ACA/health reform

ACA, Medicaid expansion reduce income inequality, study finds

Coverage gains made and subsidies offered under the Affordable Care Act reduced income inequality by more than 10% in 2019, according to a new study (Source: “ACA's coverage gains decreased income inequality: study,” Fierce Healthcare, Jan. 7).

The study from the left-leaning think tank Urban Institute, backed by the Robert Wood Johnson Foundation and published in Health Affairs, found that for a typical person in the bottom 10th percentile of income, those who enrolled in a plan under the ACA saw their incomes increase by an average of 18.8%.

In states that expanded Medicaid, their incomes rose by an average of 22%, the study found. The study also found that coverage gains led to reductions in income inequality within and between age and racial groups.


Supreme Court justices signal likely support for keeping ACA

Statements made by Supreme Court justices during the latest challenge to the Affordable Care Act indicate that the law is likely to be upheld (Source: “‘Obamacare’ likely to survive, high court arguments indicate,” Associated Press, Nov. 10).

Meeting remotely a week after the election and in the midst of a pandemic that has closed their courtroom, the justices on Tuesday took on the latest Republican challenge to the Obama-era health care law, with three appointees of President Donald Trump, an outspoken critic of the law, among them.

But at least one of those Trump appointees, Justice Brett Kavanaugh, seemed likely to vote to leave the bulk of the law intact, even if he were to find the law’s now-toothless individual mandate that everyone obtain health insurance to be unconstitutional.

“It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the act in place,” Kavanaugh said.

Chief Justice John Roberts, who wrote two earlier opinions preserving the law, stated similar views, and the court’s three liberal justices are almost certain to vote to uphold the law in its entirety. That presumably would form a majority by joining a decision to cut away only the mandate, which now has no financial penalty attached to it. Congress zeroed out the penalty in 2017, but left the rest of the law untouched.


Medicaid facing unprecedented strains amid pandemic, unemployment surge

As COVID-19 roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed (Source: “Medicaid Nearing ‘Eye of The Storm’ As Newly Unemployed Look For Coverage,” Kaiser Health News, April 3, 2020).

That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers. The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and health care in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.


Insurance premiums to spike in 2021 because of COVID-19, report forecasts

The cost of COVID-19 testing and treatment is likely to squeeze U.S. health insurers' profits, which could lead to higher premiums in 2021 (Source: “COVID-19 could prompt higher 2021 insurance premiums, benefit cuts,” Modern Healthcare, March 23, 2020).

A new report from Covered California, the state's Affordable Care Act marketplace, projected that commercial insurers and employers across the United States could face a $34 billion to $251 billion bill for coronavirus testing and treatment this year. Their best estimate is $103 billion.

Absent any federal action, those costs could prompt commercial health insurers to increase premiums between 4% to 40% in 2021 to make up for increased medical claims and stay solvent, according to the report.

The report by Covered California's chief actuary John Bertko focuses on costs for the commercially insured, which includes about 170 million Americans who receive coverage through their jobs and the individual market. It doesn't address the separate and likely significant costs to Medicare, Medicaid or other public programs, though Bertko said those costs would be "huge."


CMS unveils plan to allow states to cap Medicaid spending, shift to block grants

The Trump administration said last week that it would allow states to cap Medicaid spending for many adults with lower incomes, a major shift long sought by conservatives that gives states the option of reducing health benefits for millions who gained coverage through the program under the Affordable Care Act (Source: “Trump Administration Unveils a Major Shift in Medicaid,” New York Times, Jan. 30, 2020).

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said states that sought the arrangement — an approach often referred to as block grants — would have broad flexibility to design coverage for the affected group under Medicaid, the state-federal health insurance program for the poor that was created more than 50 years ago as part of President Lyndon B. Johnson’s Great Society.

The CMS announcement comes as the agency’s efforts to let states require adults on Medicaid to work or train for a job — which led to 17,000 people in Arkansas losing coverage in 2018 — are mired in court battles.

“Government has a solemn responsibility to provide for the most vulnerable among us,” Ms. Verma said in a morning call with reporters. “Part and parcel of that responsibility is making sure the Medicaid program is sustainable.”


ACA, Medicaid expansion led to reduced access disparities, analysis finds

Racial gaps in access to health care narrowed after the Affordable Care Act took effect, a new study reports  (Source: “Obamacare Curbed Racial and Ethnic Coverage Gaps, but Progress Has Slowed,” U.S. News, Jan. 16, 2020).

These gaps in health insurance coverage have fallen across the country since 2014, especially in states that expanded eligibility for Medicaid, according to Commonwealth Fund analysis.

From 2013 to 2018, the black-white gap in insurance coverage dropped from 8.4 to 3.7 percentage points in Medicaid expansion states, while the Hispanic-white gap fell from 23.2 to 12.7 percentage points. Gains were so significant that the uninsured rate among blacks in expansion states in 2018 – 10.1% – was lower than the 12.3% rate among whites in non-expansion states, the report says.

The Affordable Care Act also led to a decline in cost-related barriers to care, the report found. In 2013, about 23% of black adults and 28% of Hispanic adults said they didn't get the health care they needed due to the cost. In 2018, those shares had fallen to 17.6% among black adults and 21.2% among Hispanic adults, though each share remained significantly higher than the 12.9% of white adults who skipped care because of costs.


More employee pay going to health insurance in Ohio, U.S., study finds

Across the United States, the cost of health insurance and deductibles for those with employer-sponsored plans is outpacing median income, according to a new report (Source: “Employees spending greater share of income on health insurance in Ohio, U.S.,” Cleveland Plain Dealer, Nov. 21, 2019).

According to the Commonwealth Fund report, premiums and deductibles in 2018 were 10% or more of the median income for workers in 42 states, including Ohio. A decade before, that was only true in seven states. The report analyzed data from the U.S. Census Bureau and a federal insurance questionnaire.

Nationally, the average employee premium contribution and deductible represented 11.5% of median household income in 2018, up from 7.8% a decade before. In Ohio, the average premium contribution and deductible made up 11.1% of median household income, compared with 6.9% in 2008, according to the report.

Rising deductibles could make employees more likely to delay or skip care or, to not take prescription medications, the report said. And if premiums get too high, some might forgo health insurance all together, the study’s authors said.

“Over the last decade, employer health insurance premiums and deductibles have grown faster than workers’ wages. This is concerning, because it may put both coverage and health care out of reach for millions of people,” said Sara Collins, vice president of health care coverage and access for the Commonwealth Fund and one of the authors of the report.


Premiums stable, more choices available in 2020 ACA marketplace

Consumers will have more health insurance choices next year in the ACA marketplace and premiums will dip slightly for many, the Trump administration announced Tuesday (Source: “More choices and stable premiums for ‘Obamacare’ next year,” Associated Press, Oct. 22, 2019).

According to the Department of Health and Human Services, an additional 20 insurers will participate in ACA marketplaces in 2020, expanding consumer choice in many states. Nearly 70 percent of customers will have three or more insurers from which to pick a plan.

About 10 million people are covered through the health law’s insurance markets, which offer taxpayer-subsidized private plans for people who aren’t covered on the job. Premiums for a hypothetical 27-year-old choosing a standard plan will decline 4% on average in 2020 for states (including Ohio) served by the federal HealthCare.gov website, the Trump administration said.


Study: Employer-sponsored health insurance increasingly unafforable

Employers remain the main source of health insurance in the U.S., but premiums and deductibles are pushing employer-based coverage increasingly out of reach, according to a new national study (Source: “Employer Health Insurance Is Increasingly Unaffordable, Study Finds,” New York Times, Sept. 25, 2019).

A new analysis released Wednesday by the Kaiser Family Foundation found that the average premium paid by the employer and the employee for a family plan now tops $20,000 a year, with the worker contributing about $6,000. More than a quarter of all covered workers and nearly half of those working for small businesses face an annual deductible of $2,000 or more.

The new data on employer coverage comes as the Democratic presidential candidates debate sweeping reforms to diminish the role of private insurance in the American health system, including expanding the federal Medicare program to everyone or giving people the option to enroll in a government-run plan.

Many of the arguments for both systems center on expanding health insurance to more of the estimated 27 million people who lack it. But millions of people who already have coverage are deeply dissatisfied with the current system as well.


Census data: Uninsured rate goes up in Ohio for first time since 2009

Ohio was one of only eight states in the country to see its uninsured rate climb, according to new federal data (Source: “Ohio one of eight states to see uninsured rate rise, 58,000 more people uninsured,” Cleveland Plain Dealer, Sept. 10, 2019).  

According to the U.S. Census Bureau data, the number of people in Ohio without medical insurance rose to 744,000 in 2018, up 58,000 from the previous year. Ohio also was one of just four Medicaid expansion states to see its uninsured population increase.

The state increase is part of a national rise in the number of uninsured Americans, from 25.6 million in 2017 to 27.5 million in 2018. Of that 1.9 million increase, 22 percent were children, according to the Census data. This is the first time the national rate has increased since 2009, before the Affordable Care Act was passed in 2010.