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State trends in the cost of employer health insurance coverage, 2003-2013. 2003-2013年各州雇主健康保险费用趋势。
LDI issue brief Pub Date : 2015-01-01 DOI: 10.15868/socialsector.25022
C. Schoen, D. Radley, S. Collins
{"title":"State trends in the cost of employer health insurance coverage, 2003-2013.","authors":"C. Schoen, D. Radley, S. Collins","doi":"10.15868/socialsector.25022","DOIUrl":"https://doi.org/10.15868/socialsector.25022","url":null,"abstract":"From 2010 to 2013--the years following the implementation of the Affordable Care Act--there has been a marked slowdown in premium growth in 31 states and the District of Columbia. Yet, the costs employees and their families pay out-of-pocket for deductibles and their share of premiums continued to rise, consuming a greater share of incomes across the country. In all but a handful of states, average deductibles more than doubled over the past decade for employees working in large and small firms. Workers are paying more but getting less protective benefits. Costs are particularly high, compared with median income, in Southern and South Central states, where incomes are below the national average. Based on recent forecasts that predict an uptick in private insurance growth rates starting in 2015, securing slow cost growth for workers, families, and employers will likely require action to address rising costs of medical care services.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"119 1","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89615059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 11
How states are expanding Medicaid to low-income adults through Section 1115 waiver demonstrations. 各州如何通过1115条款豁免示范将医疗补助扩大到低收入成年人。
LDI issue brief Pub Date : 2014-12-19 DOI: 10.15868/socialsector.25020
S. Rosenbaum, C. Hurt
{"title":"How states are expanding Medicaid to low-income adults through Section 1115 waiver demonstrations.","authors":"S. Rosenbaum, C. Hurt","doi":"10.15868/socialsector.25020","DOIUrl":"https://doi.org/10.15868/socialsector.25020","url":null,"abstract":"In the wake of the Supreme Court's 2012 decision making state expansion of Medicaid to more adults optional under the Affordable Care Act, several states have received approval to combine such expansion with broader Medicaid reforms. They are doing so under Section 1115 of the Social Security Act, which authorizes Medicaid demonstrations that further program objectives. State demonstrations approved so far combine expanded adult coverage with changes in that coverage and in how the states deliver and pay for health care. These states have focused especially on expanding the use of private health insurance, requiring beneficiaries to pay premiums, and incentivizing them to choose cost-effective care. By enabling states to link wider program reforms to the adult expansion, Section 1115 has allowed them to better align Medicaid with local political conditions while extending insurance to more than 1 million adults who would otherwise lack a pathway to coverage.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"57 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2014-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85589144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Why a national high-risk insurance pool is not a workable alternative to the marketplace. 为什么国家高风险保险池不是市场的可行选择。
LDI issue brief Pub Date : 2014-12-01 DOI: 10.15868/socialsector.25019
Jean P. Hall
{"title":"Why a national high-risk insurance pool is not a workable alternative to the marketplace.","authors":"Jean P. Hall","doi":"10.15868/socialsector.25019","DOIUrl":"https://doi.org/10.15868/socialsector.25019","url":null,"abstract":"The Pre-Existing Condition Insurance Plan (PCIP) was a national high-risk pool established under the Affordable Care Act (ACA) to provide coverage for individuals with preexisting conditions who had been uninsured for at least six months. It was intended to be a temporary program: PCIPs opened in 2010 and closed in April 2014. At that point, those with preexisting conditions could shop for health insurance in the marketplaces, where plans are prevented from using applicants' health status to deny coverage or charge more. This issue brief draws on the PCIP experience to outline why national high-risk pools, which continue to be proposed as policy alternatives to ACA coverage expansions, are expensive to enrollees as well as their administrators and ultimately unsustainable. The key lesson--and the principle on which the ACA is built--is that insurance works best when risk is evenly spread across a broad population.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"33 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86076389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Too high a price: out-of-pocket health care costs in the United States. Findings from the Commonwealth Fund Health Care Affordability Tracking Survey. September-October 2014. 代价太高:美国的自付医疗费用。联邦基金卫生保健负担能力跟踪调查的结果。2014年9 ~ 10月。
LDI issue brief Pub Date : 2014-11-13 DOI: 10.15868/socialsector.19573
S. Collins, P. Rasmussen, M. Doty, S. Beutel
{"title":"Too high a price: out-of-pocket health care costs in the United States. Findings from the Commonwealth Fund Health Care Affordability Tracking Survey. September-October 2014.","authors":"S. Collins, P. Rasmussen, M. Doty, S. Beutel","doi":"10.15868/socialsector.19573","DOIUrl":"https://doi.org/10.15868/socialsector.19573","url":null,"abstract":"Whether they have health insurance through an employer or buy it on their own, Americans are paying more out-of-pocket for health care now than they did in the past decade. A Commonwealth Fund survey fielded in the fall of 2014 asked consumers about these costs. More than one of five 19-to-64-year-old adults who were insured all year spent 5 percent or more of their income on out-of-pocket costs, not including premiums, and 13 percent spent 10 percent or more. Adults with low incomes had the highest rates of steep out-of-pocket costs. About three of five privately insured adults with low incomes and half of those with moderate incomes reported that their deductibles are difficult to afford. Two of five adults with private insurance who had high deductibles relative to their income said they had delayed needed care because of the deductible.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"405 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2014-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86834120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 44
Implementing the Affordable Care Act: Revisiting the ACA's Essential Health Benefits Requirements. 实施平价医疗法案:重新审视ACA的基本健康福利要求。
LDI issue brief Pub Date : 2014-10-31 DOI: 10.15868/socialsector.25014
Justin Giovannelli, Kevin W Lucia, S. Corlette
{"title":"Implementing the Affordable Care Act: Revisiting the ACA's Essential Health Benefits Requirements.","authors":"Justin Giovannelli, Kevin W Lucia, S. Corlette","doi":"10.15868/socialsector.25014","DOIUrl":"https://doi.org/10.15868/socialsector.25014","url":null,"abstract":"The Affordable Care Act broadens and strengthens the health insurance benefits available to consumers by requiring insurers to provide coverage of a minimum set of medical services known as \"essential health benefits.\" Federal officials implemented this reform using transitional policies that left many important decisions to the states, while pledging to reassess that approach in time for the 2016 coverage year. This issue brief examines how states have exercised their options under the initial federal essential health benefits framework. We find significant variation in how states have developed their essential health benefits packages, including their approaches to benefit substitution and coverage of habilitative services. Federal regulators should use insurance company data describing enrollees' experiences with their coverage--information called for under the law's delayed transparency requirements--to determine whether states' differing strategies are producing the coverage improvements promised by reform.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"117 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2014-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79419592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 11
What will be the impact of the employer mandate on the U.S. workforce? 雇主强制令将对美国劳动力产生什么影响?
LDI issue brief Pub Date : 2014-10-01 DOI: 10.15868/socialsector.25013
S. Glied, C. Solís-Román
{"title":"What will be the impact of the employer mandate on the U.S. workforce?","authors":"S. Glied, C. Solís-Román","doi":"10.15868/socialsector.25013","DOIUrl":"https://doi.org/10.15868/socialsector.25013","url":null,"abstract":"The Affordable Care Act's employer mandate requires large firms to pay penalties unless they offer affordable health insurance coverage to full-time employees, raising concerns that employers might lay off workers or reduce hours. In this brief, we estimate the number of workers potentially at risk of losing their jobs or having hours reduced. Most workers near the thresholds--those in firms with around 50 full-time-equivalent employees or those working near 30 hours per week--are already insured or have been offered coverage. There are 100,000 full-time workers at the firm-size threshold and 296,000 at the hourly threshold who are unin­sured. Fewer than 10 percent, less than 0.03 percent of the U.S. labor force, might see reduc­tions in employment or hours in the short run. Over time, employment patterns might change, leading to fewer firm sizes and work schedules near the thresholds, potentially affecting up to 0.5 percent of the workforce.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"8 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83764306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Are Americans finding affordable coverage in the health insurance marketplaces? Results from the Commonwealth Fund Affordable Care Act Tracking Survey. 美国人能否在医疗保险市场上找到负担得起的保险?联邦基金平价医疗法案跟踪调查的结果。
LDI issue brief Pub Date : 2014-09-01 DOI: 10.15868/socialsector.25010
P. Rasmussen, S. Collins, M. Doty, S. Beutel
{"title":"Are Americans finding affordable coverage in the health insurance marketplaces? Results from the Commonwealth Fund Affordable Care Act Tracking Survey.","authors":"P. Rasmussen, S. Collins, M. Doty, S. Beutel","doi":"10.15868/socialsector.25010","DOIUrl":"https://doi.org/10.15868/socialsector.25010","url":null,"abstract":"By the end of the first open enrollment period for coverage offered through the Affordable Care Act's marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund's Affordable Care Act Tracking Survey, April-June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"89 1","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77467853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
Arkansas: a leading laboratory for health care payment and delivery system reform. 阿肯色州:医疗保健支付和交付系统改革的领先实验室。
LDI issue brief Pub Date : 2014-08-01 DOI: 10.15868/socialsector.25009
D. Bachrach, Lammot du Pont, M. Lipson
{"title":"Arkansas: a leading laboratory for health care payment and delivery system reform.","authors":"D. Bachrach, Lammot du Pont, M. Lipson","doi":"10.15868/socialsector.25009","DOIUrl":"https://doi.org/10.15868/socialsector.25009","url":null,"abstract":"As states' Medicaid programs continue to evolve from traditional fee-for-service to value-based health care delivery, there is growing recognition that systemwide multipayer approaches provide the market power needed to address the triple aim of improved patient care, improved health of populations, and reduced costs. Federal initiatives, such as the State Innovation Model grant program, make significant funds available for states seeking to transform their health care systems. In crafting their reform strategies, states can learn from early innovators. This issue brief focuses on one such state: Arkansas. Insights and lessons from the Arkansas Health Care Payment Improvement Initiative (AHCPII) suggest that progress is best gained through an inclusive, deliberative process facilitated by committed leadership, a shared agreement on root problems and opportunities for improvement, and a strategy grounded in the state's particular health care landscape.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"23 1","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91306956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Caring for high-need, high-cost patients: what makes for a successful care management program? 照顾高需求、高成本的病人:成功的护理管理计划的要素是什么?
LDI issue brief Pub Date : 2014-08-01 DOI: 10.15868/socialsector.25007
Clemens S. Hong, A. L. Siegel, T. Ferris
{"title":"Caring for high-need, high-cost patients: what makes for a successful care management program?","authors":"Clemens S. Hong, A. L. Siegel, T. Ferris","doi":"10.15868/socialsector.25007","DOIUrl":"https://doi.org/10.15868/socialsector.25007","url":null,"abstract":"Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target \"high-need, high-cost\" patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"30 1","pages":"1-19"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74066448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 206
Implementing the Affordable Care Act: state action on quality improvement in state-based marketplaces. 实施《合理医疗费用法案》:在以州为基础的市场中提高质量的国家行动。
LDI issue brief Pub Date : 2014-07-29 DOI: 10.15868/socialsector.25006
S. Dash, S. Corlette, Amy Thomas
{"title":"Implementing the Affordable Care Act: state action on quality improvement in state-based marketplaces.","authors":"S. Dash, S. Corlette, Amy Thomas","doi":"10.15868/socialsector.25006","DOIUrl":"https://doi.org/10.15868/socialsector.25006","url":null,"abstract":"Under the Affordable Care Act, the health insurance marketplaces can encourage improvements in health care quality by: allowing consumers to compare plans based on quality and value, setting common quality improvement requirements for qualified health plans, and collecting quality and cost data to inform improvements. This issue brief reviews actions taken by state-based marketplaces to improve health care quality in three areas: 1) using selective contracting to drive quality and delivery system reforms; 2) informing consumers about plan quality; and 3) collecting data to inform quality improvement. Thirteen state-based marketplaces took action to promote quality improvement and delivery system reforms through their marketplaces in 2014. Although technical and operational challenges remain, marketplaces have the potential to drive systemwide changes in health care delivery.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"2 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2014-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87989346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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