Note: iProtean editorial staff will be on holiday next week, celebrating Memorial Day. Look for the next blog/newsletter June 1. Enjoy the holiday!
The uninsured rated dropped from a high of 16.3 percent in 2010, the year the Affordable Care Act was enacted, to 9.1 percent in 2015, according to data released by the CDC this week. This is the first year that fewer than 1 in 10 Americans lacked health insurance.
The secretary of HHS released a written statement in response to the data from the CDC, noting “exceptionally slow” increases for employer-based insurance coverage premiums, Medicare spending and healthcare prices.
Despite these slowdowns, concerns about healthcare affordability continue to dominate policy-making decisions. Discussions center on data highlighting increases in out-of-pocket costs, drug costs and rates of underinsurance.
One area where enrollee affordability may have improved, according to the CDC, was in a slowdown, even plateauing, of enrollment in high-deductible health plans (HDHPs). Policy-makers and analysts have criticized these plans for reducing enrollee utilization of both elective and needed healthcare services, while leaving providers with uncollectable bills.
HDHP enrollments jumped from 25.3 percent of the pre-Medicare population in 2010 to 36.9 percent in 2014; then dropped slightly to 36.7 percent in 2015. (“As Uninsured Rate Drops, Affordability Challenges Grow,” HFMA Weekly, May 21, 2016)
(Note: data from other surveys show HDHP enrollments increasing in both individual and employer-sponsored health plans in 2015. For example, Mercer’s national survey
of employer-sponsored health plans found enrollments in HDHPs increased two percentage points from 2014 and comprised 25 percent of all employees in 2015.)
What Is Happening On the Ground?
Hospitals have seen an increased number of underinsured patients this year, according to a recent survey of disproportionate share, children’s and rural hospitals responding to the survey.
Insured patients at those hospitals are struggling to afford their outpatient drugs because of unaffordable copayments (according to 88 percent of hospitals in the survey), deductibles (84 percent), or drug benefit design (71 percent). (“As Uninsured Rate Drops, Affordability Challenges Grow,” HFMA Weekly, May 21, 2016)
Patients’ inability to afford their out-of-pocket costs leaves that share of the costs to accumulate as hospital bad debt. Some of the largest publicly traded hospitals reported earlier this year that they have had large increases in bad debt. (“As Uninsured Rate Drops, Affordability Challenges Grow,” HFMA Weekly, May 21, 2016)
iProtean subscribers, the advanced Finance course, Population Health and Alternative Payment Models, featuring Marian Jennings and Dan Grauman, is in your library. Jennings and Grauman discuss the onset of alternative payment models within the context of population health management, and the levels of risk associated with these models.
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