Tag Archives: health reform

Health Reform Realities

Health reform is the signature achievement of the Obama presidency. It was the biggest expansion of the social safety net since Medicare was established in the 1960s. It more or less achieves a goal — access to health insurance for all Americans — that progressives have been trying to reach for three generations. And it is already producing dramatic results, with the percentage of uninsured Americans falling to record lows.

Obamacare is, however, what engineers would call a kludge: a somewhat awkward, clumsy device with lots of moving parts. This makes it more expensive than it should be, and will probably always cause a significant number of people to fall through the cracks.

The question for progressives — a question that is now central to the Democratic primary — is whether these failings mean that they should re-litigate their own biggest political success in almost half a century, and try for something better.

My answer, as you might guess, is that they shouldn’t, that they should seek incremental change on health care (Bring back the public option!) and focus their main efforts on other issues — that is, that Bernie Sanders is wrong about this and Hillary Clinton is right. But the main point is that we should think clearly about why health reform looks the way it does.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

H.M.O Plans Have The Lowest Premium Increase

Health insurers are selling more than 100,000 plans at a county level through the Affordable Care Act’s marketplaces, at radically different prices and varied designs. The carriers range from established local Blue Cross plans and national for-profit behemoths to upstarts like local hospital systems and the new consumer-oriented co-ops that were created under the federal law.

Many people will see their premiums increase significantly for 2015 if they haven’t yet taken the advice of my colleague, Margot Sanger-Katz, to shop around. But a new analysis from the McKinsey Center for U.S. Health System Reform suggests insurers had some luck in holding down prices if they offered plans that limited a consumer’s choice of doctors and hospitals.

Plans featuring health maintenance organizations or restricted networks of providers typically had the lowest year-over-year premium increases, according to McKinsey, which sifted through information on the 223,000 plans offered in the marketplaces at the county level over the last two years. Plans featuring an H.M.O. had a median increase of only 2 percent. The more widely known P.P.O., or preferred provider organization, plans, which typically allow people to go outside their plan’s network if they are willing to pay a greater share of the cost, had a median increase of 9 percent.

The same contrast was found in comparing the median price increases for plans designed around a narrowed network, in which people are limited to a smaller group of hospitals or are asked to pay more when they go to an expensive facility. While plans featuring broad networks had a median increase of 8 percent, narrowed network plans increased just 4 percent.

Plans that limit a patient’s choice of where to go to seek care are not without controversy, of course. H.M.O.s experienced a backlash in the early 1990s after employers embraced them as a solution to rising health care costs, and patients and doctors complained about strategies they said were aimed at keeping patients from getting the care they needed.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Number of Americans Without Health Insurance Has Dropped

Federal researchers reported on Tuesday that the number of Americans without health insurance had declined substantially in the first quarter of this year, the first federal measure of the number of uninsured Americans since the Affordable Care Act extended coverage to millions of people in January.

The number of uninsured Americans fell by about 8 percent to 41 million people in the first quarter of this year, compared with 2013, a drop that represented about 3.8 million people and that roughly matched what experts were expecting based on polling by private groups, like Gallup. The survey also measured physical health but found little evidence of change.

The findings were part of the National Health Interview Survey, a nationally representative examination that is considered a gold standard by researchers. It interviewed about 27,000 people in the first quarter, fewer than Gallup, which interviewed 45,000 people in the second quarter alone. But researchers say it is considered particularly trustworthy because federal interviewers conduct the survey in Americans’ homes. It also sets a federal level that others can use as a benchmark.

Larry Levitt, a director at the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, a health research organization, said the first-quarter findings “dramatically understate the effect” of the law, as almost half of the people who signed up for insurance during the open enrollment period did so in March and did not get their insurance cards until later. Private surveys have shown that there were eight million to 10 million fewer uninsured by the second quarter, he said.

Regardless of what you think of the A.C.A., there should be no doubt at this point that the law is increasing the number of people insured,” he said.

Katherine Baicker, a professor of health economics at the Harvard School of Public Health, said of the finding: “That sounds reasonably consistent with what had been expected.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary