Filling the need for trusted information on national health issues…

Trending on kff Ebola Marketplaces Enrollment

Those Long Lines To Enroll In The ACA

In this Policy Insight, Kaiser Family Foundation President and CEO Drew Altman discusses the need for community based outreach to enroll the long term uninsured.

Policy Insights Read Post

Obamacare: The Metrics In The News Are Mostly Wrong

In this Policy Insights, Kaiser Family Foundation President and CEO Drew Altman explains how the measures of success for year one of Obamacare used in media coverage and national discussion is the equivalent of judging the local weather from national averages.

Policy Insights Read Post

Health Cost Growth Is Down, Or Not. It Depends Who You Ask.

In this Policy Insight, Kaiser President and CEO Drew Altman explores the disconnect between experts, national studies and the public about whether health care costs are slowing or accelerating—it’s a matter of perspective.

Policy Insights Read Post

Obamacare Vital Signs Not Just Numbers

In his latest column, Kaiser President and CEO Drew Altman discusses the focus on first year metrics, especially enrollment projections, in the ACA debate.

Policy Insights Read Post

No Quick Verdict on Obamacare

This column originally appeared in Politico on September 30. Dr. Altman’s future Politico columns will be posted on kff.org one day after publication. October 1, the focus of great attention in the Obamacare wars, is finally here. Today is the day open enrollment begins for the new health insurance marketplaces,…

Policy Insights Read Post

How Obamacare May Be Holding Down Costs

In his latest column published in Politico, Kaiser President and CEO Drew Altman examines the recent historic slowdown in health-care costs and discusses whether Obamacare is a contributing factor.

Policy Insights Read Post
WP_Query Object
(
    [query] => Array
        (
            [post_type] => Array
                (
                    [0] => perspective
                    [1] => page
                )

            [orderby] => date
            [order] => DESC
            [posts_per_page] => 6
            [paged] => 1
            [tax_query] => Array
                (
                    [0] => Array
                        (
                            [taxonomy] => perspective-type
                            [field] => slug
                            [terms] => policy-insights
                        )

                )

            [meta_query] => Array
                (
                    [relation] => OR
                    [0] => Array
                        (
                            [key] => kff_author
                            [value] => 49507
                        )

                    [1] => Array
                        (
                            [key] => included_on_page
                            [value] => 105174
                        )

                )

            [es] => 
        )

    [query_vars] => Array
        (
            [post_type] => Array
                (
                    [0] => perspective
                    [1] => page
                )

            [orderby] => date
            [order] => DESC
            [posts_per_page] => 6
            [paged] => 1
            [tax_query] => Array
                (
                    [0] => Array
                        (
                            [taxonomy] => perspective-type
                            [field] => slug
                            [terms] => policy-insights
                        )

                )

            [meta_query] => Array
                (
                    [relation] => OR
                    [0] => Array
                        (
                            [key] => kff_author
                            [value] => 49507
                        )

                    [1] => Array
                        (
                            [key] => included_on_page
                            [value] => 105174
                        )

                )

            [es] => 
            [error] => 
            [m] => 
            [p] => 0
            [post_parent] => 
            [subpost] => 
            [subpost_id] => 
            [attachment] => 
            [attachment_id] => 0
            [name] => 
            [static] => 
            [pagename] => 
            [page_id] => 0
            [second] => 
            [minute] => 
            [hour] => 
            [day] => 0
            [monthnum] => 0
            [year] => 0
            [w] => 0
            [category_name] => 
            [tag] => 
            [cat] => 
            [tag_id] => 
            [author] => 
            [author_name] => 
            [feed] => 
            [tb] => 
            [comments_popup] => 
            [meta_key] => 
            [meta_value] => 
            [preview] => 
            [s] => 
            [sentence] => 
            [fields] => 
            [menu_order] => 
            [category__in] => Array
                (
                )

            [category__not_in] => Array
                (
                )

            [category__and] => Array
                (
                )

            [post__in] => Array
                (
                )

            [post__not_in] => Array
                (
                )

            [tag__in] => Array
                (
                )

            [tag__not_in] => Array
                (
                )

            [tag__and] => Array
                (
                )

            [tag_slug__in] => Array
                (
                )

            [tag_slug__and] => Array
                (
                )

            [post_parent__in] => Array
                (
                )

            [post_parent__not_in] => Array
                (
                )

            [author__in] => Array
                (
                )

            [author__not_in] => Array
                (
                )

            [ignore_sticky_posts] => 
            [suppress_filters] => 
            [cache_results] => 
            [update_post_term_cache] => 1
            [update_post_meta_cache] => 1
            [nopaging] => 
            [comments_per_page] => 50
            [no_found_rows] => 
            [taxonomy] => perspective-type
            [term] => policy-insights
        )

    [tax_query] => WP_Tax_Query Object
        (
            [queries] => Array
                (
                    [0] => Array
                        (
                            [taxonomy] => perspective-type
                            [terms] => Array
                                (
                                    [0] => policy-insights
                                )

                            [include_children] => 1
                            [field] => slug
                            [operator] => IN
                        )

                )

            [relation] => AND
        )

    [meta_query] => WP_Meta_Query Object
        (
            [queries] => Array
                (
                    [0] => Array
                        (
                            [key] => kff_author
                            [value] => 49507
                        )

                    [1] => Array
                        (
                            [key] => included_on_page
                            [value] => 105174
                        )

                )

            [relation] => OR
        )

    [date_query] => 
    [request] => SELECT SQL_CALC_FOUND_ROWS  wp_50276312_posts.ID FROM wp_50276312_posts  INNER JOIN wp_50276312_term_relationships ON (wp_50276312_posts.ID = wp_50276312_term_relationships.object_id) INNER JOIN wp_50276312_postmeta ON (wp_50276312_posts.ID = wp_50276312_postmeta.post_id)
INNER JOIN wp_50276312_postmeta AS mt1 ON (wp_50276312_posts.ID = mt1.post_id) WHERE 1=1  AND ( wp_50276312_term_relationships.term_taxonomy_id IN (649) ) AND wp_50276312_posts.post_type IN ('perspective', 'page') AND (wp_50276312_posts.post_status = 'publish') AND ( (wp_50276312_postmeta.meta_key = 'kff_author' AND CAST(wp_50276312_postmeta.meta_value AS CHAR) = '49507')
OR  (mt1.meta_key = 'included_on_page' AND CAST(mt1.meta_value AS CHAR) = '105174') ) GROUP BY wp_50276312_posts.ID ORDER BY wp_50276312_posts.post_date DESC LIMIT 0, 6
    [posts] => Array
        (
            [0] => WP_Post Object
                (
                    [ID] => 108179
                    [post_author] => 36621681
                    [post_date] => 2014-04-08 08:00:54
                    [post_date_gmt] => 2014-04-08 12:00:54
                    [post_content] => On the last day of open enrollment for private insurance plans under Obamacare Twitter was full of powerful photographs of people waiting in long lines to sign up for coverage. 

The photos were a signal that the Administration was going to reach its goal of seven million exchange enrollees in year one; a remarkable comeback from the rollout woes of October and November.

They also showed that people procrastinate, especially when it comes to insurance, just as they do when they file their taxes; about a quarter of all tax filings are made in the last two weeks before the deadline.

And the lines show that the mandate and the deadline have an effect, even if it took until the last minute for many people to act on it.

But the pictures showed something else as well. Those people weren’t online, they were lining up at community centers and local government agencies. When they finally decided to enroll they wanted to go somewhere and talk to a real person. And they felt they needed help navigating the enrollment process.

A survey of the uninsured we did in California recently showed that almost seven in ten have been uninsured for two years or more and about three in ten have never had insurance. More than three in ten do not have internet access at home and roughly one in five say they don’t have any access to the internet.  Studies show that health insurance literacy – the percentage of uninsured people who know what a premium is or what a deductible is – is low. For the long term, harder to reach uninsured, enrolling will never be as simple as shopping on Travelocity or Amazon.com. Reaching them will take hands on community based outreach.

Experience so far shows that outreach can be reinforced by targeted media campaigns emphasizing how the tax credits offered under the law can make insurance more affordable. It is also important to emphasize the deadline and the penalty if the uninsured don’t buy insurance. The tax credits – and Medicaid, especially in the half of states that have decided to expand eligibility under the ACA – are important to outreach messages because the uninsured have always found insurance unaffordable in the past and need a reason to believe it might now be something they can finally afford.

Through a quirk in the law, states operating their own health insurance exchanges had access to substantial federal grant dollars to conduct outreach and consumer assistance. Resources in states using the federally-operated health insurance marketplace were much more limited since an appropriation to support Obamacare was never going to get through the current Congress.

California, which operates its own exchange, had more money for outreach from public and private sources than all of the federal exchange states have combined.

It’s hard to see where more money for outreach will come from in the short term. Foundations can help at the margin at the state and local level. State governments that have embraced the idea of expanding coverage might be able to do more. It starts with the recognition that while a working website is critical to the ACA, and to enrolling people with health insurance experience who are likely to be healthier to ensure a sound risk pool, enrolling the long term uninsured will take hands on outreach at the community level. That’s one thing the pictures of the long lines showed clearly. If the ACA is to reach the uninsured who need its coverage expansions most, it is  – and ultimately needs to be – much “more than a website”.
                    [post_title] => Those Long Lines To Enroll In The ACA
                    [post_excerpt] => In this Policy Insight, Kaiser Family Foundation President and CEO Drew Altman discusses the need for community based outreach to enroll the long term uninsured.
                    [post_status] => publish
                    [comment_status] => closed
                    [ping_status] => closed
                    [post_password] => 
                    [post_name] => those-long-lines-to-enroll-in-the-aca
                    [to_ping] => 
                    [pinged] => 
                    [post_modified] => 2014-09-29 13:59:52
                    [post_modified_gmt] => 2014-09-29 17:59:52
                    [post_content_filtered] => 
                    [post_parent] => 0
                    [guid] => http://kff.org/?post_type=perspective&p=108179
                    [menu_order] => 0
                    [post_type] => perspective
                    [post_mime_type] => 
                    [comment_count] => 0
                    [filter] => raw
                )

            [1] => WP_Post Object
                (
                    [ID] => 106161
                    [post_author] => 36621681
                    [post_date] => 2014-03-24 09:50:10
                    [post_date_gmt] => 2014-03-24 13:50:10
                    [post_content] => 
A few weeks ago the Obama Administration reported that enrollment in the new insurance marketplaces topped four million through the end of February, then five million by mid- March, showing steady progress since the website woes of October. News organizations jumped on the numbers. Would they get to six million enrollees this year, a target many use for the law? If they do, do they have enough young adults to balance the risk pool? If they don’t, won’t premiums skyrocket? The scorecards were out. Story after story followed essentially this pattern, which has now become the familiar metric for judging year one success for Obamacare.  Here’s how it goes.  If the law gets about six million enrollees nationwide and a decent percentage of them are young people, the risk pool will be stable and premiums next year will be reasonable. Year one will be a success.  If it doesn’t the law will be in trouble and year one will be a failure.  The problem is that just about everything about this narrative is wrong.  It’s the equivalent of judging the local weather from national averages. The six million number is an estimate made by the Congressional Budget Office (CBO) for year one enrollment in the new insurance marketplaces. They downgraded their estimate from seven million after the website woes slowed early enrollment. CBO estimates are made to gauge impact on the federal budget. Their purpose is not to judge the success or failure of the program.  While it is true that the greater the number of enrollees the higher the likelihood of a balanced risk pool, six million is not a magic number. How about the percentage of young people? Everyone seems focused on that.  Young people benefit the risk pool because they are healthier, but it’s really the percentage of healthy people that make or break the risk pool. Even if enrollment of young adults stays where it is – at about one-quarter instead of 40%, which our analysis shows they make up among potential enrollees – premiums would only increase by two to three percent. Though even that isn’t quite right, since many insurers expected this and already built it into their premiums.  Nevertheless, news organizations continue to hammer enrollment by young adults as if it were the sole make-it or break-it factor to the health of the risk pools and, in some news reports, the law.  There are no data yet on the overall health of enrollees because the law no longer allows insurers to collect that data in order to exclude people with pre-existing conditions from coverage. Also, there is no national risk pool, so the percentage of the six million who are young or anything else doesn’t matter all that much. Under the law risk is pooled at the state level, so what matters is the risk profile in each state and there will be variation across the country with more and less balanced risk pools in different states.  Premiums themselves are set on a smaller geographic basis, so they will vary even more depending on market competition and other factors in local markets. Of course getting to six million has become a political milestone and that won’t change. But the real questions are: Are the premiums (net of the tax credits the government is providing) affordable to people? Will they be stable or begin to spike in year two in some parts of the country if the risk pool is worse than insurers expected? Do people who get coverage under the law think it’s a good deal or not? Does enrollment ramp up as expected over time, decreasing the number of Americans uninsured? The current focus on national enrollment numbers and signups by young adults doesn’t tell us a great deal about the answers to these questions, and they are not a good metric by which to judge year one success. The problem is that it will take time to learn if the mix of enrollees is healthier or sicker, and how premium increases vary around the country, and how people feel about their coverage. Meanwhile Republican politicians will lambast the law and Democratic ones will offer lukewarm support and overall popularity of the ACA probably won’t change very much.  Anybody willing to wait for a judgment based on the right metrics?
[post_title] => Obamacare: The Metrics In The News Are Mostly Wrong [post_excerpt] => In this Policy Insights, Kaiser Family Foundation President and CEO Drew Altman explains how the measures of success for year one of Obamacare used in media coverage and national discussion is the equivalent of judging the local weather from national averages. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => obamacare-the-metrics-in-the-news-are-mostly-wrong [to_ping] => [pinged] => [post_modified] => 2014-03-24 09:49:32 [post_modified_gmt] => 2014-03-24 13:49:32 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=106161 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 103817 [post_author] => 36621681 [post_date] => 2014-03-05 13:00:19 [post_date_gmt] => 2014-03-05 18:00:19 [post_content] => Studies show that health care costs have been rising more slowly than at any time in the last fifty years, but the American people think they are rising faster than ever. Who’s right, the experts or the public? They both are, they just look at the problem from different perspectives. The most recent government study of national health spending was published by the Centers for Medicare and Medicaid Services and found that health spending grew by a very modest 3.7 percent in 2012, the fourth straight year of historically low increases in spending.  Our annual survey of premiums for employer based health insurance in 2013 told a similar story. Premiums rose just 4 percent.  There is debate among experts about how much of the slowdown is due to the weak economy and how much is due to changes in the health care system but everyone agrees both factors have played a role.  The government report says the slowdown is mainly due to the economy.  Our own analysis also found that the economy explains most of the diminishing rate of growth but changes in health insurance and health care have also played a significant role.  There is uncertainty about when and how rapidly costs will accelerate when the economy improves, but no one disputes that the slowdown is real. No one that is except the American people, who see health costs from a different perspective.  In our monthly tracking poll, almost sixty percent of the American people said “the cost of health care for the nation has been going up faster than usual in recent years”.  Less than a third say costs have been going up “about the same as usual” with just 4 percent saying they were growing “slower than usual”.  No one (correctly) said they were going down. One reason people see health costs differently than experts do is that what they pay for health care has been steadily going up.  They pay less attention to the fact that they are going up more slowly than before.  For example, the average deductible five years ago in employer plans was $735 per person and by 2013 it had grown to $1,135.  Premiums have been growing at historically low rates, but the average family premium in an employer plan in 2008 was $12,680 and in 2013 it was $16,351.  Over that time the share of the premium paid by workers rose from $3,360 to $4,560. What people pay for health care has also been going up when their wages have been flat or even falling in real dollars.  The result is that when people look at their family budgets and try to make ends meet, the pain level from paying their health care bills does not necessarily feel smaller to them and may feel larger. An estimated 1 in 3 Americans report having difficulty paying their medical bills.  They have had problems affording medical bills within the past year, or they are gradually paying past bills over time, or they have bills they can’t afford to pay at all.  People also hear and read a lot about health care costs in the media; in stories about the Affordable Care Act, or the federal budget, or about waste fraud and abuse in the health care system. That gives them a sense that costs are rising even if studies show they are rising more slowly. And, as the Wall Street Journal reported recently, people can be shocked by confusing medical bills and high health care prices. It’s a simple equation: price times volume of services equals spending. The studies reporting the slowdown focus on the change in total national health spending, but people focus on the eye-popping prices. For its part, the Affordable Care Act attacks both the health spending problem experts worry about and the affordability concerns people have, chiefly by reducing future increases in Medicare payments and by providing coverage to a projected thirty million Americans with tax credit subsidies for many of them, lowering their out-of-pocket expenses.  Other provisions of the law dealing with costs appear to be working well, such as its review of outsized premium increases in the non-group market and requirement that insurance companies devote most of their premium dollars to patient services.  The Affordable Care Act’s ultimate impact on costs is hard to gauge but it puts downward pressure on costs for the system and consumers. The Congressional Budget Office projects that Medicare will cost significantly less in the future than previously thought, both because of the ACA’s changes to Medicare’s payments, as well as the general slowdown in health spending growth. There are huge vested interests in the health care industry with a stake in declaring that health costs are under control, because the more the nation believes the health cost problem is solved, the less likely we are to keep the pressure on to try new, more innovative, and perhaps more painful cost control strategies.  We have not seen this many years in a row of slow growth in spending like this before and we can be hopeful that cost growth will remain modest, but we should also be careful not to declare victory too soon, and we should remember how the consumer sees it in a rough economy when the next  study of national health spending comes out. [post_title] => Health Cost Growth Is Down, Or Not. It Depends Who You Ask. [post_excerpt] => In this Policy Insight, Kaiser President and CEO Drew Altman explores the disconnect between experts, national studies and the public about whether health care costs are slowing or accelerating—it’s a matter of perspective. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => health-cost-growth-is-down-or-not-it-depends-who-you-ask [to_ping] => [pinged] => [post_modified] => 2014-03-05 13:09:05 [post_modified_gmt] => 2014-03-05 18:09:05 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=103817 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 89737 [post_author] => 36621681 [post_date] => 2013-10-29 00:01:52 [post_date_gmt] => 2013-10-29 04:01:52 [post_content] => This column originally appeared in Politico on October 27. Dr. Altman's future Politico columns will be posted on kff.org one day after publication. The battle over the Affordable Care Act and its problem-plagued rollout is fast becoming a numbers game: How many people have gone to HealthCare.gov, established an account or actually enrolled in a health plan? How will the website’s problems affect enrollment in the first year? Will the administration need to make major changes, such as extending the open enrollment period or delaying the individual mandate penalty? Obviously, the website must be fixed soon, or the ACA will be in deep trouble. If it is not fixed, the political fallout will worsen, and one of the ACA’s gateways to coverage, the federal exchange, will remain dysfunctional. But assuming the website is repaired fairly soon, the public’s judgment about Year One will be based much more on whether people believe the coverage they get is a good deal than on early website numbers or projections made in Washington for first-year enrollment.

And what about those numbers? The figure most frequently used as a metric for first-year enrollment under the ACA comes from the Congressional Budget Office. The CBO estimated that 7 million people will be covered in the state and federal insurance exchanges and 9 million more by expanded state Medicaid programs in 2014. The CBO does estimates to gauge impact on the federal budget, not to evaluate the implementation of laws, but these numbers have taken on a life of their own. The 7 million figure, in particular, has become the yardstick for measuring the ACA’s success or failure in Year One. But that’s sort of like mistaking fantasy football for real football.

Let’s be honest: Any projection like this is largely an informed guesstimate about something that has never been done. It’s not an exact science. Just last week, Ohio changed the numbers when it decided to expand its Medicaid program. There’s no way the CBO’s number crunchers could have anticipated either that eleventh-hour expansion or the troubled rollout of the federal exchange website, which could have an impact on both the mix and number of people enrolled in the first year if it is not fixed soon. But the impact of these serious website problems on the total number of enrollees may not be huge, since the majority of the uninsured projected to be covered in the first year will be enrolled through state Medicaid expansions and state-operated exchanges. Medicaid and state-exchange enrollment seem to be working more smoothly than enrollment through HealthCare.gov. While some people of low income will be directed to Medicaid through the federal exchange, states are conducting outreach and many applicants will enroll directly through a state program. The impact on the mix of enrollees could be more problematic if younger, healthier people are turned off and stop trying to enroll. There is concern about this but no evidence yet that it is actually happening. One misconception about the 7 million number creeping into the conversation is that it is a target necessary to achieve a viable insurance pool with a good mix of healthier and sick people. The principle is right — the larger the number, the better the chances of spreading risk — but the CBO was calculating the number who might be covered in the first year to estimate federal spending, not to lay down a threshold for the program’s success. So let’s not make too much of the CBO estimate: What people should be paying attention to at the end of the first year is not whether a specific projection is attained but whether people feel the coverage they are getting is a good deal and whether the states that have chosen to move forward with the ACA are satisfied. For instance, let’s say 10 million people are covered in the state and federal exchanges, substantially more than the 7 million projected by the CBO. If people widely complain about the individual mandate or affordability of coverage, and states that have embraced the law balk, would that be a success? Imagine, on the other hand, that enrollment ramps up more slowly than the CBO expected simply because it takes more time than expected to enroll the uninsured. That could happen not only because of early website problems but because the uninsured are largely uninformed about the law and many do not know that they are eligible for tax credits. Say 5 million people enroll in the state and federal exchanges (plus millions more in Medicaid), but most people are happy with their coverage and enrollment reflects a good mix of healthier and sicker folks. Media reports would become increasingly upbeat, or at least they should, and states that have chosen to sit on the sidelines might take notice. ACA’s first year could be judged a success despite the early hiccups. Maybe it’s asking too much to expect the pundits and partisans on both sides to resist turning this into a ballgame scorecard, with a simple measure of whether Obamacare wins or loses in its first year. But for those of us just trying to understand whether the ACA is really working or not, it’s definitely too early to say which way things will go, and there is no single magic number that will tell us whether the law succeeded or failed in the first year. [post_title] => Obamacare Vital Signs Not Just Numbers [post_excerpt] => In his latest column, Kaiser President and CEO Drew Altman discusses the focus on first year metrics, especially enrollment projections, in the ACA debate. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => obamacare-vital-signs-not-just-numbers [to_ping] => [pinged] => [post_modified] => 2014-03-04 11:16:30 [post_modified_gmt] => 2014-03-04 16:16:30 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=89737 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 86880 [post_author] => 48951013 [post_date] => 2013-10-01 12:40:47 [post_date_gmt] => 2013-10-01 16:40:47 [post_content] => This column originally appeared in Politico on September 30. Dr. Altman's future Politico columns will be posted on kff.org one day after publication. October 1, the focus of great attention in the Obamacare wars, is finally here. Today is the day open enrollment begins for the new health insurance marketplaces, where Americans can log on and sign up for coverage. The media, opponents, and proponents have been gearing up for a big day — or, maybe, a big week — when they can make pronouncements about how well Obamacare is working. But all we will really know at this point is how well eligibility and enrollment systems are working initially, since actual coverage doesn’t begin until January 1. When they throw the switch today, do the lights shine brightly, flicker, or not come on at all? The media will jump on early glitches, but if they are addressed, the memory of them will fade. It will take weeks, if not months or more, before anyone knows how many people are signing up for coverage. People might take a wait-and-see attitude before they sign up or just procrastinate. And if you are uninsured, bewildered by the debate about the Affordable Care Act (Act), and wondering whom to believe, it’s not crazy to wait just a little while to enroll, as long as you don’t wait too long and miss out on your coverage kicking in next year. We may not really have a good sense of how many people will show up for coverage and whether they feel the premiums they are paying (after tax credits) are a good deal or not until the open enrollment period ends in March 2014. Plus, how many sign up and how they perceive the affordability of the premiums themselves is only half the story. In addition to premiums, people will face out-of-pocket costs when they seek health-care services. And there are the benefits that Obamacare requires all insurers to provide — the usual hospital care and doctor visits, plus maternity care, mental health, prescription drugs, and more. We won’t know how they feel about their coverage overall until people begin to use health services. If you think about your own family you know that not everybody will go to the doctor or the hospital or purchase drugs right away. Only when people start to use care will they pay their up-front deductibles, which in some cases will run thousands of dollars for plans sold in the exchanges, or pay their other forms of costs-sharing for doctor visits and drugs, or get free preventive services under Obamacare. All this will probably take at least a year to shake out, and maybe longer. The Congressional Budget Office has estimated that about 14 million more Americans will be insured in year one, primarily through the exchanges or the state Medicaid expansions, which the Supreme Court made a state option in its ruling on the ACA. People’s experiences with their coverage will vary widely, depending on their state Medicaid programs, the plans offered in the exchanges in their states, and the health-care delivery systems where they live. Some people will be in a state-run exchange and others in a federal exchange. Every state Medicaid program is different. With so much variation, it will be even harder to come to a quick summary judgment about how the law is working nationally. This same variation offers opportunities to learn what is working best and to make improvements in the law, assuming our polarized Congress can ever get its act together to agree on changes to the ACA. Then, in year two, an additional six million people are expected to be insured. More states might also choose to expand Medicaid or run exchanges themselves. It should be easier to get a broad picture of how the law is working by then. October 1 is a handy news hook for coverage of Obamacare as it moves from a political dogfight to a reality — a new phase for the law. But it is not a magic moment to make a judgment about the ACA. All sides will be spinning their version of the early implementation experience, but it will take longer to come to any kind of reasonable judgment about how the law is working and what its lessons are. And while the noise level will be highest in Washington, in the end it’s the American people who will decide whether they like what they are getting from Obamacare or not. [post_title] => No Quick Verdict on Obamacare [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => no-quick-verdict-on-obamacare [to_ping] => [pinged] => [post_modified] => 2014-03-04 11:14:31 [post_modified_gmt] => 2014-03-04 16:14:31 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=86880 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 86626 [post_author] => 36621681 [post_date] => 2013-09-27 08:00:25 [post_date_gmt] => 2013-09-27 12:00:25 [post_content] => This column originally appeared in Politico on September 26.  Dr. Altman's future Politico columns will be posted on kff.org one day after publication.  The historic slowdown in health-care costs is continuing. Earlier this month, the government’s actuaries found that total national health spending continues to grow at the lowest rate we’ve ever seen. And our annual employer health benefits survey released in August found premiums up just 4 percent on average for family policies this year, while overall health spending is growing at the slowest rate in 50 years (dating back to when the government first started tabulating health expenditures). Experts debate how much of the slowdown is due to the weak economy, which causes people to use less health care, and how much is due to changes in health insurance and the health-care system, such as higher cost-sharing or new efforts to limit avoidable tests or hospital days. But the consensus – including the actuaries – is that both factors are playing some role. What is far less clear is how much Obamacare may also be contributing to the slowdown in costs. Proponents of the law say it is helping to control costs because the cost- containment provisions of the law are working as advertised. These include new limits on how much insurance companies can charge for administration and profits (with rebates to consumers if they charge too much), and state review of rates proposed by insurance companies. There is solid evidence that these provisions are working as intended, but they mainly apply to the individual and small group markets, just a small slice of the overall health care marketplace. Obamacare also reduced the rate of increase in future payments to providers for Medicare. These reductions are projected to take more than $700 billion out of health spending over the next 10 years, but they haven’t had much effect yet. Other provisions of the law, such as the Medicare experiments in payment and delivery, are still just getting started. Critics of Obamacare, of course, dispute that the law is having any effect on costs because, well, there is basically nothing they like about Obamacare. Even though its direct effects on system-wide costs may be limited so far, I believe Obamacare is having a significant indirect effect, although cause and effect and the magnitude are hard to prove. (As the actuaries rightly point out, insuring more people will boost the rate of spending growth temporarily, but the effect should be small and short-lived.) Historically, we have always seen the health-care marketplace respond by lowering costs when there is the threat of impending health reform legislation or government action on costs. Now we have not only the threat but the reality. When President Jimmy Carter threatened aggressive cost-containment legislation in 1977, the industry responded with something called “the voluntary effort,” and for several years cost growth came sharply down. Similarly, cost increases came down when Bill Clinton’s health reform loomed, spurring the so-called managed-care revolution that reached its apex in the mid to late 90s. Costs also have responded to direct government intervention, as they did when President Richard Nixon imposed temporary wage and price controls in the early 1970s, including in health. Health inflation came down but, not surprisingly, rose again when the regulations were lifted. Obamacare appeared first in the form of the threat of sweeping health-reform legislation and then the reality when the law passed. It is likely that what Obamacare has mainly done so far is accelerate changes already underway in the marketplace as part of a constellation of forces affecting the health-care industry. Already feeling pressure from insurers and employers, providers saw Obamacare coming, with its reductions in the rate of growth in Medicare reimbursement and Medicare payment demonstrations. The old saying in health policy is “when Medicare sneezes, health care catches cold.” The market saw these changes as harbingers of the future. The bill’s rate review and limits on insurance-company overhead and profits – as well as more intense price competition coming in the new exchanges – put new pressure on insurers to be more innovative and to take on providers more aggressively, even if they only apply to relatively small slices of the marketplace. Public and private payers in general seemed to be aligning behind a new interest in redesigning reimbursement incentives and the delivery of care. Obamacare became part of a larger handwriting on the wall, not just in Medicare but in the private marketplace as well. The marketplace has also reacted defensively to protect its bottom line, and not all of the changes in the system will lower costs. The raft of mergers and consolidation of market power in the delivery system could raise costs as providers get bigger and drive a harder bargain with insurers. Revenues and profits have not been abandoned as the basic yardstick for CEOs and boards of directors. The cost slowdown preceded Obamacare, so there is no doubt that other forces have been at play as well. Cost-sharing has been increasing in the market for years, and we know it has a very real impact on the use of health services. The bad economy has had the biggest influence on health care utilization and spending, as our recent study and this month’s actuaries’ report both suggest. But, history tells us that the health-care market has always responded to the threat (and now, for the first time, also the reality) of health reform. For this reason it is entirely likely that Obamacare has played and will continue to play a role in the slowdown in health-care cost growth and accelerating market change. Ask almost any hospital administrator or insurance CEO, and that’s the answer you’ll get. Just don’t ask me to prove it. [post_title] => How Obamacare May Be Holding Down Costs [post_excerpt] => In his latest column published in Politico, Kaiser President and CEO Drew Altman examines the recent historic slowdown in health-care costs and discusses whether Obamacare is a contributing factor. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-obamacare-may-be-holding-down-costs [to_ping] => [pinged] => [post_modified] => 2014-03-04 11:14:32 [post_modified_gmt] => 2014-03-04 16:14:32 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=86626 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 108179 [post_author] => 36621681 [post_date] => 2014-04-08 08:00:54 [post_date_gmt] => 2014-04-08 12:00:54 [post_content] => On the last day of open enrollment for private insurance plans under Obamacare Twitter was full of powerful photographs of people waiting in long lines to sign up for coverage. The photos were a signal that the Administration was going to reach its goal of seven million exchange enrollees in year one; a remarkable comeback from the rollout woes of October and November. They also showed that people procrastinate, especially when it comes to insurance, just as they do when they file their taxes; about a quarter of all tax filings are made in the last two weeks before the deadline. And the lines show that the mandate and the deadline have an effect, even if it took until the last minute for many people to act on it. But the pictures showed something else as well. Those people weren’t online, they were lining up at community centers and local government agencies. When they finally decided to enroll they wanted to go somewhere and talk to a real person. And they felt they needed help navigating the enrollment process. A survey of the uninsured we did in California recently showed that almost seven in ten have been uninsured for two years or more and about three in ten have never had insurance. More than three in ten do not have internet access at home and roughly one in five say they don’t have any access to the internet.  Studies show that health insurance literacy – the percentage of uninsured people who know what a premium is or what a deductible is – is low. For the long term, harder to reach uninsured, enrolling will never be as simple as shopping on Travelocity or Amazon.com. Reaching them will take hands on community based outreach. Experience so far shows that outreach can be reinforced by targeted media campaigns emphasizing how the tax credits offered under the law can make insurance more affordable. It is also important to emphasize the deadline and the penalty if the uninsured don’t buy insurance. The tax credits – and Medicaid, especially in the half of states that have decided to expand eligibility under the ACA – are important to outreach messages because the uninsured have always found insurance unaffordable in the past and need a reason to believe it might now be something they can finally afford. Through a quirk in the law, states operating their own health insurance exchanges had access to substantial federal grant dollars to conduct outreach and consumer assistance. Resources in states using the federally-operated health insurance marketplace were much more limited since an appropriation to support Obamacare was never going to get through the current Congress. California, which operates its own exchange, had more money for outreach from public and private sources than all of the federal exchange states have combined. It’s hard to see where more money for outreach will come from in the short term. Foundations can help at the margin at the state and local level. State governments that have embraced the idea of expanding coverage might be able to do more. It starts with the recognition that while a working website is critical to the ACA, and to enrolling people with health insurance experience who are likely to be healthier to ensure a sound risk pool, enrolling the long term uninsured will take hands on outreach at the community level. That’s one thing the pictures of the long lines showed clearly. If the ACA is to reach the uninsured who need its coverage expansions most, it is  – and ultimately needs to be – much “more than a website”. [post_title] => Those Long Lines To Enroll In The ACA [post_excerpt] => In this Policy Insight, Kaiser Family Foundation President and CEO Drew Altman discusses the need for community based outreach to enroll the long term uninsured. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => those-long-lines-to-enroll-in-the-aca [to_ping] => [pinged] => [post_modified] => 2014-09-29 13:59:52 [post_modified_gmt] => 2014-09-29 17:59:52 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=108179 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 20 [max_num_pages] => 4 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => 1 [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_404] => [is_comments_popup] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 3931faeeb157b27d5443494aa7ebd98e [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => )