Health

What If No One Sells In an Obamacare Marketplace?

Sarah Kliff: “There are at least three states that currently have just one health insurer planning to sell on their Obamacare marketplace in 2017: Alaska, Alabama, and Wyoming.”

“The health care law doesn’t have a backup plan if any of those states have their sole carriers drop out… A federal official told the Wall Street Journal he was “pretty confident” there would be no areas with zero carriers — but he also couldn’t rule out the possibility.”

“An Obamacare market with no sellers would leave thousands of enrollees unable to use tax subsidies to buy insurance coverage. And the government doesn’t have any particular legal power to cajole carriers into setting up shop in the markets they find undesirable. The most they can do, it turns out, is ask really nicely.”

Who Benefited Most from Obamacare?

New York Times: “The health care law was one of the most bitterly contested pieces of legislation in the country’s history. It remains controversial because of its costs to both taxpayers and insurance customers. The high premiums and high deductibles of many plans still make coverage a crushing financial burden for some families.”

“And the law is not close to achieving the goal of universal coverage, in part because 19 states have declined to expand their Medicaid programs for the poor, an option the Supreme Court granted them in a landmark 2012 case. Nevertheless, the Times’s analysis shows that by the end of that first full year, 2014, so many low-income people gained coverage that it halted the decades-long expansion of the gap between the haves and the have-nots in the American health insurance system, a striking change at a time when disparities between rich and poor are growing in many areas.”

A Nation Free of Lead? Clinton Says She’ll Do It

Philip Bump examines the viability of Hillary Clinton’s pledge that should she be elected president she will “within five years to remove lead from everywhere.”

“That’s almost certainly impossible.”

“Lead isn’t only transmitted in water through lead pipes. It exists, as Clinton pointed out, in paint in homes. For decades it was added to gasoline — an initiative of the auto industry that once made Flint prosperous. Once in gasoline, it spread throughout the environment, contaminating the dirt around roads and the houses adjacent to those roads … Getting rid of those pipes alone within five years would be hugely difficult and massively expensive.”

“The Centers for Disease Control notes that most housing built prior to 1978 uses some lead paint. According to the Census Bureau, there are nearly 70 million houses in the United States that meet that standard. Seventy million.”

“The problem of lead in the United States is a problem for which there is no easy solution. At best, we’ve reached a stalemate with lead, doing our best to reduce our children’s exposure to the metal, an effort that extends back to the late 1970s.”

What is the Outlook for Obamacare Enrollment?

The latest Kaiser Family Foundation report finds that “sign-ups in Affordable Care Act marketplace plans could continue to grow modestly over the next few years to 16.3 million (up 28%), based on the experience of the top-performing states.”

“The analysis estimates that if all states performed at least as well as the top 10 states, the number of people signing up during annual open enrollment periods could reach 16.3 million (14.7 million after attrition when some enrollees fail to pay premiums, called effectuated enrollment), up from 12.7 million this year. This would still be less than enrollment of over 20 million projected by the Congressional Budget Office.”
Figure 2: Marketplace Plan Selections (Millions)
“The analysis also charts coverage gains from 2013 to 2014 for uninsured people eligible for ACA marketplace plans. It shows that the biggest coverage gain came for people with incomes between 150 and 200 percent of the federal poverty level, who qualify for substantial premium subsidies under the health law. The number of marketplace-eligible people without insurance in that group declined by 33 percent during that period. The two groups experiencing the smallest gains in coverage were those with incomes below 150 percent of the federal poverty level (18% reduction in marketplace-eligible uninsured) and those with incomes between three and four times the poverty level (14% reduction).”

Obamacare Enrollment Reaches 20 Million

Newsweek: “President Barack Obama said on Thursday that some 20 million Americans had become insured as a result of the Affordable Care Act.”

‘Today I can announce that thanks to the law, 20 million more Americans now know the security of health insurance,’ Obama told a crowd in Milwaukee.”

“The U.S. Department of Health and Human Services said the estimates Obama referenced included coverage from the expansion of the Medicaid program, health insurance marketplaces, and provisions that allowed young people to stay on their parents’ private insurance plans longer.”

“The 20 million figure was an update to a September 2015 government estimate that 17.6 million Americans had been insured as a result of the Affordable Care Act.”

Despite Low Unemployment, Job Security Remains Top Concern

Kaiser Family Foundation:  “With the 2016 primary election campaign in full swing, three-fourths of Americans (73 percent) report they are following news about it closely with the economy/jobs currently being the most important issue to voters in the upcoming presidential election (27 percent).  Health care ranks fourth at 8 percent, behind presidential candidates’ characteristics or positions on the issues (21 percent), and foreign policy (16 percent). Similar shares of Democratic voters (7 percent), independent voters (10 percent), and Republican voters (7 percent) say health care is a top voting issue.”

Figure 1: Economy/Jobs Is Top Voter Issue Across Parties, Health Care Ranks Lower

Americans Want to Improve, Not Repeal, Obamacare

The Kaiser Family Foundation 2/25/16 Newsletter reports on the latest Kaiser Health Tracking Poll, which finds the “public as divided as the remaining presidential candidates over their vision for the future of the nation’s health care system.”

“When asked to choose among four broad approaches for changing the health care system currently being discussed, the largest share (36%) say lawmakers should build on the Affordable Care Act to improve affordability and access to care, while fewer choose establishing guaranteed coverage through a single government plan (24%), repealing the ACA and not replacing it (16%), or repealing the law and replacing it with a Republican alternative (13%).”

Figure 2: Views of the Future of the U.S. Health Care System

“The survey also finds that the words to describe such a plan clearly affect how people view it … When asked directly about “guaranteed health insurance coverage in which all Americans would get their insurance through a single government health plan,” the poll finds half (50%) in favor and 43 percent opposed. Majorities of Democrats (70%) and independents (54%) support the concept, while few Republicans (20%) do.”

“The poll also finds the public’s view of the ACA largely stable so far this year, with 46 percent holding an unfavorable view of the law and 41 percent holding a favorable view.”

A Dramatic Drop in New York’s Uninsured Rate

Associated Press: The New York Health Exchange says more than 2.8 million people have signed up for Medicaid and low-cost insurance through its 2016 open enrollment that ended Jan. 31.

According to state health officials, federal data show the number of uninsured New Yorkers has declined by nearly 850,000 since the exchange opened in 2013, dropping from 10 percent to 5 percent by last September.

The enrollment totals include 1,966,920 people in government-funded Medicaid

Most Uninsured Escape Obamacare Penalty

The Hill: “Nearly three in four people who lacked health insurance last year were exempt from the penalty under ObamaCare, according to data from the tax-filing software TurboTax.”

“A total of 70 percent of people filed an exemption to ObamaCare’s individual mandate, about the same figure as last year, according to TurboTax.”

“The two most common exemptions were related to the cost of coverage. Many people without coverage said they couldn’t afford healthcare plans in their area or couldn’t afford plans through their workplace.”

“The other common exemptions were related to a recent eviction or the death of a family member.”

“The number of people seeking cost-related exemptions poses a challenge to the Obama administration, which has made affordability a central part of its strategy to reduce the uninsured.” If you’re interested in using TurboTax, check out this TurboTax promo code to save some money.

Life Expectancy Gap Between Rich and Poor is Growing

Daily Kos: another study, this time from the Brookings Institution, has confirmed that there’s something going on with life expectancies, and it’s increasingly related to inequality.​​

“Looking at the extreme ends of the income spectrum, economists at the Brookings Institution found that for men born in 1920, there was a six-year difference in life expectancy between the top 10 percent of earners and the bottom 10 percent. For men born in 1950, that difference had more than doubled, to 14 years. For women, the gap grew to 13 years, from 4.7 years.”
Brookings.jpg

“Limited access to health care doesn’t account for many of the nation’s premature deaths. More than anything, the gap, again, seems to be behavioral, starting with smoking.”

“Two other factors are the rise in deaths related to drug overdoses (including prescription drugs), and the rise in obesity. However, obesity may not be the main driver of the income disparity, if only because obesity is something that’s increasing on all sides of the income divide: In 2010, the number had risen to the point where 37 percent of adults at the lower end of the income ladder were obese, compared with 31 percent at the higher end.”

U.S. Obesity Rate Continues to Climb to New Highs

Gallup: “The obesity rate among U.S. adults in 2015 climbed to a new high of 28.0%, up 2.5 percentage points since 2008. This represents an increase of about 6.1 million U.S. adults who are obese.”

Obesity_1

“The obesity rate has continued to rise in the U.S. after leveling off from 2011 to 2013, and has done so despite rising public concern. Past research has demonstrated that obesity and its associated chronic conditions including diabetes cost the U.S. economy $153 billion per year in unplanned absenteeism due to poor health, a figure that has increased since the time of that study. And while blacks suffer disproportionately from chronic conditions associated with obesity, the sharp increase in obesity measured among whites since 2008 signifies that this is not a problem isolated to one racial or ethnic group.”

The Lingering Challenge of Universal Health Coverage

Drew Altman: “Both Democratic presidential candidates are calling for universal health coverage, though they disagree sharply on how to get there. Here’s the bottom line: There is no single program or policy likely to achieve full coverage of the complex collection of subgroups who make up the remaining uninsured in the U.S. except for a single-payer strategy. But Sen. Bernie Sanders has acknowledged that single-payer health care is not politically feasible in the foreseeable future and has said that it is unlikely without, among other things, campaign finance reform first.”

 

Kaiser Family Foundation chart of eligibility for health coverage under the Affordable Care Act among non-elderly uninsured Americans in 2015.

“More than 17 million people who previously did not have insurance have been covered so far by the Affordable Care Act. That’s enormous progress on one of health care’s biggest problems. But as the chart above shows, slightly more than 30 million people in the U.S. remained uninsured as of last year.”

Hillary Clinton and Bernie Sanders have staked out strong positions on universal coverage. The makeup of the uninsured population and political realities suggest that the most likely path to universal coverage is a series of incremental steps–implemented in combination or sequentially– that build on the progress made by the ACA and chip away at the remaining uninsured in the U.S. group by group.”

Significant Decline in Uninsured in Eight States Attributed to Obamacare

Associated Press: “Eight states saw a significant drop last year in the number of residents going without health insurance, according to a government report out Tuesday that has implications for the presidential campaign.”

“All but Florida had accepted a Medicaid expansion that is one of two major pathways to coverage under President Barack Obama’s health care law. The law’s other coverage route is subsidized private insurance, available in all 50 states.”

“Politically, the eight states with statistically significant coverage gains in the National Health Interview Survey are a mix of red, blue and purple. They are Arizona, California, Colorado, Florida, Illinois, Kentucky, Michigan, and New York. Five have GOP governors.”

“The federal report does not analyze the reasons for the coverage gains, but independent experts say the trend is due to the Obama health care law, boosted by economic recovery.”

“Kentucky led the way among the states with statistically significant reductions in the share of residents uninsured, with a drop of 6.5 percentage points … Another Republican-led state, Arizona, had the second-biggest reduction, a drop of 5.9 percentage points. New York followed, with a reduction of 5.6 percentage points.”

Obamacare’s Latest Enrollment Numbers: Success or Failure?

Kaiser Health News: “The annual Obamacare enrollment numbers routinely draw debate. Supporters boast that millions of people have gained coverage.  Republican detractors stress millions remain uninsured because they can’t afford coverage and that not enough healthy young adults are enrolling. The latter issue threatens to make coverage uneconomical for insurers, causing them to lose money and raise prices or drop out of the exchanges.”

USA Today: “Nearly 13 million people signed up for health insurance ahead of the Jan. 31 deadline for 2016 on the state and federal exchanges, federal health officials said Thursday.”

“The numbers represent an increase of 4 million new people enrolled in the 38 states using HealthCare.gov. Of the 9.6 million consumers who got coverage through HealthCare.gov, about 42% were new to the exchange in 2016.”

“Supporters of the law were expecting an uptick in enrollment after a strong December and the typical lull over the holidays. About 700,000 people signed up in the last week of January, compared to more than 1 million in the last week of enrollment last year.”

The enrollment numbers “fall far short of the Congressional Budget Office’s estimate last March that 21 million would have ACA plans on average each month this year, a prediction that Gaba said was ‘insane.'”

Washington Post: Most repeat customers shopped for the best available health plan. “On the federal exchange, nearly 7 in 10 repeat customers shopped for coverage rather than let the computer system renew them automatically, and about three-fifths of those switched plans. Last year, nearly half let the computer system auto-enroll them.”

“The latest results show that the exchanges are making relatively little headway in attracting a group of customers that insurers consider vital to their financial well-being: young adults who tend to be healthy and thus cost relatively little. In the federal marketplace, 2.7 million people ages 18 to 34 signed up for coverage — 28 percent of the total, the same proportion as last year.”