Tag Archives: health coverage

Health Coverage Expansion Could be a Trade-Off for Care

One concern about the Affordable Care Act is that as more Americans get health insurance and start using it, those who already have coverage will have to wait longer for care.

Recent research with a focus on Massachusetts suggests this may actually happen, but may not last long. Several years after the coverage expansion in that state, access to care for other, previously covered residents appears to be no worse than before the expansion.

Coverage expansion would present this potential trade-off if the supply of care (the number of doctors or their productivity) does not expand to meet the greater demand for it from the newly insured.

Increasing coverage is likely to increase demand for care. A longstanding finding in the research literature is that uninsured people avoid and delay care more than insured people do, and that this can harm health. According to Gallup, uninsured Americans are about twice as likely as insured Americans to delay care, and about 30 percent have put off care because of costs. A large body of research on the effects of the coverage expansion in Massachusetts found that it increased access to care for previously uninsured residents. For example, residents in that state were almost 5 percent less likely to forgo care, compared with the expected rate without the expansion.

But improving access to care for the uninsured doesn’t necessarily reduce access for everyone else, according to a new study published in the journal Health Services Research and led by Dr. Karen Joynt of Harvard. The authors found that neither receipt of outpatient services nor quality of care suffered when coverage expanded under the state’s health overhaul, which started in 2007. The findings, which are consistent with previous work by the same authors, are based on analysis of changes in receipt of outpatient care from 2006 to 2009 for elderly Medicare beneficiaries with chronic illnesses in Massachusetts, as compared with those in other New England states.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The SHOP Falls Short on Enrollments

Remember those “other” new Obamacare exchanges—the ones that small businesses were supposed to use to sign up workers for health insurance?

Yeah, well, apparently a whole bunch of small businesses forgot about them, too.

A new Government Accountability Office report finds that a stunningly low number of workers have enrolled in insurance plans sold on small-business health exchanges run by federal and state governments.

The report suggests that the Small Business Health Options Program exchanges will fall well short of the 2 million people that had been projected to sign up by January.

As of last summer, only about 76,000 people working for about 12,000 employers had enrolled in insurance plans sold by 18 state-run SHOP exchanges, according to the GAO report released Thursday.

While the other 33 SHOP exchanges run by the federal government didn’t have enrollment data available for the GAO, officials in charge of them “do not expect major differences in enrollment trends between” the state-run SHOP exchanges and their federally run counterparts, the report noted. The federal Centers for Medicare and Medicaid Service was still compiling enrollment data from insurers and did not expect complete numbers until early 2015, the GAO said.

Obamacare’s small business health marketplaces are likely to fall well short of the 2 million enrollees projected for 2014, a GAO report suggests.

The SHOP exchanges are supposed to help small employees provide group health coverage to their workers. But most such employers clearly haven’t bothered to take the exchanges up on that offer, or aren’t aware that it’s available, raising questions about whether these exchanges can get close to the 4 million enrollees that had been projected by 2017.

One state-run SHOP—Mississippi’s—had just one person enrolled, the GAO report said. Washington state had the second-lowest enrollment with 42 people.

Two population-heavy states, California and New York, had just 9,563 and 10,023 people enrolled, respectively, in their SHOP exchanges during their first year of operation.

Vermont, the second-least populous state, had by far, the highest enrollments in a state-run SHOP: 33,696 people. That represents 44 percent of all enrollees on the state-run SHOPs.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

Analyzing Health Coverage Across America

We know that about 10 million more people have insurance coverage this year as a result of the Affordable Care Act. But until now it has been difficult to say much about who was getting that coverage — where they live, their age, their income and other such details.

Now a large set of data — from Enroll America, the group trying to sign up people for the program, and from the data firm Civis Analytics — is allowing a much clearer picture. The data shows that the law has done something rather unusual in the American economy this century: It has pushed back against inequality, essentially redistributing income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The biggest winners from the law include people between the ages of 18 and 34; blacks; Hispanics; and people who live in rural areas. The areas with the largest increases in the health insurance rate, for example, include rural Arkansas and Nevada; southern Texas; large swaths of New Mexico, Kentucky and West Virginia; and much of inland California and Oregon.

Each of these trends is going in the opposite direction of larger economic patterns. Young people have fared substantially worse in the job market than older people in recent years. Blacks and Hispanics have fared worse than whites and Asians. Rural areas have fallen further behind larger metropolitan areas.

Women are the one modest exception. They have benefited more from Obamacare than men, and they have received larger raises in recent years. But of course women still make considerably less money than men, so an economic benefit for women still pushes against inequality in many ways.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary