Health Care for the Privately Insured
"Six states and DC have policies requiring insurers in the individual market to cover certain services pre-deductible, such as doctor's visits and generic prescription drugs.... [S]tates designed these plans to make high-value health care services more accessible and affordable, although data to assess the impact of pre-deductible coverage is not yet available. Although stakeholders identified challenges in the development of these plans, states' open, public processes contributed to a generally smooth implementation." (Urban Institute)
Evidence on Recent Health Care Spending Growth and the Impact of the ACA (PDF)
13 pages. "Though average marketplace premium increases were higher in 2017 than in 2015 and 2016, marketplace competition in large urban markets has generally been intense, leading to narrower networks of providers who are willing to accept lower payment rates in private insurance plans.... 20 states have average 2017 nongroup marketplace premiums that are below their average employer-sponsored insurance premiums; 11 states have average marketplace premiums that exceed employer-sponsored insurance premiums by less than 10 percent." (Urban Institute)
Market Uncertainty Driving ACA Rate Increases
"Two market influences, in particular, are complicating 2018 rate setting: the uncertainty surrounding continued funding of cost sharing reduction (CSR) payments and the question of how the relaxation of the individual mandate will impact enrollment and risk pools.... [Up] to two-thirds of 2018 rate increases will be due to the uncertainty surrounding these two market influences." (Oliver Wyman Health)
2017 Retirement Health Care Costs Data Report (PDF)
"[A] 66-year-old couple retiring this year will require 59% of their Social Security benefits to cover total retirement health care costs. A 55-year-old couple will need 92% of benefits, and 45-year-old couple, 122%.... [A] 65-year-old couple will pay $404,253 ($607,662 in future dollars) for total lifetime health care costs.... [In] ten years, a 55-year-old couple will pay 25% more for the same coverage. In two decades, equivalent insurance will cost a 45-year-old couple over $635,000." (HealthView)
Individual Rates Jump; Employers Insulated
"Michigan's nine insurers submitted two sets of individual market rates last week to the state Department of Insurance and Financial Services that showed some eye-popping price hikes. One set -- including the controversial federal subsidy designed to hold down premiums -- requests rate increases from insurers that range from 8 percent to 27 percent. The second set, without the subsidies, range from 19 percent to 60 percent." (Crain's Detroit Business)
The Rise of the Group Health Insurance Captive
"Under [one] approach, the group captive consists of a series of 'fronted' captive cells that are sponsored by the commercial carrier from who the stop-loss coverage is purchased. Under the second approach, the group captive is separately maintained and subscribed to under an enabling state law. Both approaches accomplish the pooling of stop-loss coverage at the tranche of risk underwritten by the captive.... Group captives rest on a modestly reliable regulatory foundation. To be ideally positioned to withstand challenge, group captives would need to follow to the letter the steps outlined in [two DOL] advisory opinions[.]" (Mintz Levin)
Health Spending by State 1991-2014: Measuring Per Capita Spending by Payers and Programs
"This study examines per capita health spending by state of residence and per enrollee spending for the three largest payers (Medicare, Medicaid, and private health insurance) through 2014. [It] discusses in detail the impacts of the [ACA] implementation and the most recent economic recession and recovery on health spending at the state level.... [T]hese factors affected overall annual growth in state health spending and the payers and programs that paid for that care. They did not, however, substantially change state rankings based on per capita spending levels over the period." (Health Affairs)
Health Expenditures by State of Residence, 1991-2014 (PDF)
"These data provide a resident-based view of health care spending (that is, spending for the individuals who reside in a state) by service and by major payer (Medicare, Medicaid, and Private Health Insurance) that are consistent in methodology and definition over time, offering a context for understanding variation in health spending across states." [Also available: [1] State Health Expenditure Accounts: Methodology Paper, 1980-2014, Definitions, Sources and Methods (ZIP); [2] Health expenditures by state of residence: summary tables, 1991-2014 (ZIP); [3] Health expenditures by state of residence, 1991-2014 (ZIP); and [4] Econometric Analysis of State Health Expenditures: Methodology and Model Specification (PDF).] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
For AHCA, CMS Actuary Finds Smaller Coverage Losses, Smaller Spending Reductions Than CBO
"The headline from the Actuary's report that is likely to receive the most attention is that the CMS Actuary sees the AHCA as increasing the uninsured by 4 million for 2018/2019 and by 13 million by 2026. By contrast, the CBO estimated that the AHCA would increase the uninsured by 14 million for 2018 and 23 million by 2026. The Actuary also, however, projects far smaller reductions in federal health care spending from the AHCA than did the CBO -- a total of $328 billion over ten years[.]" (Timothy Jost, in Health Affairs)
Estimated Financial Effect of the American Health Care Act of 2017 (PDF)
"Over fiscal years 2017-2026, selected provisions of the AHCA are anticipated to reduce Federal expenditures by over $328 billion primarily because of lower Medicaid spending. In 2018, the number of uninsured is estimated to be about 4 million higher under the AHCA than under current law ... By 2026, the number of uninsured is estimated to be roughly 13 million higher under the AHCA.... For the individual insurance market, average gross premiums are estimated to be roughly 13 percent lower in 2026 under the AHCA than under current law." (Office of the Actuary, Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

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