iLoveBenefits: Industry News Blog

Congressional budget implications for health care

Congressional Recess Is Underway; Budget Decisions Still Unresolved

Both chambers of Congress have begun their Easter recess, allowing for a brief pause in legislative activity at the federal level. The Senate is scheduled to return from recess on April 4 and the House will return on April 11.

When Congress reconvenes, House leaders will make a decision about whether to proceed with the budget resolution that was approved on March 16 by the House Budget Committee. A key point of contention, which may result in changes to the committee’s version of the budget resolution, is the total amount of funding that will be allotted for the annual appropriations bills. Leaders of the House and Senate Appropriations Committee are eager to see this issue resolved, so they can take action in April and May on the 12 annual spending bills that will provide funding to support federal programs and agencies in fiscal year 2017.

The next stretch of the 2016 session also will include continued discussions by a series of House Republican Task Forces that are working to develop legislative recommendations on priority issues. One task force is charged with addressing health reform and others are focusing on national security, jobs and economic growth, poverty and opportunity, and constitutional authority. In January, House Speaker Paul Ryan (R-WI) stated that he expected these task forces to develop a complete agenda by the time Republicans choose their nominee for the presidential election.

Medicaid programs educating beneficiaries

A new AHIP Issue Brief provides background information about the Medicaid program and explains how health plans work with the states to deliver care for Medicaid beneficiaries.

Our issue brief provides an overview of the federal-state Medicaid partnership, who is covered by Medicaid and the benefits they receive, the role of Medicaid health plans, research findings on the value offered by Medicaid health plans, and the key issues health plans face under the Medicaid “mega reg” that CMS is expected to finalize at some point this spring.

The brief also highlights key areas where Medicaid health plans are demonstrating strong leadership:

  • By offering integrated health care delivery systems, Medicaid health plans promote access to coordinated, quality care and prevent overutilization of services that are both unnecessarily costly and potentially harmful for their enrollees, including dual eligibles.
  • By conducting outreach and health education efforts that encourage Medicaid beneficiaries to receive needed preventive care, Medicaid health plans help to reduce unnecessary hospital admissions.

By helping to manage chronic conditions through patient-centric disease management programs, Medicaid health plans are improving health outcomes while also reducing the costs of providing health care to beneficiaries with complex health care needs.

Race/Ethnicity for persons without health insurance

According to data from the January–September 2015 National Health Interview Survey, after adjusting for age and sex, the percentage of persons without health insurance coverage by race/ethnicity was:

  • 19.5% for Hispanic persons
  • 6.3% for non-Hispanic white persons
  • 10.0% for non-Hispanic black persons

Source: “Early Release of Selected Estimates Based on Data From the January–September 2015 National Health Interview Survey,” National Center for Health Statistics, Centers for Disease Control and Prevention, February 2016,

February 25, 2016 | Categories: Benefits,healthcare,insurance | Tags: , , | Comments (0)

4 in 5 expect that by 2021, patients will compare ratings before choosing a hospital

Survey: Most Patients Will Belong to Incentivized Health Plans by 2021

The Society for Healthcare Strategy & Market Development recently conducted a survey on healthcare leaders’ thoughts on emerging trends in healthcare. Here are some key findings from the report:

  • 99% agreed that by 2021 patients will demand a greater role in treatment planning.
  • 4 in 5 expect that by 2021, patients will compare ratings before choosing a hospital.
  • 89% said that most of their hospital’s insured patients will belong to incentivized health plans by 2021.
  • Most practitioners (88%) predict that at least a quarter of chronic disease patients will receive it remotely.
  • Two-thirds of practitioners predict that most chronic illness patients will receive primary care that includes some type of psychotherapy service.

Source: Society for Healthcare Strategy & Market Development, January 26, 2016

US Healthcare Spending $3 Trillion

U.S. Healthcare Spending was $9,523 Per Capita in 2014

Health Affairs recently published a study on national health spending trends in 2014. Here are some key findings from the report:

  • U.S. health care spending increased 5.3% to $3.0 trillion in 2014.
  • Health spending was $9,523 per capita in 2014, 4.5% higher than in 2013.
  • The share of gross domestic product used for health care was 17.5%, up from 17.3% in 2013.
  • Retail prescription drug expenditures increased by 12.2% in 2014.
  • Medicaid spending growth increased at a rate of 11%, compared to 5.9% in 2013.
  • The federal government’s share of health spending increased from 26% in 2013 to 28% in 2014.

Source: Health Affairs, November 2015

Health Benefits Cost $11,635 Per Employee in 2015

Mercer recently conducted the annual National Survey of Employer-Sponsored Health Plans. Here are some key findings from the report:

  • Total health benefits cost averaged $11,635 per employee in 2015.
  • Large employers experienced a 2.9% increase, while smaller employers experienced a 5.9% increase.
  • One fourth of all covered employees are now enrolled in a CDHP.
  • Employers predict that in 2016 their cost per employee will rise by 4.3% after making plan adjustments.
  • 24% of employers provided transparency tools in 2015, up from 15% in 2014.
  • 1 in 4 large employers encourage employees to track physical activity with a ‘wearable’ device.

Source: Mercer, November 23, 2015

Shifting the cost of health care

According to a recent analysis, total health care costs covered by employers have fallen by about 1% per year since 2012. Source: “2015 Records Lowest U.S. Health Care Cost Increases in Nearly 20 years,” Aon Media Center, November 12, 2015,

1% might not sound like a lot, but consider that on a roughly right basis if the cost of individual health care is $10,000 and the employer had been picking up 80% and the employee 20% a 1% shift is $80 PLUS the amount of the annual increase. If the increase is 6% then that’s an increase of $600 (of which the employee is paying an additional $120. So the total increase including the shift is @$200. So where they were paying $2000 (20% of $10,000) they are now paying 21% of $10,600 or $2226. That is an 11.3% increase year over year.

U.S. Spends $9,086 Per Person Annually on Healthcare

The Commonwealth Fund recently released an analysis comparing U.S. healthcare to 12 other high-income countries. Here are some key findings from the report:

  • The U.S. spends $9,086 per person annually on healthcare, compared to $6,325 in Switzerland.
  • Health care consumed 17.1% of U.S. GDP in 2013, about 50% more than any other country.
  • People in the U.S. visit doctors an average of four times per year.
  • Americans have 126 hospital visits per every 1,000 people, compared to 252 visits in Germany.
  • Prescription drugs are 2x more expensive in the U.S. than the U.K., Australia, and Canada.
  • Heart bypass surgery costs $75,345 in the U.S., compared to $15,742 in the Netherlands.

Source: The Commonwealth Fund, October 8, 2015

October 26, 2015 | Categories: Benefits,Cost,healthcare | Tags: , , , | Comments (0)

NCQA Health Insurance Plan Ratings 2015–2016

Using a new methodology, NCQA has announced their Health Insurance Plan Ratings 2015–2016. NCQA studied 1,358 health plans and rated 1,016: 491 private (commercial), 376 Medicare and 149 Medicaid. The ratings align with the CMS Star Ratings of Medicare Advantage plans, and incorporate health outcomes and consumer satisfaction data. Click to continue.

AHRQ Stats: Health Care Coverage

The percentage of people without health insurance decreased from 22 percent in 2010 to 20 percent in 2013. The percentage of uninsured fell further, to 16 percent, in the first half of 2014. (Source: Agency for Healthcare Research and Quality, 2014 National Healthcare Quality and Disparities Report Chartbook on Access to Health Care.)

September 16, 2015 | Categories: Benefits,healthcare,insurance | Tags: , , , | Comments (0)
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