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The Next Big Debate in Health Care

In this Wall Street Journal Think Tank column, Drew Altman discusses why adequacy of health coverage will rise as an issue when
the political world moves on from its focus on the Affordable Care Act.

Column/Op-Ed Read Post

Will House Republican Health Proposal and Trustees’ Report Make Medicare a Factor in Election?

In this Wall Street Journal Think Tank column, Drew Altman discusses Medicare having a low profile this campaign season, and whether the House Republican health reform plan and Medicare trustees’ report this week will push it more into the spotlight as an issue.

Column/Op-Ed Read Post

Questions to Ask About the House Republican Health Reform Proposal

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses the critical issues to look for and questions to ask about the U.S. House task force health reform outline due out this week.

Column/Op-Ed Read Post

The Fundamentally Different Goals of the Affordable Care Act and Republican Replacement Plans

Drew Altman discusses Republican and Democratic health reform objectives, and why GOP proposals and the Affordable Care Act are better understood as policies with very different goals, trade-offs and consequences.

Column/Op-Ed Read Post

Why Today’s Poll Numbers on Health Proposals Are Bound to Change

Drew Altman discusses how public opinion can change as health proposals move from the idea stage to real legislative debates in this Wall Street Journal Think Tank column.

Column/Op-Ed Read Post

Two Studies Draw Different Conclusions on State of Black America

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses how studies with conflicting views of progress and problems for African Americans can both be true, and why African Americans may feel the problems more than the progress.

Column/Op-Ed Read Post
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                    [post_content] => This was published as a Wall Street Journal Think Tank column on June 30, 2016.
Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).
Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).
  With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer. As the chart above shows, payments toward deductibles by consumers who have insurance through large employers rose 256% from 2004 to 2014; over the same period, wages increased 32%. The chart shows what people actually paid toward their deductibles and other forms of cost-sharing, not just their exposure as deductibles climbed (which is more typically what studies and data report). Deductibles accounted for 47% of cost-sharing payments in 2014, up from 24% in 2004. During the same period some other forms of cost-sharing fell. Payments for co-pays declined by 26%. It’s no wonder that consumers say in polls that deductibles are their top health-cost concern. Rising payments for deductibles cause people to use less health care and have played a role in the moderation we have seen in recent years in the growth of health spending. That rate of growth has begun to tick up but remains moderate by historical standards. Ever larger deductibles may dampen growth in spending but can also be a significant burden for many family budgets and a barrier to care for the chronically ill.
They can also change the relationship between patients and health-care providers by focusing interactions more on the price of health services, though patients often have trouble comparison shopping for health care, even when pricing tools are available.
Rising payments for deductibles could also affect longtime patterns in the politics of health care. The health-care industry has generally favored Republicans and their health proposals. But Democratic proposals to improve benefits or limit cost-sharing could mean more business for health-care providers, while Republican legislation to increase deductibles or other forms of cost-sharing could mean less demand for their services and more unpaid medical bills. This may be one reason the industry has generally not aligned with Republican efforts to repeal the Affordable Care Act. In the coming years the industry may pick its spots on specific legislative issues based on its interests, with a less consistent partisan alignment. It’s not clear whether deductibles will continue to rise as they have over the past decade. Rising cost-sharing is not employers’ preferred strategy  for containing health costs, but it’s the one they resort to when they need to quickly reduce their annual premium increase. If the economy weakens again employers will feel greater pressure to reduce their health-benefits costs, and the trend toward higher deductibles will be more likely to continue. The question of how much cost-sharing is too much, and what to do about it, could be the next big debate in health care–once the political world moves on from its focus on the ACA. [post_title] => The Next Big Debate in Health Care [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman discusses why adequacy of health coverage will rise as an issue when the political world moves on from its focus on the Affordable Care Act. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-next-big-debate-in-health-care [to_ping] => [pinged] => [post_modified] => 2017-02-06 14:41:49 [post_modified_gmt] => 2017-02-06 19:41:49 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=192351 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 191804 [post_author] => 36621681 [post_date] => 2016-06-24 06:47:26 [post_date_gmt] => 2016-06-24 10:47:26 [post_content] =>
This was published as a Wall Street Journal Think Tank column on June 24, 2016.
Kaiser Family Foundation polling on whether Medicare should continue as structured or shift to a 'premium support' system.
Two things happened this week that could heighten Medicare’s visibility in the coming election cycle. So far Medicare has not been one of the major health-care issues in the presidential campaign. Neither Hillary Clinton nor Donald Trump has talked about it much. The former secretary of state has discussed the idea of a Medicare buy-in for the near-elderly, but that’s been mentioned more as a way of strengthening the Affordable Care Act, not reforming Medicare. Meanwhile, Medicare faces serious long-term challenges, including how to finance care for an aging population, ensure its solvency in the future, fill gaps in coverage, and address cost-sharing burdens that can be onerous for its mostly lower- and moderate-income beneficiaries. But more attention may be coming, thanks to this week’s events. First, Speaker Paul Ryan released the House Republican health-care plan, which includes a number of major and potentially controversial changes to Medicare, including premium support, raising the age of program eligibility, and altering deductibles and cost-sharing for seniors in traditional Medicare. The primary Republican idea for reforming Medicare, called premium support, can take different forms; that leads to different impacts on seniors and Medicare savings, depending on the details. Whatever its form, premium support would represent a fundamental change to the program, and it would spark a partisan political fight rivaling anything we have seen so far on the ACA. Opinion can change as a policy debate unfolds, but as the chart above shows, the public’s starting position is strongly against shifting Medicare to a premium-support model: Only 31% of Republicans and 18% of seniors back the idea. Premium support has its pros and cons. And almost any big change to Medicare will be an uphill fight.
 Also this week, Medicare’s trustees released their annual report, which projects a shortfall in the Medicare Hospital Insurance Trust Fund beginning in 2028. That’s just 12 years down the line and two years sooner than was projected last year. The report also raised a flag about the increase in Medicare drug spending–an issue both presidential candidates have raised. Mr. Trump has said that he is for removing barriers to the safe re-importation of drugs manufactured here and for allowing the federal government to negotiate lower drug prices. Mrs. Clinton is also for safe re-importation of drugs and allowing government negotiations on drug prices; she has also said that she would secure higher rebates from drug companies on prescriptions for Medicare and its enrollees.
Before he launched his presidential campaign, Mr. Trump pledged that he wouldn’t touch Medicare if elected, and his campaign Web site does not include proposals to change the program. How he responds to the House Republican proposals, if he responds, will affect how the issue plays in the presidential campaign. He may come under pressure to embrace part or all of the GOP plan, or Mrs. Clinton could draw him out in general-election debates. For congressional candidates, the main role of the House plan appears to be enabling down-ballot Republicans to tell voters that they are not only for repealing Obamacare but also that they have a “plan” to replace it. Democrats are likely to respond by underscoring the major differences between the parties with respect to Medicare’s future.
Medicare entered the election this week; the coming months will show whether it becomes an issue as in past campaigns, activating senior voters.
[post_title] => Will House Republican Health Proposal and Trustees’ Report Make Medicare a Factor in Election? [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman discusses Medicare having a low profile this campaign season, and whether the House Republican health reform plan and Medicare trustees' report this week will push it more into the spotlight as an issue. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => will-house-republican-health-proposal-and-trustees-report-make-medicare-a-factor-in-election [to_ping] => [pinged] => [post_modified] => 2017-02-06 14:47:09 [post_modified_gmt] => 2017-02-06 19:47:09 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=191804 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 191378 [post_author] => 36621681 [post_date] => 2016-06-20 14:13:45 [post_date_gmt] => 2016-06-20 18:13:45 [post_content] =>
This was published as a Wall Street Journal Think Tank column on June 20, 2016.
House Speaker Paul Ryan’s health-care task force is expected to outline its alternative to Obamacare this week. The outline reportedly will not include the level of detail that would allow much external analysis of its impact by health-care experts and the media, though Democrats are likely to attack its concepts, most of which will be familiar proposals that Republicans favor and that Democrats have opposed in the past. The outline is part of Mr. Ryan’s effort to add Republican policy ideas to the election debate, in particular to the presidential campaign, and seems aimed at helping down-ticket Republicans as a part of an agenda that can appeal to their base. Details will be needed to understand whether the plan is more progressive or regressive and how many uninsured people would be covered. Another big question is how Donald Trump will respond. One expected feature is a tax credit to help people pay for insurance. It matters whether this is a flat credit, which would be more regressive, or a progressive credit that would provide more help for lower-income people (like the Affordable Care Act does). The impact of tax credits can be complex and whether it varies by age and geography, as well as income, is important. A flat credit of around $2,000, for example, will be better on average for people earning more than about 200% of the poverty level (about $24,000 for a single person) and worse for people earning less than that; it may induce more people to buy high-deductible plans with somewhat lower premiums.
Previous Republican proposals called for converting Medicaid into a traditional block grant to the states. Giving each state a fixed allotment of federal dollars through a block grant can provide an incentive for states to limit enrollment or cut eligibility when the economy slows down and enrollment rises. When governors saw how many more uninsured people might be in their states under the traditional block-grant approach, many soured on the idea. Another approach that is reportedly part of the forthcoming GOP outline, called a per capita cap, allows federal payments to states to rise and fall with enrollment. But a primary Republican goal is to limit future federal Medicaid spending. And as growth in federal Medicaid spending tightens in the future and health costs rise, states may face an incentive to limit the benefits they provide for low-income residents. If the cap on federal spending hits far enough down the road, more governors may be persuaded to support the idea in return for the flexibility they would get; if the cap hits sooner, fewer may support it.
Democrats are sure to oppose any Medicaid cap as a cut in program funding and as a fundamental change to the federal-state Medicaid bargain in which the federal government matches state efforts based on a formula reflecting state needs. Without the prospect of millions losing coverage, a per capita cap is a tougher target for Democrats than the traditional block grant was. For states, the Medicaid wars with the federal government have historically been framed as a fight about flexibility and control when they have always been at least as much, if not more, about money and the consequences of federal funding reductions. I learned this firsthand while overseeing a Medicaid program for a Republican governor in New Jersey in the late 1980s. Overall, the ACA has increased the number of people with health coverage by about 20 million. Without specific details of the GOP proposal, it will be difficult to assess how much that would change if all the elements expected to be part of the Republican outline were implemented.
Donald Trump’s reaction is even harder to predict than its impact. He could choose not to comment or to endorse some elements but not others. His campaign website says that any health reform effort “must begin with Congress.” Mr. Trump has said that he opposes any cuts to Medicare and Medicaid but has also endorsed a Medicaid block grant. He has endorsed high-deductible health insurance plans with savings accounts and allowing the purchase of insurance across state lines, both of which are expected to be elements of the Republican outline. Health policy has not been a focus for Mr. Trump so far, though it may come into play in the general election in back-and-forth over Obamacare or when Hillary Clinton challenges Mr. Trump’s health-care ideas and command of detail about the issues.
Debate over the forthcoming GOP outline will reflect both partisan politics in an election year and strongly held differences in policy goals between Republicans and Democrats. For those of us in the business of independent analysis, the expected lack of detail will make informing the discussion more challenging.
[post_title] => Questions to Ask About the House Republican Health Reform Proposal [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses the critical issues to look for and questions to ask about the U.S. House task force health reform outline due out this week. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => questions-to-ask-about-the-house-republican-health-reform-proposal [to_ping] => [pinged] => [post_modified] => 2017-02-06 14:50:51 [post_modified_gmt] => 2017-02-06 19:50:51 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=191378 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 189914 [post_author] => 71503784 [post_date] => 2016-06-07 07:04:09 [post_date_gmt] => 2016-06-07 11:04:09 [post_content] => This was published as a Wall Street Journal’s Think Tank column on June 7, 2016. Rep. Pete Sessions and Sen. Bill Cassidy introduced legislation last month calling for replacing elements of the Affordable Care Act. A House task force established by Speaker Paul Ryan is expected to follow with more health-care proposals. These Republican health plans are generally referred to as “replacements” for the ACA–in the spirit of “repeal and replace”–as though they would accomplish the same objectives in ways that conservatives prefer. But the proposals are better understood as alternatives with very different goals, trade-offs, and consequences. Whether they are “better” or “worse” depends on your perspective. To boil down to the most basic differences: The central focus of the Affordable Care Act is expanding coverage and strengthening consumer protections in the health insurance marketplace through government regulation. By contrast, the primary objective of Republican plans is to try to reduce health-care spending by giving people incentives to purchase less costly insurance with more “skin in the game,” with the expectation that they will become more prudent consumers of health services. They also aim to reduce federal spending on Medicare and Medicaid and the federal government’s role in both programs. Elements of the ACA were designed to reduce costs, such as the law’s Medicare payment reforms, and elements of Republican plans such as tax credits aim to expand access to insurance, but the primary aims of the ACA and the Republican plans differ.
 In public discussion the architects of these Republican plans often gloss over their differences from the ACA. But it is not as if they can somehow achieve the same things the ACA achieves, just in a way that involves less spending and regulation. Sen. Orrin Hatch acknowledged the fundamental difference in goals during the 2012 election: “Conservatives cannot allow themselves to be browbeaten for failing to provide the same coverage numbers as Obamacare. To be clear, it is a disgrace that so many American families go without health insurance coverage. But we cannot succumb to the pressure to argue on the left’s terms.”
The differences between Republican and Democratic objectives make it tricky to fairly evaluate the GOP proposals. With the ACA now the status quo, should Republican plans be evaluated against whether they maintain or don’t maintain ACA coverage gains and insurance protections? Should they be evaluated on how well they achieve their own objectives–promoting consumer choice and lower-cost insurance plans, reducing marketplace regulation, and reducing federal spending and the federal role in health care? Should GOP proposals and the ACA both be assessed against general criteria pretty much everyone in health care uses, such as how well they improve access and quality, and control costs? All of these metrics can be used, but conservatives and liberals are likely to weigh them differently. There are many ideas that conservatives have favored embodied in the ACA, just as there are ideas in Republican plans that will be palatable to Democrats. But fundamentally, Democrats could not cover almost everyone, while ensuring that they get comprehensive benefits and that sick people were protected in a market that had excluded them and at the same time achieve Republican goals. In the same way, Republicans cannot deregulate, reduce spending and the federal role, give consumers more skin in the game and all the while achieve Democratic goals. There is an inherent tension between the objectives each side wants in health reform.
Karl Rove recently wrote in The Wall Street Journal that “Republicans must campaign on credible, substantive alternatives to ObamaCare.” That seems fair enough. But health-care experts, the media, and architects of health-care proposals can do more to make it clear that the ACA and Republican plans are not different means to the same ends but means to different ends–each legitimate depending on one’s political and policy priorities, and each with their own trade-offs and consequences for the public.
[post_title] => The Fundamentally Different Goals of the Affordable Care Act and Republican Replacement Plans [post_excerpt] => Drew Altman discusses Republican and Democratic health reform objectives, and why GOP proposals and the Affordable Care Act are better understood as policies with very different goals, trade-offs and consequences. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-fundamentally-different-goals-of-the-affordable-care-act-and-republican-replacement-plans [to_ping] => [pinged] => [post_modified] => 2017-02-06 14:54:07 [post_modified_gmt] => 2017-02-06 19:54:07 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=189914 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 188919 [post_author] => 36621681 [post_date] => 2016-05-24 07:22:20 [post_date_gmt] => 2016-05-24 11:22:20 [post_content] =>
This was publishes as a Wall Street Journal Think Tank column on May 24, 2016.
Kaiser Family Foundation polling from February on how public opinion of single-payer health care is swayed by the framing of arguments for and against the proposal.
Gallup polling released last week showed majority support–58%–for replacing the Affordable Care Act with a federally funded health system. The same poll found 51% support for repealing the ACA. There is a basic point that often gets lost in reaction to poll findings like these: They measure the public’s initial response to ideas and words, and proposals such as single payer or ACA repeal that people associate with candidates–but they don’t tell us much about the likely level of support for a policy if there is a real debate about legislation before Congress, with winners and losers laid bare. It’s always a fair bet that support would decline for big changes that come with big trade-offs–whether it is single-payer health care or ACA repeal or something else–but there is no way to know those levels in advance, and support could rise or fall depending on how a legislative debate plays out. Consider single-payer health care as an example. In February, the Kaiser Family Foundation monthly tracking poll simulated some of the arguments the public might hear in a debate about single payer. As the chart shows, public sentiment about a single-payer plan moves in both directions depending on the arguments heard. For instance, 50% of the public supports the idea of a single government health plan, but that share fell by 14 points if people heard that such a plan would “require Americans to pay more in taxes” and diminished by 20 points if they heard it would  “give the government too much control over health care” or “eliminate the health care law.” Those arguments would be made in a substantive debate about single-payer legislation. Similarly, support grew by 11 points if people heard that legislation would “ensure that health care was a basic right” or that it would “reduce health insurance administrative costs.” Support rose by 13 points if they heard it would “eliminate private insurance premiums, copays and deductibles paid by employers and individuals.”
 The same could be true in a debate about legislation to repeal the ACA. Opinion about the health-care law has been stubbornly partisan and resistant to change. But the prospect of the 20 million people who have gained coverage becoming uninsured again if the ACA is repealed could shift some ACA critics who support repeal into the other camp. Or, if there are Republican alternatives to the ACA that people find plausible and attractive, some ACA supporters could move in the other direction.
How opinion changes in a legislative debate depends on not only the arguments or the facts but also on who is making the point, how influential and credible those sources are, and the potency of their messages. Put another way: Polling questions asked now about ideas such as replacing the ACA with a federally funded health-care system don’t tell us much about which way public opinion would break in a real national debate about single-payer health care, repealing the ACA, or any other major health legislation where partisans and interest groups can be expected to take to the airwaves and there will be winners and losers.
[post_title] => Why Today's Poll Numbers on Health Proposals Are Bound to Change [post_excerpt] => Drew Altman discusses how public opinion can change as health proposals move from the idea stage to real legislative debates in this Wall Street Journal Think Tank column. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => why-todays-poll-numbers-on-health-proposals-are-bound-to-change [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:26:12 [post_modified_gmt] => 2017-02-06 21:26:12 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=188919 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 188333 [post_author] => 36621681 [post_date] => 2016-05-13 13:25:47 [post_date_gmt] => 2016-05-13 17:25:47 [post_content] =>
This was published as a Wall Street Journal's Think Tank column on May 13, 2016.
In the past few weeks, one report painted a picture of real progress in the African American community with gains on many critical measures, while another – a survey my organization conducted with the New York Times – painted an alarming portrait of life for African Americans in Chicago and the prospects for African American youth there. Both the more positive and negative portrayals are accurate, but it’s very clear why statistical progress is hard for African American residents in cities like Chicago or Baltimore or Ferguson to appreciate. The more positive picture came in a New York Times story about federal data showing significant gains for black Americans in infant mortality, suicide rates, teen births, and even deaths from homicide which fell significantly, all driving gains in life expectancy for African Americans. In the story, Harvard sociologist Robert J. Sampson is quoted as saying: “ The decline in violence is a major social fact that is really reshaping society and the lived experience of kids growing up-particularly blacks.” That may seem jarring after Ferguson and Baltimore and the regular reports of violence in Chicago, to name just a few urban areas plagued by crime and tensions between the community and police.
SOURCE: Kaiser Family Foundation/New York Times Survey of Chicago Residents (conducted April 21- May 3, 2016)
SOURCE: Kaiser Family Foundation/New York Times Survey of Chicago Residents (conducted April 21- May 3, 2016)
The Kaiser Family Foundation/New York Times survey of Chicago residents shows the other side of the coin. In that survey, as the chart shows, 54% of blacks in Chicago say it is very likely for a young person in their community to end up in jail, 49% to be a victim of a violent crime, and 47% to join a gang. By contrast 36% of blacks say a young person in their neighborhood is very likely to graduate from high school and 26% expect them to graduate from college. Almost half of black residents report knowing a victim of gun violence and 41% of black men said there was a time when they felt their life was in danger. Confidence in the police is so low that 54% of black residents say that if you call the police in a dangerous situation it either won’t make things better or will make them worse. One picture, the more positive one, is the bird’s eye view of gradual changes over time, and the other is the worm’s eye view of point in time reality today. We see this in other areas as well. The economy has been gradually improving, but people don’t experience it because, until recently, wage growth has been flat. Health spending has been growing at historically moderate rates, but people don’t feel it because what they pay out of pocket for health care is going up. Similarly, as shown by Sabrina Tavernise’s excellent reporting in the New York Times, there have been gains over time for black Americans on many measures, and gaps have closed between blacks and whites on measures such as homicide rates and life expectancy. Still, reality on the ground is a far different thing. There were fifty one homicides in Chicago in January and two hundred and forty two shootings. Chicago may be an especially troubled city but it is also emblematic of problems in other urban areas. It is more than understandable why African Americans in many urban communities would have a hard time taking the bird’s eye view of statistical progress when the reality they see every day is so different – and troubling –  and why their trust in local institutions and hope for a better future for young people is fraying.
[post_title] => Two Studies Draw Different Conclusions on State of Black America [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses how studies with conflicting views of progress and problems for African Americans can both be true, and why African Americans may feel the problems more than the progress. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => two-studies-draw-different-conclusions-on-state-of-black-america [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:37:36 [post_modified_gmt] => 2017-02-06 21:37:36 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=188333 [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] => 192351 [post_author] => 36621681 [post_date] => 2016-06-30 11:51:11 [post_date_gmt] => 2016-06-30 15:51:11 [post_content] => This was published as a Wall Street Journal Think Tank column on June 30, 2016.
Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).
Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).
  With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer. As the chart above shows, payments toward deductibles by consumers who have insurance through large employers rose 256% from 2004 to 2014; over the same period, wages increased 32%. The chart shows what people actually paid toward their deductibles and other forms of cost-sharing, not just their exposure as deductibles climbed (which is more typically what studies and data report). Deductibles accounted for 47% of cost-sharing payments in 2014, up from 24% in 2004. During the same period some other forms of cost-sharing fell. Payments for co-pays declined by 26%. It’s no wonder that consumers say in polls that deductibles are their top health-cost concern. Rising payments for deductibles cause people to use less health care and have played a role in the moderation we have seen in recent years in the growth of health spending. That rate of growth has begun to tick up but remains moderate by historical standards. Ever larger deductibles may dampen growth in spending but can also be a significant burden for many family budgets and a barrier to care for the chronically ill.
They can also change the relationship between patients and health-care providers by focusing interactions more on the price of health services, though patients often have trouble comparison shopping for health care, even when pricing tools are available.
Rising payments for deductibles could also affect longtime patterns in the politics of health care. The health-care industry has generally favored Republicans and their health proposals. But Democratic proposals to improve benefits or limit cost-sharing could mean more business for health-care providers, while Republican legislation to increase deductibles or other forms of cost-sharing could mean less demand for their services and more unpaid medical bills. This may be one reason the industry has generally not aligned with Republican efforts to repeal the Affordable Care Act. In the coming years the industry may pick its spots on specific legislative issues based on its interests, with a less consistent partisan alignment. It’s not clear whether deductibles will continue to rise as they have over the past decade. Rising cost-sharing is not employers’ preferred strategy  for containing health costs, but it’s the one they resort to when they need to quickly reduce their annual premium increase. If the economy weakens again employers will feel greater pressure to reduce their health-benefits costs, and the trend toward higher deductibles will be more likely to continue. The question of how much cost-sharing is too much, and what to do about it, could be the next big debate in health care–once the political world moves on from its focus on the ACA. [post_title] => The Next Big Debate in Health Care [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman discusses why adequacy of health coverage will rise as an issue when the political world moves on from its focus on the Affordable Care Act. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-next-big-debate-in-health-care [to_ping] => [pinged] => [post_modified] => 2017-02-06 14:41:49 [post_modified_gmt] => 2017-02-06 19:41:49 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=192351 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 159 [max_num_pages] => 27 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_404] => [is_embed] => [is_paged] => 1 [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 41ecaa29208ae50a6202fcd7a43dbee2 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )

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