How big is your retirement package? Benefits from government retirement programs—Social Security and Medicare—vary over time, but the trend has been toward higher lifetime benefits for each successive cohort. Expansion derives mainly from increases in real annual benefits, more years of benefits through longer lifespans, and better and more expensive health care. In 1960, a couple where each spouse earned constant “average” wages over a career beginning at age 22 and retired on his or her 65th birthday would receive about $300,000 in health and retirement benefits; today, that figure is over $1 million in health and retirement benefits (figure 1). The expected benefits for couples turning 65 in 2050—age 30 today—are scheduled to rise under current law to almost $2 million.
Changes in Medicare Spending per Beneficiary by Age: Working Paper 2015-08 | Congressional Budget OfficeNovember 23, 2015
The aging of the population exerts upward pressure on federal spending for health care, especially Medicare, as both the number and average age of elderly beneficiaries increase. Total Medicare expenditures may also be affected by changes in relative per-beneficiary spending for beneficiaries of different ages as the population ages. In this paper, we use the Master Beneficiary Summary File to estimate spending per beneficiary for the elderly population (people between ages 65 and 105) enrolled in the traditional fee-for-service (FFS) Medicare program between 1999 and 2012. Over that period, the age for which Medicare spending per beneficiary was highest increased from 89 to 97. In addition, spending per beneficiary grew faster for older beneficiaries than for younger ones in the second half of the period.
Over the entire period, the average annual growth rate of Medicare spending per beneficiary for people ages 65 to 74 was about half of that for those ages 85 to 94. Faster decline in the use of acute inpatient hospital care among younger beneficiaries than among older beneficiaries contributed to the slower growth of spending per beneficiary for the 65- to 74-year-old age group. More rapid growth in spending on care provided in skilled nursing facilities and hospice care—services that are more widely used by older beneficiaries—than in spending on other Medicare services contributed to the faster growth in spending per beneficiary among the older groups; that growth also accounted for the increase in the age for which Medicare spending per beneficiary was highest. Neither increases in life expectancy nor changes in the composition of beneficiaries who were enrolled in the Medicare FFS program can account for those changes in Medicare spending per beneficiary by age.
It’s proof anew that Obamacare was always destined to erode into a Medicaid-like benefit. Critics, including myself, have argued this for years. What couldn’t be predicted was how quickly it would be the Medicaid-only plans that serviced it.
We’ll see a clearer split in the health plan space — between plans that continue to service the Medicaid/Obamacare segment, and those that move more squarely into Medicare and into the commercial markets. Obamacare plans have all but ended PPO offerings. Most of the plans this year are closed network “exclusive provider organizations” that are the most restrictive HMOs structure possible. In the end, as Obamacare becomes more like Medicaid, it will be the Medicaid HMOs servicing it.
In a new study published today by the Mercatus Center at George Mason University, I assess key predictions made by both government and nonprofit research organizations about the Affordable Care Act’s (ACA) impact. The misestimates include: overestimating total exchange enrollment, overestimating enrollment of higher income people who do not qualify for subsidies to reduce premiums, projecting too many healthy enrollees relative to less healthy enrollees, and underestimating premium increases.
Starting in January, the Affordable Care Act requires businesses with 50 or more full-time-equivalent employees to offer workers health insurance or face penalties that can exceed $2,000 per employee. Ms. Hunter, who has 45 employees, is determined not to cross that threshold. Paying for health insurance would wipe out her company’s profit and the five-figure salary she pays herself from it, she said.“
The margins are not big enough within our industry to support it,” she said. “It’s not that I don’t want to — I love my employees, and I want to do everything I can for them — but the numbers just don’t work.”
Premiums for individual plans offered by the dominant local insurers are rising almost everywhere for 2016, typically by double-digit percentage increases, according to a Wall Street Journal analysis of plan data in 34 states where the HealthCare.gov site sells insurance. More than half of the midrange “silver” plans are boosting the out-of-pocket costs enrollees must pay, while more than 80% of the less-expensive “bronze” plans are doing so.
In The Politics of Pain Medicine: A Rhetorical-Ontological Inquiry, S. Scott Graham offers a rich and detailed exploration of the medical rhetoric surrounding pain medicine. Graham chronicles the work of interdisciplinary pain management specialists to found a new science of pain and a new approach to pain medicine grounded in a more comprehensive biospychosocial model. His insightful analysis demonstrates how these materials ultimately shape the healthcare community’s understanding of what pain medicine is, how the medicine should be practiced and regulated, and how practitioner-patient relationships are best managed. It is a fascinating, novel examination of one of the most vexing issues in contemporary medicine.
NIHCR: Limiting Tax Breaks for Employer-Sponsored Health Insurance: Cadillac Tax vs. Capping the Tax ExclusionNovember 18, 2015
A new National Institute for Health Care Reform analysis compares the Cadillac tax to capping the tax exclusion on employer health benefits. The analysis found only modest differences in progressivity—or the degree to which higher-income people bear a higher tax burden—between the Cadillac tax and capping the tax exclusion, primarily because employers are likely to avoid a substantial portion of the taxes by restructuring health benefits, particularly in response to the Cadillac tax.
We’ve identified at least seven states that have taken recent legislative action to lower the burden of high-price prescription drugs,* both inside and outside the insurance marketplaces (see Table 1). And seven state-based marketplaces require insurers to offer standardized benefit designs that also place limits on pharmaceutical cost-sharing.
A new analysis by Avalere finds that causes of health insurance premium increases in 2016 generally mirror the distribution of healthcare spending in the individual and small group market. Specifically, inpatient and outpatient hospital services are modestly driving premium increases, while physician and other professionals make up less than their expected portion of premium growth. Prescription drugs’ contribution to 2016 premium increases is roughly in line with their costs in 2014. Overall, premiums for 2016 will rise an average of $25.26 per month, with $5.44 of that increase caused by outpatient hospital services