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September 8, 2008

Washington Health Policy Week in Review Archive 29409dc7-ba47-4ec9-b316-62ac0a993192

Newsletter Article


AHRQ Survey Examines Employees' Costs for Health Care

By Frances Symes, CQ Staff

September 2, 2008 -- Workers at large private-sector companies are more likely to be required to pay for their individual health coverage than workers with small private-sector companies, according to a survey by the Agency for Healthcare Research and Quality.

Of the 112.2 million private-sector employees in the United States, 86.9 percent work in firms where employer-sponsored health insurance is offered. According to the survey, 62.5 percent of private employees in 2005 were enrolled in company-offered health insurance plans.

The survey, called the Insurance Component of the 2005 Medical Expenditure Panel Survey, draws a strong distinction in health coverage and premium payment between small and large firms (50 employees being the cutoff). An AHRQ release stated that less than half—48 percent—of workers at small private sector-companies contribute to monthly premiums, while 86 percent of workers at large companies were required to pay for individual coverage.

The survey also showed a difference in contributions between employees seeking single coverage and those seeking family coverage. At small firms, 64 percent of employees contributed to premiums for family coverage, while 91 percent contributed at large firms.

In a comparison of 10 states with high populations, California had the highest percentage of employees in both small and large firms who didn't contribute to premiums for individual coverage, with only 37 percent contributing to premium payments in small firms and 73 percent contributing in large firms.

Small businesses have expressed their concerns about rising health care costs, however. Todd Stottlemyer, president and CEO of the National Federation of Independent Business, said small businesses often cite the cost and availability of health care as the number one problem they face.

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Newsletter Article


Americans Facing Increasing Problems with Medical Debts

By Ben Weyl, CQ Staff

September 2, 2008 -- The number of Americans struggling to repay medical debt soared in 2007, adding to an already bleak picture of the country's health system and economy, according to a new report (Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families).

In 2007, 41 percent of working-age Americans, or 72 million people, had medical bill problems or were paying back medical debt, a 7 percent, or 14 million-person, increase since 2005, according to a survey by The Commonwealth Fund. An additional 7 million Americans age 65 and over also struggled to pay their medical bills.

The 2007 Commonwealth Fund Biennial Health Insurance Survey and its accompanying report, Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families, detail the scope of the crisis facing many Americans.

At every income level, people saw their medical debt increase or faced problems with medical bills, with the increase most pronounced among low- and moderate-income Americans, the report noted. A majority of those making less than $40,000 a year reported medical bill problems such as not being able to pay bills or being contacted by a collection agency.

Mounting medical debt can be life altering. According to the study, 39 percent of respondents used up all their savings to repay their debt; 10 percent took out a mortgage on their home or took out a loan; and 30 percent took on credit card debt. More than a quarter of working age adults (29 percent) said they were unable to pay for basic necessities like food, heating, or rent because of medical bills.

"Medical debt can push people over the edge," said Commonwealth Fund President Karen Davis in a conference call with reporters. "People have less in reserve and are more vulnerable when medical emergencies arise that take away what little they have set aside for retirement or for other contingencies."

Those with health insurance were more immune to the rise in medical bill problems, though it was not a complete safeguard. Sixty-one percent of respondents who had health insurance the whole year but were underinsured and had high out-of-pocket expenses or deductibles, reported problems, the same number as those with no health insurance. Just 26 percent of respondents with adequate health insurance said they had medical bill problems.

The report echoes the findings of other recent studies. A new Health Affairs study found that $30 billion will be spent out of pocket this year for health services by those who lack health insurance. A Kaiser Family Foundation poll conducted in August found that one of four Americans currently struggle to pay for health care. And the National Association of Insurance Commissioners found in July that 22 percent of people were seeing a doctor less regularly in light of the declining economy.

If Americans continue to shy away from getting the health services they need, the country's economic health could worsen along with their own health, according to experts. "Health care is the biggest sector of the economy, 15 percent of the economy," said Paul Fronstin, director of the Health Research and Education Program at the Employee Benefit Research Institute, in an interview. "Even a small increase in medical debt will have a big impact."

Furthermore, rising health care costs have caused people to reduce their savings overall, which could slow any economic recovery. "If people are saving less, there's less money to invest, and we're slower to sort of grow out of these things," Fronstin said. "All these things are interrelated to one degree or another."

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Newsletter Article


CMS Adds Children's Health Care Info to Hospital Compare Site

By Miriam Straus, CQ Staff

September 3, 2008 -- The Centers for Medicare and Medicaid Services (CMS) announced it has added information on 30-day mortality rates for pneumonia and on inpatient asthma treatment for children to Hospital Compare, its Web site on the quality of care in U.S. hospitals. This is the first time the site has included data on children's health care, the agency said.

The site has been viewed more than 20 million times this year, according to CMS press release. The addition in March 2008 of patient experience information and Medicare payment and volume data has contributed to an over four-fold increase in monthly views, CMS said.

"Expanding the scope of measures is making Hospital Compare a more valuable tool," Michael O. Leavitt, secretary of Health and Human Services, said in a statement.

Including the latest additions, Hospital Compare reports on 26 process of care measures, three outcome of care measures, two children's asthma care measures, and 10 patient experience measures. Along with the new data on 30-day pneumonia mortality rates, the site also posts information on the 30-day mortality rates for heart failure and heart attacks.

Since Hospital Compare began reporting such data last summer, the national 30-day heart attack mortality rate has fallen, from 16.3 percent to 16.1 percent, the CMS press release noted. There also is less variance in individual hospitals' heart attack mortality rates, CMS said.

The site also reports whether individual hospitals' mortality rates for pneumonia, heart attacks, and heart failures are "Better than," "No different from," or "Worse than" the national mortality rates for these conditions. The rates are risk-adjusted to account for the state of patients when they enter the hospital, CMS said. Hospital Compare also provides the interval estimate and the number of eligible cases for each hospital.

"CMS is giving customers and communities additional insight into the performance of their local hospitals in hopes that this will prompt all hospitals to work toward achieving the level of the top-performing hospitals in the country," the press release said. The agency also advised consumers not to view any one process or outcome measure on the Web site as a means to "shop" for a hospital.

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Drop in Uninsured Unlikely to Influence Health Care Overhaul, Experts Say

By Neda Semnani, CQ Staff

September 5, 2008 -- While new government figures show that a greater enrollment in public health programs has helped reduce the number of Americans without health insurance, experts said the data are unlikely to help make the case for expanding those programs as part of broader health care legislation next year.

According to recent data from the Census Bureau, 1.3 million more people had insurance in 2007 than in 2006, the first increase in the number of individuals with health insurance since 2000. During the same period, there was a slight dip in the percentage of people covered by private or employer-based health insurance, while 3 million more people received coverage through publicly funded health insurance programs.

Overall, most groups, including Hispanics and African Americans, witnessed a modest increase in the insured rate, with one major exception. The rate of uninsured non-citizens and foreign-born went up significantly from 2006 to 2007, with the number of uninsured in this group more than twice the uninsured rate in the broader population.

David S. Johnson, the Census Bureau's chief of Housing and Household Economics Statistics, which published the new figures, credits public programs like Medicaid and SCHIP for the increase in the insured, a trend experts believe may continue as employer-based coverage falls.

Analysts said the drop in the uninsured rate will have little influence in the broader discussion of health care legislation expected next year when a new president and Congress take office. The economic downturn and other budget priorities make it difficult for health care overhaul—a costly endeavor—to take center stage, they said.

"How much flexibility does the federal government have, given the declining economy and vast array of other problem areas? We have a lot of policy priorities. Health is an important one, but it's not the only one," said Joseph Antos, a health care scholar with the American Enterprise Institute, a conservative think tank. "Some kind of reform needs to happen . . . eventually. Gigantic reforms cost money. So 'eventually' may not happen in the first year or even in the first ten years of a new administration."

Mark McClellan, director of the Engelberg Center for Health Care Reform with the non-partisan Brookings Institution, said, "With the fiscal outlook so tight, the challenge will be finding new ways get costs down and coverage up, while filling gaps in quality."

Judith Solomon, a senior fellow at the left-leaning Center on Budget and Policy Priorities, said the report examines the period just before the economic downturn and "doesn't change what is the case for reform, it doesn't change the case for reauthorizing strong public programs," said Solomon, who specializes in Medicaid and the State Children's Health Insurance Program (SCHIP).

The trend of greater enrollment in public health programs may continue in the current economic slowdown, said Karen Davenport, director of health policy with the liberal Center for American Progress. "On the one hand, we're likely to see a greater insecurity in health coverage; on the other, a further up-tick in public coverage ... The report points out just how effective these programs are in catching people when they fall. It shows that the individual market alone doesn't work."

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Study: Government Should Help Americans Determine Reliability of Health Info

By Neda Semnani, CQ Staff

September 4, 2008 -- The government should do more to help American consumers sift through multiple sources of health care information to help them to determine the material they use is timely and accurate, the Center for Studying Health System Change (HSC) said in a new study.

Determining the source of the information and the date it was published, as well as finding out whether the material is sponsored by a drug company or an independent entity, are basic ways individuals can vet the information they receive, according to the study.

"I think a lot of consumers need some guidance to find information they can trust," said Ha T. Tu, senior health researcher and co-author of the HSC report.

In 2007, 56 percent of adults—up from 38 percent in 2001—sought health care information from a variety of sources, including books and periodicals and from friends and family, the study found. In addition, 32 percent of consumers—70 million American adults—reported using the Internet to find health information, double the number of adults who reported using Web sources in 2001.

While there are several good Web sites that help consumers compare medical services, such as the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare site, there are few that also include consumer guidelines, and finding them requires a level of consumer sophistication that many don't have, Tu said.

CMS spokesman Peter Ashkenaz disagreed that reliable information is hard to find. CMS' Hospital Compare site, which reports on the quality of care in U.S. hospitals, has been viewed more than 20 million times this year, the agency said.

"Our Compare sites are important for helping people make decisions," Ashkenaz said. CMS currently does not publish guidelines for individuals on what to look for when researching health information.

The HSC report said the amount of individuals looking for health information has increased, including among those consumers who have been less inclined to seek out health information in the past, such as elderly populations or those without a high level of education. In 2007, both groups actively sought information about their health concerns and often used the Internet in their search. The study also found that 85 percent of African Americans and 87 percent of Hispanics who sought health information were more likely to report changes to their daily health routine than other groups.

However, it is mainly highly educated consumers or those with chronic conditions who are likely to discuss their health findings with their doctors, the study found.

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Study Says MA Plans Will Cost Medicare 12.4 Percent More this Year

By Neda Semnani, CQ Staff

September 5, 2008 -- Government payments to Medicare Advantage (MA) plans will continue to strain public coffers even after planned reductions go into effect as part of recent Medicare legislation (PL 110-275) blocking physician payment cuts, according to a new Commonwealth Fund report.

Payments to MA plans combined with rapidly increasing enrollment has resulted in $33 billion in additional spending over the past five years, or $795 per Medicare beneficiary in 2004, the study's author and lead researcher, Brian Biles, said in a news release. The funds could be spent in other ways, such as slowing the rate of increase in Medicare Part B premiums or increasing eligibility for low-income Medicare subsidies, the study concluded.

A spokesman for the health insurance industry said the report does not reflect that MA beneficiaries receive more benefits at less cost when compared with Medicare's traditional fee-for-service program. Robert Zirkelbach of America's Health Insurance Plans (AHIP) also noted that the cost of the Medicare drug benefit has been less than previously estimated.

Earlier this month Medicare's actuary estimated that the Part D program will cost $37.2 billion in 2008 and $46.4 billion in 2009. When Congress debated the drug benefit, the actuary estimated the benefit would cost $68 billion in 2008 and $74 billion in 2009.

Zirkelbach also noted beneficiaries' satisfaction with Medicare Advantage. An AHIP survey released June 2008 found that 88 percent of seniors enrolled in MA plans report being satisfied with their coverage.

Critics of Medicare Advantage questioned the wisdom of overpaying private insurance companies by an average of the 12.4 percent per enrollee, or by 10.6 percent under the changes in the Medicare physician payment legislation. "Policymakers should carefully examine whether extra payments to Medicare Advantage plans are the best use of dollars for the beneficiaries the program is designed to serve," said Commonwealth Fund president Karen Davis.

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