Tag Archives: Insurance

ACA Has Little Impact on Health Care Attained Through Employers

Politico (9/11, Norman) reported that a survey released Wednesday by the Kaiser Family Foundation showed that the Affordable Care Act “so far has had little impact on the insurance people get through their jobs,” and that premiums increased 3% in the first year of healthcare exchanges. According to Politico, the survey also found that roughly the same number of employers are offering coverage as in 2013, and the number of workers accepting insurance from work remained at 80%.

The Wall Street Journal (9/11, Mathews, Subscription Publication) reports that the 3% increase raised average premium costs for a family to $16,834 is slightly below the 4% increase in 2013. Employees’ share of family plan premiums remained static at 29%, roughly $4,823.

The New York Times (9/11, Sanger-Katz, Subscription Publication) “Upshot” blog notes that the increase is the smallest in the 16 years that the Foundation has been tracking health premiums. Most years have seen double digit increases in premiums, which has squeezed both employees and employers. The survey found the average cost of a family health plan is $16,834 per year.

Congressional Quarterly (9/11, Subscription Publication) reports that, despite the improved premium situation, “workers are getting socked by rising deductibles.”

The Los Angeles Times (9/11, Terhune) reports “the average employee deductible has increased 47% since 2009 to $1,217 annually.” Some businesses have responded to the increase by shifting more costs onto their workers. The survey’s finding of reduced premium growth, however, reflects a more recent trend of slower growth in healthcare spending nationwide.

Kaiser Health News (9/10, Appleby) reports that the survey also found a non-statistically significant decrease in the percentage of employers offering health coverage to their workers. However, some health economists predict an increasing number of small businesses will shift employees to health insurance exchanges set up through the ACA.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

End-of-Life Coverage May Be Covered as Soon as 2015

Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.

Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans. People are living longer with illnesses, and many want more input into how they will spend their final days, including whether they want to die at home or in the hospital, and whether they want full-fledged life-sustaining treatment, just pain relief or something in between. Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients.

But far more significant, Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association, the country’s largest association of physicians and medical students. One of the A.M.A.’s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.

The Centers for Medicare and Medicaid Services, which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its decision is expected this fall. But the agency often adopts A.M.A. recommendations, which are developed in meetings attended by its representatives. And the political environment is less toxic than it was when the “death panel” label was coined; although there are still opponents, there are more proponents, including Republican politicians.

If Medicare adopts the change, its decision will also set the standard for private insurers, encouraging many more doctors to engage in these conversations.

“We think it’s really important to incentivize this kind of care,” said Dr. Barbara Levy, chairwoman of the A.M.A. committee that submits reimbursement recommendations to Medicare. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary



Wide Gaps in Healthcare Prices

A patient insured through an employer in Dallas might pay as little as $15 or as much as $343 for a cholesterol test, and a patient in Philadelphia could pay anywhere between $264 and $3,271 for a head CT scan, according to a new cost-comparison map from Castlight Health.

The company, which sells price transparency products and services to large employers, compared prices of four common outpatient services in more than 62 metropolitan areas of the U.S. and found tremendous variation in what patients pay, even when they are insured through their job.

Consumers often assume that by choosing an in-network plan, they are getting a better price or value, said Dr. Jennifer Schneider, president of strategic analytics for Castlight, who notes that 48% of Americans are covered by employer-sponsored insurance. The new findings highlight that more transparency on costs is needed to prevent employees, especially those in high-deductible plans, from feeling sticker shock.

“There’s no way today for someone to know what things will cost if they simply follow the rules and go in-network,” Schneider said. “It’s like letting someone shop on your credit card without any sort of limit.”

Castlight gathered medical claims data from self-insured employers, as well as rate sheets from providers, to create the city-by-city tool showing prices for four common procedures: a cholesterol test, head CT scan, an MRI of the lower back, and a visit to a primary-care doctor.

Among the most notable variations revealed were in Dallas, where the top price paid to providers of a cholesterol test was about 23 times as much as the lowest price, and in Philadelphia, where the highest cost for CT scans was more than 12 times as much as the lowest. In New York City, the lowest price for an MRI of the lower back was $416, while the highest (nearly 11 times as much higher) was $4,527. In Charlotte, N.C., a patient might pay as little as $60 or up to $241, a 300% increase, to visit a primary-care physician.

“Healthcare is a line item that just keeps increasing,” noted Schneider, who says employers need to negotiate better to help drive down the costs. Just as chief financial officers often know how much they spend on travel or marketing and can set spending parameters, she said, the same needs to happen for healthcare. The tool, she said, is meant to help drive those negotiations.

“Understanding healthcare costs is a first step in enabling employers to fix what is broken in enterprise healthcare,” Schneider said.

To read more, click here.

Jeffrey R. Ungvary


Jeffrey R. Ungvary