Third Party Resources

Heritage Foundation Recommends Eliminating Premium Subsidy for High Income Beneficiaries to Shore-Up Medicare

Posted on May 16, 2012

According to an issue brief recently published by the Heritage Foundation, wealthy seniors should pay more in Medicare premiums. Taxpayers spend an extra $4,897 per Medicare beneficiary beyond what is collected in taxes and premiums. Currently, Medicare beneficiaries pay a basic premium for Part B of $99.90 per month, which covers some costs while the remaining costs are covered by subsidies from the general revenue. The subsidy declines for married seniors with combined income above $170,000. When a senior’s income reaches $428,000, the premium tops out at $319.70 per month, leaving a 20 percent subsidy. According to the report, a retired couple with a $428,000 combined salary would have total financial assets worth more than $7.1 million, excluding the value of their home. In other words, this means that multimillionaire retiree seniors still qualify for a 20 percent Medicare subsidy. The report explores this issue and suggests eliminating premium subsidies for such high income Medicare beneficiaries.

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Report estimates impact of small business tax credit

Posted on May 11, 2012

Congress included in the Affordable Care Act (ACA) a significant new tax credit for small business owners who provide their workers with health insurance. Under this new tax credit, businesses that have fewer than 25 full-time workers and average wages of less than $50,000 are now eligible to receive a tax credit of up to 35 percent of the cost of the health insurance that they provide for their workers. To qualify for the tax credit, small businesses must cover at least 50 percent of each employee’s health insurance premiums. In 2014, the size of the credit will increase to cover up to 50 percent of the cost of health insurance provided to workers.

Families USA and Small Business Majority recently commissioned The Lewin Group to develop estimates of the number of small businesses that are eligible for this new tax break in tax year 2011 and…

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Health Affairs article explores power of providers to win payment increases

Posted on May 10, 2012

An article published in Health Affairs entitled, “The Growing Power Of Some Providers To Win Steep Payment Increases From Insurers Suggests Policy Remedies May Be Needed,” explores the power that some health care providers, particularly dominant hospital systems, can wield to negotiate higher payment rates from insurers. The report discusses interviews conducted in twelve US communities which indicate that so-called must-have hospital systems and large physician groups can exert considerable market power to obtain steep payment rates from insurers. Other factors, such as offering an important, unique service or access in a particular geographic area, can contribute to provider leverage as well. Even in markets with dominant health plans, insurers generally have not been aggressive in constraining rate increases, perhaps because the insurers can simply pass along the costs to employers and their workers. The findings suggest a range of market and regulatory approaches should be examined in any attempt to address the consequences of growing provider market clout.

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New report explores federal plan management of the Exchanges

Posted on May 10, 2012

Health insurance exchanges are a provision under the Affordable Care Act (ACA) and must engage in five core functions: 1) determine eligibility for federal subsidies or public coverage, 2) enroll consumers and employees into qualified health coverage (or connect eligible individuals with Medicaid and CHIP), 3) conduct plan management, 4) provide consumer assistance, and 5) perform financial management. The Center on Health Insurance Reforms at Georgetown University Health Policy Institute and the National Academy of Social Insurance (NASI), with funding from the Robert Wood Johnson Foundation (RWJF) recently released a paper focuses on one of these core functions: the series of oversight activities that federal officials have called “plan management.” States face three choices: establish their own exchange and exercise control over plan management functions, allow the federal government to establish a federally facilitated exchange (FFE) but enter into a partnership arrangement to perform plan management, or cede all plan management functions to the FFE. With the latter two approaches, the state will essentially turn over to the federal government some of its traditional authority to regulate its private health insurance markets. However, through a partnership arrangement, state regulators can recapture that authority and oversight.

The U.S. Department of Health and Human Services (HHS) has defined plan management to…

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Commonwealth Fund brief examines high US health care spending

Posted on May 4, 2012

An analysis recently released by The Commonwealth Fund uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation.

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PCORI amends research agenda after comment period

Posted on May 4, 2012

The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors recently amended its January 2012 draft research agenda in response to public comments. The board found 15 major themes that emerged from 474 public comments. The purpose of the National Priorities for Research and Research Agenda is to guide funding for comparative clinical effectiveness research. The agenda amendments address PCORI’s focus on patient engagement and transparency, patients with multiple chronic conditions, patients with rare diseases, improvement of health delivery systems, and health literacy.

The final version of the agenda and the national research priorities…

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Urban Institute releases report on chronic disease prevention

Posted on May 1, 2012

The Urban Institute recently released a report documenting the potential savings available in prevention of avoidable chronic illness. The high and rising prevalence of chronic disease represents a substantial burden on the medical care system and a major cost for society, leaving aside its toll on individuals. The burden presents as rising rates of obesity, increased prevalence of diabetes, greater incidence of disability, and the rising cost of medical care and other disease-related costs. The Congressional Budget Office (CBO) reports that medical spending on obese adults is 38 percent higher than on their normal-weight counterparts. The cost of cardiovascular disease in medical treatment and lost productivity has been estimated at $400 billion per year, of which about one-quarter comes from lost productivity.

The California Public Employees’ Retirement System (CalPERS) health program covers…

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KFF analysis reports on MLR insurance rebates

Posted on April 27, 2012

A new analysis from the Kaiser Family Foundation reports that consumers and businesses are expected to receive an estimated $1.3 billion by August 2012 in rebates from insurers who exceeded Affordable Care Act (ACA) limits on administrative expenses and profits.

The rebates include…

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GAO releases report on medical underwriting and pre-existing conditions

Posted on April 27, 2012

Individuals who buy coverage directly from a health insurer are often denied coverage due to a pre-existing condition during a process called medical underwriting, which assesses an applicant’s health status and other risk factors. Beginning January 1, 2014, the Affordable Care Act (ACA) prohibits health insurers in the individual market from denying coverage, increasing premiums, or restricting benefits because of a pre-existing condition. The Government Accountability Office (GAO) examined the effect of this provision on adults who are 19-64 years old in a new report released today. GAO examined (1) the most common medical conditions that would cause an insurance company to restrict or deny insurance coverage for adults and the average annual costs associated with these conditions, (2) estimates of the number of adults with pre-existing conditions, and (3) the geographic and demographic profile of adults with pre-existing conditions.

To address these three issues…

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KFF issue brief compares Medicare to plans offered by large employers

Posted on April 26, 2012

The Kaiser Family Foundation recently released an issue brief which compares the expected value of benefits for individuals ages 65 and older under Medicare’s fee-for-service program to two “typical” plans offered by large employers: a typical large employer preferred provider organization (PPO) plan and the Blue Cross/Blue Shield Standard Option for enrollees in the Federal Employees Health Benefits Program (FEHBP), also a PPO plan.

The analysis updates a 2008 Kaiser Family Foundation report that found…

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