Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution.

From the 27 January 2014 Brookings Institute post
The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

Clinical Preventive Services for Women: Closing the Gaps

 

From the Institute of Medicine press release

 

As a centerpiece of the Patient Protection and Affordable Care Act (ACA) of 2010, the focus on preventive services is a profound shift from a reactive system that primarily responds to acute problems and urgent needs to one that helps foster optimal health and well-being. The ACA addresses preventive services for both men and women of all ages, and women in particular stand to benefit from additional preventive health services. The inclusion of evidence-based screenings, counseling and procedures that address women’s greater need for services over the course of a lifetime may have a profound impact for individuals and the nation as a whole.
Given the magnitude of change, the U.S. Department of Health and Human Services charged the IOM with reviewing what preventive services are important to women’s health and well-being and then recommending which of these should be considered in the development of comprehensive guidelines. The IOM defined preventive health services as measures—including medications, procedures, devices, tests, education and counseling—shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition.

The IOM recommends that women’s preventive services include:

 

• improved screening for cervical cancer, counseling for sexually transmitted infections, and counseling and screening for HIV;
• a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes;
• services for pregnant women including screening for gestational diabetes and lactation counseling and equipment to help women who choose to breastfeed do so successfully;
• at least one well-woman preventive care visit annually for women to receive comprehensive services; and
• screening and counseling for all women and adolescent girls for interpersonal and domestic violence in a culturally sensitive and supportive manner.

Looking at Healthcare through Payer Lens

Looking at Healthcare through Payer Lens (so far Part I and Part II) gives great insight on how the healthcare industry can successfully work with with individuals and other stakeholders to deliver health insurance coverage.
These items (and realated others) may be found at Chilmark Research:Providing perspective on key IT trends in the healthcare sector

Part I outlines quick current summaries (snapshots) of Accountable Care Organizations, Consumer/Member Engagement, and Health Insurance Exchanges (HIX)

Part II outlines the necessary steps of establishing trust, engagement, and collaboration

Related articles

• “Single-Payer Healthcare for Vermont: A Small State Takes a Giant Leap for the Nation” and related posts (buzzflash.com)
• Health Care Costs And The Third-Party Payer Problem (outsidethebeltway.com)
• Vermont Poised to Become First State to Enact Single-Payer Healthcare (alternet.org)

Study Finds High-Deductible Health Plans Pose No Special Risks To The Medically Vulnerable

From a 19 April 2011 Medical News Today article

People who are medically vulnerable – those with low incomes or chronic health problems – who enroll in high-deductible health plans are at no more risk for cutting back on needed health care than other people who enroll in the plans, according to a new RAND Corporation study. [Abstract, for suggestions on how to get this article for free or at low cost, click here] …

…The project examined the first-year experiences of more than 360,000 families nationwide who enrolled in high-deductible health plans offered by their employers from 2003 to 2007. The study, conducted with consulting firm Towers Watson, was published online by the journal Forum for Health Economics & Policy.

“One important issue is whether high-deductible health plans will leave low-income and chronically ill patients with inadequate access to health care,” said Amelia Haviland, lead author of the study and a statistician at RAND, a nonprofit research organization. “We did not find greater cut backs for medically vulnerable families. The evidence suggests that non-vulnerable families, low-income families and high-risk families are equally affected under high-deductible plans.”

High-deductible and consumer-directed health plans have been gaining favor as one way to help control health care costs. By 2009, about 20 percent of Americans with employer-sponsored health coverage were enrolled in such plans. A 2010 survey found that more than 54 percent of large employers offered at least one high-deductible health plan to their employees. …
…Medical spending declined among all families enrolled in high-deductible and consumer-directed health plans, relative to similar families in traditional plans, with the reductions among medically vulnerable families generally being similar to that seen among other families, according to researchers.

Researchers note that the medically vulnerable families studied all had a member working full time with benefits and the results here may not hold for families with less financial stability, and in addition that similar reductions may have different health or economic impacts for these vulnerable families. …

Related Articles

• New Tool to Look-Up OutofPocket Costs (outofpocket.com)
• How to Find Health Insurance in Retirement (money.usnews.com)
• The Conservative ACA (aleksandreia.wordpress.com)

HHS Secretary Released the National Strategy for Quality Improvement in Health Care Report

From the AHRQ  (Agency for Healthcare Research and Quality) press release

HHS Secretary Kathleen Sebelius released the National Strategy for Quality Improvement in Health Care.  The Strategy was called for under the Affordable Care Act and is the first effort to create national aims and priorities to guide local, State, and national efforts to improve the quality of health care in the United States.  The National Quality Strategy will promote quality health care that is focused on the needs of patients, families, and communities.  At the same time, the Strategy is designed to move the system to work better for doctors and other health care providers – reducing their administrative burdens and helping them collaborate to improve care.  The Strategy presents three aims:

• Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
• Healthy People & Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
• Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government

To help achieve these aims, the Strategy also establishes six priorities, to help focus efforts by public and private partners.  Those priorities are:

• Making care safer by reducing harm caused in the delivery of care.
• Ensuring that each person and family is engaged as partners in their care.
• Promoting effective communication and coordination of care.
• Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
• Working with communities to promote wide use of best practices to enable healthy living.
• Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

The National Quality Strategy is designed to be an evolving guide for the Nation as we continue to move forward with efforts to measure and improve health and health care quality, and I hope that you will use it to guide your efforts to improve the quality and safety of health care services.  Select to read the National Quality Strategy.  Supporting documents are available on the AHRQ Web site.

HHS Announces $750 Million Investment in Prevention

HHS Announces $750 Million Investment in Prevention

New health care law provides new funding to reduce tobacco use, obesity and heart disease, and build healthier communities

From the news release

epartment of Health and Human Services Secretary Kathleen Sebelius today announced a $750 million investment in prevention and public health, funded through the Prevention and Public Health Fund created by the new health care law.  Building on $500 million in investments last year, these new dollars will help prevent tobacco use, obesity, heart disease, stroke, and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.

“Prevention is something that can’t just happen in a doctor’s office.  If we are to address the big health issues of our time, from physical inactivity to poor nutrition to tobacco use, it needs to happen in local communities,” said Sebelius.  “This investment is going to build on the prevention work already under way to help make sure that we are working effectively across the federal government as well as with private groups and state and local governments to help Americans live longer, healthier lives.”

The Prevention and Public Health Fund, part of the Affordable Care Act, is designed to expand and sustain the necessary capacity to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living.  In FY2010, $500 million of the Prevention Fund was distributed to states and communities to boost prevention and public health efforts, improve health, enhance health care quality, and foster the next generation of primary health professionals.  Today, HHS posted new fact sheets detailing how that $500 million was allocated in every state. Those fact sheets are available at www.HealthCare.gov/news/factsheets/prevention02092011a.html.

This year, building on the initial investment, new funds are dedicated to expanding on four critical priorities:

• Community Prevention ($298 million): These funds will be used to help promote health and wellness in local communities, including efforts to prevent and reduce tobacco use; improve nutrition and increase physical activity to prevent obesity; and coordinate and focus efforts to prevent chronic diseases like diabetes, heart disease, and cancer.
• Clinical Prevention ($182 million): These funds will help improve access to preventive care, including increasing awareness of the new prevention benefits provided under the new health care law.  They will also help increase availability and use of immunizations, and help integrate behavioral health services into primary care settings.
• Public Health Infrastructure ($137 million): These funds will help state and local health departments meet 21^stcentury challenges, including investments in information technology and training for the public health workforce to enable detection and response to infectious disease outbreaks and other health threats.
• Research and Tracking ($133 million): These funds will help collect data to monitor the impact of the Affordable Care Act on the health of Americans and identify and disseminate evidence-based recommendations on important public health challenges.

The Obama Administration recognizes the importance of a broad approach to addressing the health and well-being of our communities. Other initiatives put forth by the Obama Administration to promote prevention include:

• The President’s Childhood Obesity Task Force and the First Lady’s Let’s Move! initiative aimed at combating childhood obesity.
• The American Recovery and Reinvestment Act of 2009 that provides $1 billion for community-based initiatives, tobacco cessation activities, chronic disease reduction programs, and efforts to reduce healthcare-acquired infections.
• The Affordable Care Act’s National Prevention, Health Promotion and Public Health Council, composed of senior government officials, charged with designing a National Prevention and Health Promotion Strategy.

For more information about the FY2011 Prevention and Public Health Fund investments, visithttp://www.HealthCare.gov/news/factsheets/prevention02092011b.html.

Related Articles

• Administration Implements New Health Reform Provision to Improve Care Quality, Lower Costs (Healthcare.gov, April 29, 2011)
• Community-Based Prevention Essential Part For Health Care Cost Reform (hcfama.org)

18.3 million baby boomers could benefit from the Affordable Care Act

18.3 million baby boomers could benefit from the Affordable Care Act

Affordable health insurance, comprehensive benefits and stronger financial protections will be available to 8.6 million currently uninsured adults ages 50 to 64, and 9.7 million who have inadequate health insurance

From the press release

December 14, 2010, New York, NY—18.3 million men and women ages 50 to 64 stand to benefit from provisions in the Affordable Care Act that expand access to affordable health insurance, assure that all health insurance provides a standard comprehensive benefit, prevent insurers from denying coverage or charging higher premiums to people with pre-existing conditions, and eliminate lifetime and annual limits in health insurance policies, according to a new Commonwealth Fund report released today.

Adults ages 50-64 are currently suffering the highest rates of longtime unemployment among working-age adults, and millions are without health benefits. Of the 8.6 million currently uninsured in this age group—4.3 million men and 4.2 million women—3.3 million with incomes under $29,000 for a family of four will gain Medicaid coverage, 3.5 million with incomes up to $88,000 for a family of four will be able to gain subsidized private coverage through the new health insurance exchanges, and 1.4 million with higher incomes will gain new coverage with consumer protections.

In addition, an estimated 9.7 million older adults who have health insurance but have such high out-of-pocket costs relative to their income that they are effectively underinsured, will gain improved coverage through the implementation of essential benefit standards, limits on out-of-pocket spending, and elimination of lifetime benefit limits.

Uninsured adults in this age group face serious difficulty with access to needed care: three-quarters (75 %) report forgoing needed health care and medications because of costs and nearly half (46%) report not getting recommended preventive care. More than half of uninsured women in this age group had not had a mammogram within the past two years. Nearly 70 percent of uninsured and underinsured baby boomers report that they have problems paying medical bills or are paying off medical debt.

“A loss of employer health benefits can be devastating to men and women in this age group since their older age and higher rates of chronic health problems places them at risk of facing exorbitant premiums, having a condition excluded from their coverage, or being denied insurance altogether if they try to buy it on their own,” said Commonwealth Fund Vice President Sara Collins, lead author of the report. “The Affordable Care Act will change all of that. Once its provisions are in full effect, older adults who lose their employer health insurance will have access to affordable and comprehensive health benefits regardless of their age or health.”…..

…

Additional Benefits for Baby Boomers in the Affordable Care Act

The Affordable Care Act includes many additional features that will improve health insurance coverage for adults ages 50 to 64:

• Beginning in 2010, adults in this age group with chronic health problems who have been uninsured for more than six months can join new plans for people with pre-existing conditions.
• A ban on lifetime limits on insurance benefits beginning in 2010 will help an estimated 102 million people who currently have these limits on their plans; older adults are at greater risk than younger adults of exceeding their limits and being saddled with a crushing debt load as a result.
• Requiring coverage of preventive care and immunizations without cost-sharing will assure access to services such as mammograms and colorectal cancer screenings for baby boomers beginning in 2010.
• Requiring health plans to insure all who apply, preventing health plans from charging higher premiums to sicker people, and limiting how much premiums can rise by age will remove many of the barriers baby boomers face when they have to buy coverage on their own beginning in 2014.

Two lesser-known ACA provisions will also provide significant benefits to baby boomers, the report finds:

• The Early Retiree Health Benefits Reinsurance Program for Employers helps public and private sector employers pay for health benefits for employees who retire before age 65. This $5 billion temporary program has already enrolled 3,600 employers and will run through 2014, when people who retire before age 65 will be eligible to purchase health insurance through the new insurance exchanges.
• The Community Living Assistance Services and Supports (CLASS) Program will provide employers and their workers as well as self-employed individuals the option of participating in a national long-term care insurance program aimed at providing better access to affordable long-term care insurance.

###

This report is part of a series of Fund issue briefs that examines the way the Affordable Care Act of 2010 will benefit different populations and groups, as well as improve insurance coverage and change the delivery of care. For more information, please visit: http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2010/Sep/A-New-Series-of-Briefs-on-the-Affordable-Care-Act.aspx

Related Articles

• In Its First Year, The Affordable Care Act Has Brought Health Care Benefits To Millions Of Americans (medicalnewstoday.com)
• Commonwealth Fund: Unemployment has made another 9 million uninsured (dailykos.com)
• Survey: Nine Million More Americans Added to Ranks of Uninsured in Recession (crooksandliars.com)
• The Affordable Care Act’s First Year: A Few Disappointments, Lots of Progress [The Pump Handle] (scienceblogs.com)
• “Who Will Be Uninsured After Health Insurance Reform?” and related posts (healthcare-now.org)
• Nearly 4 Million Medicare Beneficiaries Receive Help with Prescription Drug Cost under Affordable Care Act
• Health reform essential to young adults: Nearly half can’t afford needed health care (eurekalert.org)
• The Affordable Care Act is Working (economistsview.typepad.com)
• Affordable Care Act Helps Fight Unreasonable Health Insurance Premium Increases (medicalnewstoday.com)

How Will The Affordable Care Act Affect 15 Million Uninsured Young Adults?

From the Commonwealth news release

New York, NY, October 8, 2010—Young adults continue to represent one of the largest groups of Americans without health insurance, with nearly 15 million people aged 19-29 uninsured in 2009—an increase of more than 1 million over 2008, according to a Commonwealth Fund report released today. However, the Affordable Care Act (ACA) is poised to make a significant difference for this population, as up to 12.1 million could gain subsidized insurance once all of the law’s provisions go into effect in 2014

The report, Realizing Health Reform’s Potential: Young Adults and the Affordable Care Act of 2010, by Commonwealth Fund researchers Sara Collins and Jennifer Nicholson, is an update of a May 2010 report, with new numbers reflecting the latest data on the number of uninsured Americans released by the U.S. Census Bureau last month.

According to the report, by 2014, when most of the bill’s provisions will have taken effect, up to 7.2 million uninsured young adults will gain coverage through Medicaid expansions and up to 4.9 million will gain subsidized private coverage through new insurance exchanges. About 1 million uninsured young adults up to age 26 are projected to join their parents’ policies beginning in 2010. The report estimates that 1.8 million uninsured young adults are not legal residents and will not be eligible for federally subsidized health insurance under the new law.

The authors conclude that, “when fully implemented, the ACA will allow young adults of all income levels to undergo a new rite of passage: establishing necessary ties with the health care system, without fear of accumulating medical debt, as they pursue their educational and career goals.”

This report is the fourth in an ongoing series of Commonwealth Fund reports designed to explain how health reform will affect various groups. More on this series, as well as access to the Fund’s new Health Reform Resource Center, can be found atwww.commonwealthfund.org.