By Leila Sullivan and Samantha Hagberg
The leaves are falling however the newest well being coverage analysis is evergreen! Final month we examine well being system competitors in metropolitan areas, well being care affordability previous to the American Rescue Plan (ARPA,) how excessive deductible medical health insurance can exacerbate racial and ethnic wealth disparities, and about unmet dental, imaginative and prescient and listening to wants amongst low-income Medicare Benefit beneficiaries.
One or Two Well being Programs Managed the Total Marketplace for Inpatient Hospital Care in Almost Half of Metropolitan Areas in 2022
Jamie Godwin, Zachary Levinson, and Tricia Neuman. KFF. October 1, 2024. Out there right here.
This KFF article analyzed well being system market competitiveness utilizing RAND hospital knowledge from 2022 and the American Hospital Affiliation’s (AHA) Annual Survey Database. Researchers measured competitors in 3 ways: The share of metropolitan statistical space (MSAs) managed by a small quantity off well being programs, the extent of market focus in MSAs primarily based on the Herfindahl-Hirschman Index (HHI), and the share of hospitals affiliated with well being programs over a span of time.
What it Finds
- Between 1-2 well being programs managed the whole marketplace for inpatient hospital care in practically half (47%) of metropolitan areas in 2022.
- In additional than 4-5 metropolitan areas (82%), 1-2 well being programs managed greater than 75% of the market; these markets have met the definition of extremely concentrated markets.
- In 79% of MSAs (with populations lower than 200,000), 1-2 well being programs managed the whole marketplace for in-patient hospital care in 2022.
- Almost all (97%) metropolitan areas had extremely concentrated markets for inpatient hospital care when making use of HHI thresholds from antitrust tips to MSAs.
- For instance, in Austin, TX, (2.4 million residents) two programs (HCA Healthcare and Ascension Well being) managed 85% of the inpatient hospital care market, although Austin is dwelling to greater than 4 well being programs.
Why it Issues
Nationwide well being spending rose to $4.5 trillion in 2022 and is projected to develop sooner than GDP via 2032. Not solely is that this inflicting an increase in healthcare prices for people, but additionally employers, states, and the federal authorities. Nearly one third of healthcare spending is funneled into hospitals. This evaluation makes plain the extent to which hospitals within the U.S. have consolidated their market energy, which they then use to demand increased costs from industrial insurers and well being plans.
Well being Care Affordability in Employer versus Personal Nongroup Protection earlier than ARPA
Michael Karpman, Fredric Blavin, Jessica Banthin, and Vincent Pancini. City Institute. October 15, 2024. Out there right here.
This City Institute report compares well being care affordability between households with employer-sponsored insurance coverage (ESI) and people with non-public non-group protection obtained via or exterior of the medical health insurance Marketplaces. Utilizing Medical Expenditure Panel Survey Information from 2016-2019, earlier than the improved premium tax credit within the American Rescue Plan Act (ARPA) of 2021 have been enacted, researchers analyze affordability measures amongst nonelderly adults in households the place each particular person had steady full-year ESI protection or a non-group plan.
What it Finds
- Adults with non-group protection reported bigger common per-person out-of-pocket (OOP) premiums ($2,912 vs $1,126) and well being care prices ($1,010 vs $825) than adults with ESI.
- Non-group enrollees have been greater than twice as probably as these with ESI to report paying at the least 10% of household revenue in the direction of well being care prices (10.5% vs 3.8%). Amongst low-income adults, 24% of these with non-group protection reported OOP well being care prices exceeding 10% of revenue.
- Greater than 1 in 3 adults with non-group protection (36.4%) and over 1 in 5 adults with ESI (21.8%) reported delayed or forgone medical care, dental care, or prescribed drugs they wanted up to now 12 months due to excessive prices. In households with revenue under 400% of the federal poverty degree, 27% skilled delayed or forgone care with ESI, whereas 41.7% skilled the identical results with non-group protection.
- Adults with non-group protection have been extra probably than these with ESI to report issues with paying household medical payments up to now 12 months (10.2% vs 6.9%).
- Non-group enrollees had decrease common incomes and higher well being wants than these with ESI; the upper prevalence of affordability challenges amongst non-group enrollees might mirror their higher probability of selecting high-deductible well being plans (44.6% vs 36%) and decrease charges of dental protection (24.4% vs 76.8%).
Why it Issues
This evaluation reveals that households with industrial medical health insurance face important affordability challenges. Folks with particular person market (non-group) insurance coverage have had explicit challenges paying for and accessing well being care, in comparison with folks with ESI. Nonetheless, the enhancement of Market premium tax credit enacted in ARPA, and later prolonged via 2025 within the Inflation Discount Act, considerably improved affordability for non-group market enrollees. As reported, ARPA subsidies decreased out-of-pocket silver plan premiums by a mean of about $1,000 for low- and moderate-income Market enrollees. Over the following yr, Congress should resolve whether or not to increase the ARPA/IRA subsidies past 2025. If Congress fails to increase these subsidies, many of the 21.4 million present Market enrollees will expertise a rise in premiums, and the Congressional Funds Workplace has projected that tens of millions will lose their protection.
Excessive-Deductible Well being Insurance coverage Could Exacerbate Racial And Ethnic Wealth Disparities
Naomi Zewde, Sergio Rodriguez, and Sherry Glied. Well being Affairs. October 2024. Out there right here.
This Well being Affairs research analyzes the influence of high-deductible well being plans via the lens of racial and ethnic wealth disparities. Utilizing Medical Expenditure Panel Survey knowledge, researchers consider the online price (from 2011-2018) and monetary property (from 2011-2016) of households with non-public insurance coverage and people in high-deductible well being plans (HDHP).
What it Finds
- Low-income households had little in monetary holdings; monetary property have been lower than $1,000 for each Black and Hispanic households within the first revenue quartile.
- White households ($4,100) within the lowest revenue quartile held monetary property that have been roughly 350% higher than these held by Black ($2,200) or Hispanic ($2,000) households at a comparable degree of revenue.
- Black and Hispanic households held considerably much less wealth than White households. Black households held $68,500 in internet price on the median — roughly half the median wealth of White households ($126,200). Hispanic households fell between the 2, at $88,700.
- Throughout all revenue ranges, Black and Hispanic households with an HDHP and a well being care financial savings account (HSA) held between $34,000 and $40,000 in monetary property; alternatively, White households with an HDHP and HSA had simply over $55,000 in median monetary property.
Why it Issues
This research signifies that low-income Black and Hispanic households with HDHPs and with out the disposable revenue to contribute to HSAs, are notably financially weak. Amongst folks with non-public insurance coverage, underlying Black-White and Hispanic-White wealth gaps create structural disparities within the affordability of well being providers. Coverage initiatives, such because the Inflation Discount Act’s enhanced premium tax credit, might scale back out-of-pocket liabilities. This in flip can mitigate households’ must depend on accrued wealth to cowl healthcare bills. On the similar time, proposals to increase HSAs primarily profit increased revenue, White households. Policymakers ought to take into account initiatives that scale back the necessity for households to keep up important monetary property with the intention to entry care.
Value-Related Unmet Dental, Imaginative and prescient, And Listening to Wants Amongst Low-Earnings Medicare Benefit Beneficiaries
Avni Gupta, Kenton J. Johnston, Diana Silver, David J. Meyers, Sherry A. Glied, Jose A. Pagan. Well being Affairs. October 2024. Out there right here.
This Well being Affairs research checked out knowledge from the 2018-19 Medicare Present Beneficiary Survey (MCBS) to find out the probability that low-income beneficiaries report unmet wants due to value for dental, imaginative and prescient, and listening to providers, in addition to whether or not a plan’s star scores are an indicating metric in income-based disparities.
What it Finds
- General, 11%, 4%, and a couple of% of beneficiaries reported unmet dental, imaginative and prescient, and listening to want, respectively, as a result of value issues.
- No matter plan profit generosity, low-income beneficiaries have been extra probably than high-income beneficiaries to report an unmet want due to value. After adjustment, beneficiaries with incomes of 200% of poverty or much less have been 6.2, 1.8, and 1.9 proportion factors extra more likely to report a dental, imaginative and prescient, or listening to unmet want, respectively, due to value.
- The authors discovered no proof that increased star scores have been persistently related to decrease unmet want due to value, and extra beneficiaries with an unmet dental want due to value have been enrolled in low-star plans in comparison with these with out unmet dental want due to value.
- The authors discovered that dental unmet wants as a result of value, however not imaginative and prescient or listening to unmet wants, have been decrease amongst beneficiaries enrolled in increased star-rated plans. Nonetheless, this end result didn’t appear to end result from bigger high quality bonuses that have been paid primarily based on previous-year scores.
Why it Issues
A purpose for the recognition of Medicare Benefit (MA) amongst low-income beneficiaries is that plans usually provide supplemental advantages at minimal or no premiums. Nonetheless, knowledge aren’t accessible about enrollees’ entry to and use of those supplemental advantages, or the standard of these advantages. Supplemental advantages for dental, imaginative and prescient, or listening to providers won’t be contributing to equitable entry for beneficiaries throughout revenue ranges. Enrollment in plans, rated extremely within the earlier yr and subsequently receiving increased high quality bonuses, doesn’t decrease the incidence of dental, imaginative and prescient, or listening to unmet wants due to value. At the moment, supplemental advantages aren’t standardized, contributing to Medicare beneficiary confusion amid an already advanced alternative panorama. Much like the ACA Marketplaces, the proportion of MA beneficiaries who report evaluating plans and advantages is decrease amongst low-income beneficiaries, resulting in them to stay of their current plan, regardless of higher choices doubtlessly being accessible.
