[cross posted from the Health Affairs blog]
Growing concern about the affordability of health care and the cost burden imposed on working families frequently appears in public debate about the next phase of health care reform. In this second brief of our affordability series, Penn LDI and United States of Care adapt a national-level affordability index to provide state-level data on the cost burden faced by working families who have employer-sponsored insurance (ESI). We examine how this burden varies across states, and how it has changed within states from 2010 to 2016.
Today, you often hear stories of patients who visit an in-network hospital and still receive a large medical bill because one or more providers involved in their care was out-of-network. Although this phenomenon of “surprise billing” has become common, no research has examined how consumers respond to surprise bills and alter their health-seeking behavior.
A surprise medical bill is a bill from an out-of-network provider that was not expected by or not chosen by the patient.To see whether consumers are more likely to switch hospitals after receiving a surprise bill, Benjamin Chartock and Sarah Schutz, and their co-author Christopher Garmon, analyzed nationwide employer-sponsored health insurance claims for labor and delivery services. Mothers who received a surprise out-of-network bill for their first delivery had 13% greater odds of switching hospitals for their second delivery compared to those who did not get a surprise bill.
The durability and vulnerability of the Affordable Care Act (ACA) was on full display last year amidst the Administration’s efforts to undermine it, according to LDI Senior Fellow and law professor Allison Hoffman. In the Journal of Law, Medicine, and Ethics, she makes the case that recent experience demonstrates the shortcomings of market-based health policy and draws insights for future health reforms.
We know that high deductibles have a significant effect on spending levels, but do they affect spending growth? In a recent National Bureau of Economic Research (NBER) working paper, LDI Associate Fellow Molly Frean and LDI Senior Fellow Mark Pauly found that spending growth was significantly lower in states where privately insured employees have higher deductibles.
On September 13 and 14, the University of Pennsylvania Law School, Penn LDI, and Princeton University's Center for Health and Wellbeing will host the Sixth Annual Health Insurance Exchange Conference. This nonpartisan, off-the-record workshop brings together senior state policymakers and researchers studying health care markets to discuss the latest research on the exchanges and current challenges.
On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”
In the not-too-distant future, individuals may be able to learn their risk of developing Alzheimer’s disease through biomarkers – measures of disease activity – detected up to 20 years before symptoms present. This information would allow individuals (and their loved ones) to prepare for future cognitive and functional decline, but it also has implications for the purchase of private long-term care insurance.
The adequacy of “narrow network” plans offered on the Affordable Care Act (ACA) Marketplaces continues to be a concern in the wake of exclusions of some high-cost providers and the incidence of “surprise medical bills” even in facilities that are in-network.