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 Techniques Managed the Whole 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 here.
This KFF article analyzed well being system market competitiveness utilizing RAND hospital information 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 techniques, the extent of market focus in MSAs based mostly on the Herfindahl-Hirschman Index (HHI), and the share of hospitals affiliated with well being techniques over a span of time.
What it Finds
- Between 1-2 well being techniques managed the complete marketplace for inpatient hospital care in almost half (47%) of metropolitan areas in 2022.
- In additional than 4-5 metropolitan areas (82%), 1-2 well being techniques 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 techniques managed the complete 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 pointers to MSAs.
- For instance, in Austin, TX, (2.4 million residents) two techniques (HCA Healthcare and Ascension Well being) managed 85% of the inpatient hospital care market, although Austin is house to greater than 4 well being techniques.
Why it Issues
Nationwide well being spending rose to $4.5 trillion in 2022 and is projected to develop sooner than GDP by way of 2032. Not solely is that this inflicting an increase in healthcare prices for people, but additionally employers, states, and the federal authorities. Virtually 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 greater costs from business 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 here.
This City Institute report compares well being care affordability between households with employer-sponsored insurance coverage (ESI) and people with personal non-group protection obtained by way of or exterior of the medical health insurance Marketplaces. Utilizing Medical Expenditure Panel Survey Knowledge 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 seemingly as these with ESI to report paying no less than 10% of household earnings in 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 earnings.
- 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 prior to now 12 months due to excessive prices. In households with earnings under 400% of the federal poverty stage, 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 seemingly than these with ESI to report issues with paying household medical payments prior to now 12 months (10.2% vs 6.9%).
- Non-group enrollees had decrease common incomes and larger well being wants than these with ESI; the upper prevalence of affordability challenges amongst non-group enrollees could mirror their larger 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 business medical health insurance face important affordability challenges. Folks with particular person market (non-group) insurance coverage have had specific 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 by way of 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 subsequent yr, Congress should determine whether or not to increase the ARPA/IRA subsidies past 2025. If Congress fails to increase these subsidies, a lot of the 21.4 million present Market enrollees will expertise a rise in premiums, and the Congressional Price range Workplace has projected that hundreds of thousands 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 here.
This Well being Affairs research analyzes the affect of high-deductible well being plans by way of the lens of racial and ethnic wealth disparities. Utilizing Medical Expenditure Panel Survey information, researchers consider the online price (from 2011-2018) and monetary belongings (from 2011-2016) of households with personal insurance coverage and people in high-deductible well being plans (HDHP).
What it Finds
- Low-income households had little in monetary holdings; monetary belongings have been lower than $1,000 for each Black and Hispanic households within the first earnings quartile.
- White households ($4,100) within the lowest earnings quartile held monetary belongings that have been roughly 350% larger than these held by Black ($2,200) or Hispanic ($2,000) households at a comparable stage of earnings.
- Black and Hispanic households held considerably much less wealth than White households. Black households held $68,500 in web 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 earnings 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 belongings; alternatively, White households with an HDHP and HSA had simply over $55,000 in median monetary belongings.
Why it Issues
This research signifies that low-income Black and Hispanic households with HDHPs and with out the disposable earnings to contribute to HSAs, are notably financially susceptible. Amongst folks with personal insurance coverage, underlying Black-White and Hispanic-White wealth gaps create structural disparities within the affordability of well being companies. Coverage initiatives, such because the Inflation Discount Act’s enhanced premium tax credit, could cut back out-of-pocket liabilities. This in flip can mitigate households’ have to depend on collected wealth to cowl healthcare bills. On the identical time, proposals to increase HSAs primarily profit greater earnings, White households. Policymakers ought to think about initiatives that cut back the necessity for households to keep up important monetary belongings to be able to entry care.
Value-Related Unmet Dental, Imaginative and prescient, And Listening to Wants Amongst Low-Revenue 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 here.
This Well being Affairs research checked out information 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 companies, 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 concerns.
- No matter plan profit generosity, low-income beneficiaries have been extra seemingly 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 greater 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 greater star-rated plans. Nonetheless, this end result didn’t appear to end result from bigger high quality bonuses that have been paid based mostly on previous-year scores.
Why it Issues
A cause for the recognition of Medicare Benefit (MA) amongst low-income beneficiaries is that plans usually provide supplemental advantages at minimal or no premiums. Nonetheless, information are usually not 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 companies may not be contributing to equitable entry for beneficiaries throughout earnings ranges. Enrollment in plans, rated extremely within the earlier yr and due to this fact receiving greater high quality bonuses, doesn’t decrease the incidence of dental, imaginative and prescient, or listening to unmet wants due to value. Presently, supplemental advantages are usually not standardized, contributing to Medicare beneficiary confusion amid an already complicated alternative panorama. Much like the ACA Marketplaces, the share of MA beneficiaries who report evaluating plans and advantages is decrease amongst low-income beneficiaries, resulting in them to stay of their present plan, regardless of higher choices doubtlessly being accessible.
