Policymakers should view with a degree of skepticism most hospital and insurance industry claims of inevitable, large-scale cost shifting. Although some cost shifting may result from changes in public payment policy, it is just one of many possible effects. Moreover, changes in the balance of market power between hospitals and health care plans also significantly affect private prices. Since they may increase hospitals’ market power, provisions of the new health reform law that may encourage greater provider integration and consolidation should be implemented with caution.
How will the minimum medical loss ratio (MLR) provisions of the Patient Protection and Affordable Care Act impact the individual market for health insurance? Jean Abraham, Ph.D, and Pinar Karaca-Mandic, Ph.D., of the University of Minnesota, sought to provide state-level estimates of the size and structure of the individual market for health insurance and to investigate the impact of the new MLR regulation.
For more than 10 years, there has been movement toward placing greater control of health care in the hands of consumers. A hallmark of this change was the introduction of consumer-driven health plans (CDHPs) into the landscape of health insurance. The large body of evidence examining the various components of CDHPs may help inform policymakers who are exploring the advantages and disadvantages of offering high deductible health plans (HDHPs) within states’ health insurance exchanges. While HDHPs are structured in such a way to promote cost savings and protect against the financial burden of a catastrophic medical event, the evidence on the success of these goals is mixed.
The government’s long-awaited draft regulations on Accountable Care Organizations have brought a dose of ugly reality to a concept that’s always seemed coated with a patina of pixie dust. Unless those regs are substantially changed before the clock strikes Jan. 1, 2012 — the statutory date for ACO implementation — Cinderella’s going to turn back into a scullery maid and the horse-drawn carriage transporting her to the Health System Transformation Ball will be revealed as nothing more than four mice and a pumpkin.
VBID is an insurance payment system that raises co-pays on services of lower medical value. It has been successfully used by many companies to lower drug costs and to send a powerful economic signal about what tests and procedures are considered medically wasteful. In other words, Medicare, if it adopted VBID for the entire program, would still pay for everything in the benefit package. But beneficiaries would pay more for tests, images, procedures and drugs that experts consider of dubious worth.
The chart clearly reveals a number of important facts that are not coming up in town hall meetings. Most obvious is the huge bulge in spending in the past few years. In 2000 spending was 18.2% of GDP. In 2007 it was 19.6%. But in the three years since 2009 it’s jumped to an average of 24.4%.
Second, and perhaps even more striking, the chart shows that Mr. Obama, in his budget submitted in February, proposed to make that spending binge permanent. Spending would still be more than 24% of GDP at the end of the budget window in 2021. The administration revealed its preference in the February budget for a much higher level of government spending than the 18.2% of GDP in 2000 or the 19.6% in 2007.
I asked the actuarial office what the cap would have to be today to have the tax hit 90 percent of all wages, the benchmark anticipated by Alan Greenspan, Ronald Reagan, the late Sen. Pat Moynihan, D-N.Y., and the other architects of the 1983 compromise. “$191,100,” the office replied with its customary precision. “If the increase began in 2012 and was fully phased in by 2017, the estimated trust fund exhaustion year would be 2049.”
According to the last Social Security trustees’ report, the current data for the trust fund’s exhaustion is 2037. Clearly, raising the tax cap won’t solve all of Social Security’s 75-year imbalance. But if the nation is committed to the goal of maintaining a stable income floor for all senior citizens, regardless of how well they did during their working years, then raising the cap is a good place to start, especially given the rise in income inequality in the U.S. over the last 30 years.