Health Reform: Costs, Variations in Care & Public Insurance

June 16, 2009June 16, 2009 J Roberts

Wall Street Journal

A brief commentary from the WSJ on-line regarding some of the issues evolving around healthcare reform. One thing is for sure, healthcare costs vary to the extreme from one end of the country to other and lack any apparent uniformity. Something to take note of the next time you receive a medical statement and/or bill and are alarmed by the actual charge.

The health-reform theme of the day seems to be widespread variations in health-care costs in different areas around the country. If one city spends twice as much as another on health care without any noticeable benefit for patients, the thinking goes, there must be a way to find some savings.

This is an old idea among health wonks (see the Health Blog’s 2007 interview with Dartmouth’s Jack Wennberg, who has been talking about this for decades), but it has gained currency lately amid the big health-reform push in Washington.
Congress may wind up capping Medicare payments in areas where costs are unusually high, or sparing low-spending regions from cuts in Medicare reimbursement, the New York Times notes in a story today.

In 2006, this morning’s Washington Post notes, Medicare spent $5,812 on the average beneficiary in La Crosse, Wisc., compared with $16,351 in Miami, without clear evidence that the extra spending resulted in better care.

Meanwhile, the WSJ reports today, we could start seeing the first proposed health-reform bill as soon as this week from a Senate committee, the start of a stream of health-reform legislation likely to flow from different committees in both houses in the coming months. Congress is aiming to pass legislation by August and deliver a single bill to President Obama by October.

Two key debates remain central, the WSJ notes. One is whether to include a national, government-backed insurance plan; a group of Republicans from the powerful Senate Finance Committee sent a letter to Obama on Monday reiterating their opposition to a public plan, which the administration backs. The other debate is, of course, how to pay for health reform. One possibility to keep an eye on: taxing some health-benefit plans, an option we discussed in this post.

Recession Will Cause More Health Cost Shifting

May 5, 2009May 5, 2009 J Roberts

> Workforce Management

According to the below article more employers are looking to shift the cost of care to their employees in 2009.

The recession likely will boost group health care costs higher than employers anticipated, leading more organizations to shift more costs to employees and adopt lower-cost consumer-driven health plans, according to a survey released Thursday, April 30.

Employers surveyed by benefit consultant Mercer of New York now expect . That compares with a 6 percent average increase employers predicted in a 2008 Mercer survey. , according to the survey. In fact, 15 percent of the 428 responding employers said medical plan utilization has been higher than expected.

Mercer consultants said . More employees, fearful of being laid off, want to get medical tests and have health care services completed while they still have employer-based coverage, said Beth Umland, Mercers director of research for health and benefits in New York.

With costs going up at a time when many employers can least afford it, many intend to shift more costs to employees next year.

For example, 47 percent of respondents said they are likely to increase the percentage of premium employees pay in 2010.

In addition, 22 percent of employers say they are likely to add consumer-driven health care planseither a CDHP linked to a health savings account or a health reimbursement arrangementin 2010. This will be a boon to CDHPs, said Linda Havlin, Mercers global leader for research and knowledge management in Chicago.

Increased employer interest in CDHPs during a recession is not surprising, given that this type of plan costs much less than other health care plans, according to Mercer.

In 2008, Mercer found that HSA-based CDHPs cost an average of $6,027 per employee, compared with an average of $7,815 per employee for more traditional preferred provider organization plans.

The survey also found that more employers were in favor of broad health care reform legislation that would require employers to offer a health care plan or pay a fee to help fund coverage for the uninsured, and a requirement that all individuals be covered in a health care plan.

Growing Number of Americans Report Problems Paying Medical Bills

February 2, 2009March 11, 2009 J Roberts

Almost One in Five Has Medical Bills of $1,000 or More

A report from Kaiser Family Foundation published in November 2008 found that the number of consumers reporting difficulty in paying medical bills is on the rise. To find out more, read the article in full below.

Menlo Park, CA — More and more people are reporting problems with health care bills, and paying for health care retains a solid hold on the public’s list of their top economic concerns, according to the Kaiser Family Foundation’s final election 2008 tracking poll.

About one in three Americans now report their family has had problems paying medical bills in the past year, up from about a quarter saying the same two years ago. Almost one in five (18%) of Americans report household problems with medical bills amounting to more than $1,000 in the past year.

Nearly half (47%) of the public reports someone in their family skipping pills, postponing or cutting back on medical care they said they needed in the past year due to the cost of care. For example, just over one-third say they or a family member put off or postponed needed care and three in ten say they skipped a recommended test or treatment – increases of seven percentage points from last April’s tracking poll which asks the same question.

“Health care is now every bit as much an economic issue for the American people as job insecurity, mortgage payments and credit card debt,” said Kaiser President and CEO Drew Altman.

In the voters’ minds the financial meltdown has not displaced the need for health reform, the poll found. Nearly twice as many voters say that in the face of the economic challenges “it is more important than ever to take on health reform” (62%) than say “we cannot take on health reform right now” (34%). However, a partisan gap remains on this question with majorities of Democratic (75%) and independent (61%) voters agreeing that health care reform is more important than ever, while over half (54%) of Republicans believe it should not be addressed right now.

Not surprisingly, an increasingly large majority of the public – seven in ten – report a “serious problem” with at least one of seven relevant economic challenges due to recent changes in the economy, up 12 percentage points from two months ago. The biggest change among the economic problems measured was with losses in the stock market, which is now a problem reported among three in ten Americans (31%), doubling from two months ago. However, paying for gas (39%) and getting a good paying job or raise (35%) continue to lead as serious problems. Paying for health care or health insurance is reported by nearly three in ten (28%). Paying for health care ranked fourth among economic problems, ahead of paying for food, problems with credit card or other personal debt and paying the rent or mortgage.

“People’s budgets are being strained in multiple ways these days, and health care is no exception,” said Mollyann Brodie, Kaiser vice president and director for Public Opinion and Survey Research. “Our surveys suggest that medical bills are a real issue for lots of families. One undesirable result: people report there are times that they neglect taking care of their health problems.”

The October Kaiser Health Tracking Poll: Election 2008, the eleventh and final in a series designed and analyzed by the Foundation’s public opinion research team, also examines voters’ specific health care issue interests and perceptions of the major presidential candidates’ positions on health care and reform. Kaiser will begin a new tracking poll series next year.

Making health care and health insurance more affordable is the most important health care issue cited by voters (50%), doubling the second ranked issue, expanding health insurance coverage for the uninsured (23%). The survey also shows that while voters tend to disagree about whether there is enough regulation in terms of the safety or cost of health care, majorities of those among all political parties agree that more regulation is needed in terms of how health insurance companies treat people with preexisting health conditions (72% of Democrats, 67% of independents, and 51% of Republicans).