Between state, federal and Medicare taxes, and insurance premium growth potentially displacing wage increases, you paid a high price for health care in 2014—even if you were healthy and never used the system once.
Every so often in punditry land there appears a column so egregiously flawed that it makes a perfect platform for a homework assignment in undergraduate health-economics courses. With a straight face and little commentary, one mandates students to fact-check the piece and to examine its inherent logic. Students relish taking apart in this way the scribblings of seasoned adults.
So we must thank Sally Pipes for contributing to pedagogy a veritable jewel along these lines in her July 28 Forbes article, entitled “Employer Health Insurance: A Bargain Compared to Government-Sponsored Coverage.”
We find that in recent years, when fiscal conditions have been tight, health insurance premiums for state workers have grown materially less rapidly than premiums for comparable private- sector employers; this slower premium growth for state workers reflects, for example, changes from traditional comprehensive plans to networked plans, increases in deductibles, and/or non-transparent reductions in access due to reductions in payments to providers. Interestingly, the share of the premium paid by state workers has tended to rise in states with high rates of public-sector unionization, where the employee share started at a low base, while the share has fallen elsewhere.
The results in this presentation expand on those published in Congressional Budget Office, Options for Reducing the Deficit: 2014 to 2023 (November 2013) using the most recent CBO baseline. The analysis provides estimates of the impact on coverage of 3 alternative policy options:
- Totally eliminate the tax exclusion for federal income tax and payroll tax purposes;
- Eliminate the tax exclusion for federal income tax but not for payroll tax purposes;
- Cap income and payroll tax exclusions at the median premium for employment-based plans
An Estimated $84.9 Billion In Uncompensated Care Was Provided In 2013; ACA Payment Cuts Could Challenge ProvidersMay 5, 2014
Millions of uninsured people use health care services every year. We estimated providers’ uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. We calculated that in the aggregate, at least 65 percent of providers’ uncompensated care costs were offset by government payments designed to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.
Many pundits, politicians and economists claim that wages have fallen behind productivity gains over the last generation. This “decoupling” explains allegedly stagnant (or in some versions of the story, declining) middle-class incomes and is held out as a crisis of the market economy.
This story, though, is built on an illusion. There is no great decoupling of worker pay from productivity. Nor have workers’ incomes stagnated over the past four decades.
The illusion is the result of two mistakes that are routinely made when pay is compared with productivity. First, the value of fringe benefits—such as health insurance and pension contributions—is often excluded from calculations of worker pay. Because fringe benefits today make up a larger share of the typical employee’s pay than they did 40 years ago (about 19% today compared with 10% back then), excluding them fosters the illusion that the workers’ slice of the (bigger) pie is shrinking.
The demand for long-term care services will explode as the population ages and more people live longer with chronic conditions. Who will pay for these services and how will they be delivered?
In 2010, 40 million Americans were age 65 or older. By 2050 that number is expected to jump to 88 million. Among these older citizens, only three in 10 will never receive long-term care services. The majority will get such care—though not necessarily in a nursing home or assisted living facility. The current definition of long-term care includes services provided in the home by family members or paid caregivers. Adult day-care is also considered a form of long-term care.
The cost will be huge. In addition to the increase in the number of people over 65, the number of people 85 and older is also predicted to jump dramatically. This is the “frail elderly” group most likely to need long-term care. In 2010 there were 5.5 million of these older people, but by 2050 there will likely be 19 million.
These demographic shifts raise two questions. How will the nation decide to pay for that care? Will it be given in different ways and settings?