Search the News Archive

States, Not the Presidential Candidates, Will Take the Lead on Health Care in 2020

"Colorado and Washington are implementing public insurance options that could be a model for Democrats at the federal level.... Pennsylvania and New Jersey are taking over their [ACA] marketplaces from the federal government.... Idaho and other red states are promoting short-term insurance plans as an alternative to the [ACA].... Georgia is seeking ACA waiver plan to ditch the state's marketplace, with consumers enrolling through insurers and web brokers[.]"

How to Keep ACA Stabilization Narrow

"[W]hen people read headlines or hear about 'premiums soaring' in the ACA marketplaces, most Americans -- 76% -- they think they are hearing about their own premiums, even though the vast majority of Americans are not in the individual insurance market and are not affected.... In fact, the rest of the health system where most Americans get their coverage looks very different from the non-group market."

Out of Pocket Costs: The Only Health Care Prices That Matter to Consumers

"Just 17 percent of people with typical deductibles shop today, and 21% with high deductible plans. More price transparency will drive these numbers up, but how much is unknown. On the other hand, there is some evidence that people want to shop when they can: 47%, for example, asked for a generic drug to save money in the past year; and 36% checked with a provider or health plan on the cost of an office visit. But just 23% used an online tool to compare provider costs. All told, 70% reported some shopping-like behavior in the survey."

Some Employers Are Giving More Health Care Help to Low-Wage Workers

"[S]ome employers have moved to 'progressive,' or wage-related, health benefits ... where their lower wage employees pay a smaller share of insurance premiums, deductibles or health account contributions than higher-wage employees do.... More large non-profits seem interested in progressive benefits than corporations do.... There are other complexities: What wage level is fair? Will employees just above the level feel aggrieved or seek a salary cut to reduce their health costs? How complicated is the policy to administer? How will this play out in unionized work forces?"

Drugs Aren't the Reason the U.S. Spends So Much on Health Care

"The U.S. spent $10,637 per capita on health care in 2018. Comparable countries spent $5,527. The overwhelming majority of the difference -- 76% of it -- came from spending on inpatient and outpatient care -- not drugs, which get more attention but represent just 10% of the difference."

For Low-Income People, Employer Health Coverage Is Worse Than ACA

"For low-income families with marketplace plans, the out-of-pocket costs are 4.7% of their income, while the premiums are just 3.7% of their income. For those with coverage through work, the out-of-pocket costs are 5% of their income, roughly the same as the families with marketplace plans. The big difference is in the premiums -- because the low-income families with workplace coverage pay about 9% of their income to cover those payments."

Health Care Spending Is More Than Just the Parts You See

"To really understand how Medicare for All or any other big change in health care financing would affect them, people need to understand how they would impact their overall family health budgets. Few people think about the other health costs they pay: their taxes to support health care, or what their employers are paying towards premiums (which is depressing their wages)."

Ditching Insurance Companies Doesn't Help Employers Cut Health Care Costs

"The average family premium for fully insured firms last year was a whopping $20,627. For larger self-insured firms, it was $20,739. There hasn't been a meaningful difference for the past 20 years. ... Self-insured firms would seem to have an advantage because they cut out the middleman.  ... Most large insured firms have implemented similar strategies. And they buy insurance from the same companies that administer self-insured plans."

Private Health Insurance Costs Are Skyrocketing

"Per capita spending for private insurance has grown by 52.6% over the last 10 years. Per-capita spending for Medicare grew by 21.5% over the same period, and Medicaid 12.5%. Private insurance generally pays higher prices for care than Medicare, which generally pays more than Medicaid. There’s a long-running debate about whether public programs deliver efficiency because of their purchasing power, or simply underpay."

A Small Group of Patients Facing High Drug Costs Drive Health Care Spending

"Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year.... 'Persistently high spenders' are people who have accumulated big health care bills for at least 3 consecutive years. They often have HIV, MS, cystic fibrosis, rheumatoid arthritis, diabetes, cancer and other serious conditions requiring frequent and often costly care. Drugs are lifesavers for these patients, but also big offenders when it comes to costs."