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Is 65 the Best Cutoff for Defining “Older Americans?”

June 10, 2015 Comments off

Is 65 the Best Cutoff for Defining “Older Americans?”
Source: American Institutes for Research

Baby Boomers are aging and the Congress is changing; public policy issues on aging have never been more important. Do the issues that define “old age” really begin at 65? Although Americans are living longer, other changes in health status and workforce behavior could be used to argue that age 65 is too late to begin to worry about the challenges of an aging population.

Two key areas of concern when considering age from a policy perspective are the health and economic status (including labor force behavior) of older individuals. These variables affect not only the well-being of older Americans but the pocketbooks of American taxpayers. If age for program eligibility can be increased without harming older Americans, billions of dollars in government spending could potentially be saved.

In an effort to enlighten this debate, the Center on Aging developed this brief, in which AIR researchers explore data on income, resources, health, and family structure to look at how well age 65 captures a good cutoff for eligibility for programs and for discussing issues facing older Americans.

New Data and Updated Report Show Medicaid Is Expanding Insurance Coverage, with Major Benefits to States’ Citizens and Economies

June 8, 2015 Comments off

New Data and Updated Report Show Medicaid Is Expanding Insurance Coverage, with Major Benefits to States’ Citizens and Economies
Source: White House

The Affordable Care Act has dramatically expanded access to health insurance coverage. Since the law’s major coverage provisions took effect at the end of 2014, the Nation has seen the sharpest reduction in the uninsured rate since the decade following the creation of Medicare and Medicaid in 1965, and the Nation’s uninsured rate is now at its lowest level ever. Combining these recent gains with earlier gains due to the law’s provision allowing young adults to remain on a parent’s plan until age 26, more than 16 million Americans had gained health insurance coverage as of early 2015.

One important way the Affordable Care Act is expanding coverage is by providing generous financial support to States that elect to expand their Medicaid programs to cover all adults with incomes below 138 percent of the Federal poverty level. New data released this morning show that the number of people with coverage through Medicaid or the Children’s Health Insurance Program (CHIP) has risen by 12.2 million people from the start of the first open enrollment period under the Affordable Care Act through March 2015. From February to March alone, the number of people with Medicaid or CHIP coverage rose by more than 500,000 people.

Upcoding: Evidence from Medicare on Squishy Risk Adjustment

June 5, 2015 Comments off

Upcoding: Evidence from Medicare on Squishy Risk Adjustment
Source: National Bureau of Economic Research

Diagnosis-based subsidies, also known as risk adjustment, are widely used in US health insurance markets to deal with problems of adverse selection and cream-skimming. The widespread use of these subsidies has generated broad policy, research, and popular interest in the idea of upcoding—the notion that diagnosed medical conditions may reflect behaviors of health plans and providers to game the payment system, rather than solely characteristics of patients. We introduce a model showing that coding differences across health plans have important consequences for public finances and consumer choices, whether or not such differences arise from gaming. We then develop and implement a novel strategy for identifying coding differences across insurers in equilibrium in the presence of selection. Empirically, we examine how coding intensity in Medicare differs between the traditional fee-for-service option, in which coding incentives are weak, and Medicare Advantage, in which insurers receive diagnosis-based subsidies. Our estimates imply that enrollees in private Medicare Advantage plans generate 6% to 16% higher diagnosis-based risk scores than the same enrollees would generate under fee-for-service Medicare. Consistent with a principal-agent problem faced by insurers attempting to induce their providers to upcode, we find that coding intensity increases with the level of vertical integration between insurers and the physicians with whom they contract. Absent a coding inflation correction, our findings imply excess public payments to Medicare Advantage plans of around $10 billion annually. This differential subsidy also distorts consumers’ choices toward private Medicare plans and away from fee-for-service Medicare.

Only 251 Hospitals Score Five Stars In Medicare’s New Ratings

May 29, 2015 Comments off

Only 251 Hospitals Score Five Stars In Medicare’s New Ratings
Source: Kaiser Family Foundation

In an effort to make comparing hospitals more like shopping for refrigerators and restaurants, the federal government has awarded its first star ratings to hospitals based on patients’ appraisals.

Many of the nation’s leading hospitals received middling ratings, while comparatively obscure local hospitals and others that specialized in lucrative surgeries frequently received the most stars.

Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers and private Medicare Advantage insurance plans. While Medicare publishes more than 100 quality measures about hospitals on its Hospital Compare website, many are hard to decipher, and there is little evidence consumers use the site very much.

Many in the hospital industry fear Medicare’s five-star scale won’t accurately reflect quality and may place too much weight on patient reviews, which are just one measurement of hospital quality. Medicare also reports the results of hospital care, such as how many died or got infections during their stay, but those are not yet assigned stars.

Family Support in Graying Societies

May 21, 2015 Comments off

Family Support in Graying Societies
Source: Pew Research Center

The United States is turning gray, with the number of people ages 65 and older expected to nearly double by 2050. This major demographic transition has implications for the economy, government programs such as Social Security and families across the U.S. Among adults with at least one parent 65 or older, nearly three-in-ten already say that in the preceding 12 months they have helped their parents financially. Twice that share report assisting a parent with personal care or day-to-day tasks. Based on demographic change alone, the burden on families seems likely to grow in the coming decades.

Germany and Italy, two of the “oldest” nations in the world, after only Japan, are already where the U.S. will be in 2050: a fifth of the population in each country is age 65 or older. Compared with the U.S. today, a higher share of adults in Germany and Italy report helping their aging parents with basic tasks, and more in Italy have also provided personal care. However, in both countries, fewer adults than in the U.S. say they have provided financial assistance to their aging parents.

Health-Care Coverage for Youth in Foster Care—and After

May 13, 2015 Comments off

Health-Care Coverage for Youth in Foster Care—and After
Source: Child Welfare Information Gateway

This issue brief reviews the eligibility pathways for children and youth in foster care to receive Medicaid or other health-care coverage and looks at some of the newer benefits now mandated through the Patient Protection and Affordable Care Act (ACA), especially those for older youth in or formerly in foster care.

High Interest GAO Report — Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence

April 29, 2015 Comments off

Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence
Source: Government Accountability Office

Advance directives, such as living wills or health care powers of attorney, specify—consistent with applicable state law—how individuals want medical decisions to be made for them should they become unable to communicate their wishes. Many individuals receive medical care from Medicare and Medicaid funded providers during the last 6 months of life, and may benefit from having advance directives that specify treatment preferences. According to IOM, advance directives are most effective when part of a comprehensive approach to end-of-life care called advanced care planning.

GAO was asked to review information related to advance directives. This report examines (1) how CMS oversees providers’ implementation of the PSDA requirement; (2) what is known about the approaches providers use and challenges they face to inform individuals about advance directives; and (3) what is known about the prevalence of advance directives and how it varies across provider types and individuals’ demographic characteristics. To do this work, GAO reviewed CMS documents and survey data reported by state survey agencies into CMS’s Certification and Survey Provider Enhanced Reporting system about covered providers’ implementation of the PSDA requirement. GAO also conducted a literature review of peer reviewed articles and federal government reports. In addition, GAO interviewed CMS officials and stakeholders representing providers and individuals likely to benefit from advance directives.

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