August 12, 2021

At $140 billion, the nation’s unpaid medical bills are the single largest form of past due debt. One thing driving this is no doubt rising deductibles for health insurance.

A third of insured Americans said in a survey that it is difficult to pay the deductibles in their employer health insurance plans and in the policies sold on the Affordable Care Act (ACA) marketplaces.

Among employer-sponsored insurance plans, policies with high deductibles are becoming more pervasive, even in large corporations. Employers are choosing high-deductible plans in part to keep their workers’ monthly premiums at a reasonable level – a tradeoff that is inherent in health insurance.

But the sky-high cost of medical care can quickly run-up out-of-pocket spending in years when someone in the family becomes very ill or needs surgery. Average deductibles exceed $3,000 for a single worker’s policy in half of the U.S. companies with less than 200 workers. The family plan deductibles exceed $6,000 in more than 40 percent of small companies.

ACA plan deductibles are rising in almost every state and have surpassed $4,000 per year, on average, in 11 states from Arizona and Michigan to Oregon. A variety of plans are available on the exchanges, including plans with lower deductibles for people willing to pay higher premiums. But ACA premiums have also been rising, though the federal government has temporarily increased the premium subsidies as part of COVID-19 relief.

New research appearing in the July issue of the Journal of the American Medical Association (JAMA) estimates that medical bills made up more than half of all the consumer debt in collections last year. And the data are through June 2020 and don’t even reflect the full cost of caring for COVID patients. …Learn More

July 29, 2021

The Affordable Care Act gives a carrot to states that expand Medicaid from a health insurance program mainly for poor people to one that also includes low-income workers.

Under the 2010 law, the federal government initially paid the full cost of adding more people to the Medicaid rolls, and a large majority of states have signed up. The federal funding for new expansions dropped a bit in 2020 to 90 percent and will remain there.

Yet 11 states are holdouts and haven’t expanded their programs, leaving nearly 2.2 million workers and family caregivers in what the Center for Budget and Policy Priorities calls the Medicaid coverage gap.

The workers falling in the gap, who would qualify for coverage if their states expanded Medicaid, do not have health insurance at their places of employment and can’t afford to buy subsidized insurance through the Affordable Care Act.

The bulk of the uncovered workers are in the South, with half in Texas and Florida. Missouri had been a holdout. But last week, the Missouri Supreme Court ordered the legislature to comply with a voter ballot initiative and fund expansion of the state’s Medicaid. Expansion was also controversial in Oklahoma, but it went into effect on July 1 after voters there approved the measure.

An analysis by the Center sketched a picture of who is in the gap, based on 2019 Medicaid data, the most recent available. People of color comprised about 40 percent of the working-age population but made up 60 percent of the people in the gap in the non-expansion states, the Center estimates.

Nationwide, one in four who lack access to Medicaid are lower-paid essential workers on the front lines during the pandemic. …Learn More

February 4, 2020

Life expectancy for 65-year-olds in the United States is less than in France, Japan, Spain, Italy, Australia, Canada, the United Kingdom, the Netherlands, and Germany.

Fifty years ago, we ranked third.

First, some perspective: during that time, the average U.S. life span increased dramatically, from age 79 to 84. The problem is that we haven’t kept up with the gains made by the nine other industrialized countries, which has caused our ranking to slide.

A troubling undercurrent in this trend is that women, more than men, are creating the downdraft, according to an analysis by the Center for Retirement Research. The life expectancy of 65-year-old American women is 2½ years less than women in the other countries. The difference for men is only about a year.

The center’s researchers identified the main culprits holding us back: circulatory diseases, respiratory conditions, and diabetes.  Smoking and obesity are the two major risk factors fueling these trends.

Americans used to consume more cigarettes per capita than anyone in the world. That’s no longer true. In recent years, the U.S. smoking rate has fallen sharply, resulting in fewer deaths from high blood pressure, stroke, and other circulatory diseases.

But women haven’t made as much progress as men.  Men’s smoking peaked back in the mid-1960s, and by around 1990, the delayed benefits of fewer and fewer smokers started improving men’s life expectancy. Smoking didn’t peak for women until the late-1970s, and their death rate for smoking-related diseases continued to rise for many years after that, slowing the gains in U.S. life expectancy overall.  More recently, this pattern has reversed so that women are now beginning to see some improvement from reduced smoking.

Obesity is a growing problem across the developed world. But in this country, the obesity rate is increasing two times faster than in the other nine countries. Nearly 40 percent of American adults today are obese, putting them at risk of type-2 diabetes and circulatory and cardiovascular diseases. …Learn More

Behavior

August 22, 2019

A popular idea for reducing healthcare costs is to arm consumers with detailed information about the prices of drugs and medical procedures so they can make smarter decisions.

But the academic community is reaching the opposite conclusion: people don’t understand the information they already have and are making bad decisions based on these misconceptions. The latest example is a survey of Wisconsin state workers who sometimes defer care because they are under the mistaken impression that they can’t afford it.

“Workers do not understand how health plans work, the role of deductibles, co-insurance and co-pays … and what goes into out-of-pocket costs,” concludes a report by the University of Wisconsin public affairs school, which surveyed 2,200 government workers.

Before getting into the specific findings, it’s important to note that Wisconsin’s employees are in an enviable position. They choose from just four health insurance options approved and overseen by the state. The broader implications of the report are more distressing, if one considers that millions of Americans buying insurance through the Affordable Care Act exchanges, Medicare Advantage plans, or Medicare Part D drug plans must sort through oodles of plan options with different copayments, deductibles, physician and hospital networks, or drug coverages.

The confusing patchwork of Part D plans hurts retirees’ pocketbooks, according to research in Health Affairs, which found that only one out of 20 retirees selects the cheapest drug plan to meet their medication needs. A different study found that health insurance buyers purchase overly expensive plans when they have to choose from a complex menu of options.

The Wisconsin report said state workers there are also overwhelmed: …
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