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New State-by-State Analysis: 32 Million Were Underinsured in 2012, Including 4 Million Middle-Income People; Nearly 80 Million in Total Lacked Health Insurance or Were Underinsured, Ranging from 14 Percent in Massachusetts to 38 Percent in New Mexico and Texas

April 11, 2014 Comments off

New State-by-State Analysis: 32 Million Were Underinsured in 2012, Including 4 Million Middle-Income People; Nearly 80 Million in Total Lacked Health Insurance or Were Underinsured, Ranging from 14 Percent in Massachusetts to 38 Percent in New Mexico and Texas
Source: Commonwealth Fund

Thirty-two million people under age 65 were underinsured in the U.S. in 2012, meaning they had health coverage but it provided inadequate protection against high health care costs relative to their income, a new Commonwealth Fund report finds. The first report to examine the underinsured at the state level, it finds that the rate of underinsured ranged from a low of 8 percent in New Hampshire to highs of 16 percent in Mississippi and Tennessee and 17 percent in Idaho and Utah.

Low- and middle-income families were most likely to be affected: 13 percent—4 million—of the underinsured were middle-income, earning between about $47,000 and $95,000 for a family of four, and 81 percent—26 million—were low-income, earning less than 200 percent of the federal poverty level, or under $47,000 a year for a family of four.

In addition, 47 million people were uninsured in 2012—a decline of nearly 2 million from 2010, likely due in large part to the Affordable Care Act’s early provision to expand dependent coverage for young adults.

Before the major expansions of the ACA began to be implemented this year, a total of 79 million people under 65 were uninsured or underinsured, and therefore at risk for not being able to afford needed health care or for facing debt from medical bills in 2012. Nationally, nearly one of three (29%) people were uninsured or underinsured, ranging from 14 percent in Massachusetts to 36 to 38 percent in Florida, Idaho, Nevada, New Mexico, and Texas.

The Affordable Care Act’s Medicaid expansion and health insurance reforms are appropriately targeted to those Americans who are most likely to be unable to afford insurance or needed health care, according to the report, America’s Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions. Based on their incomes alone, 20 million of the underinsured in 2012, as well as 24 million of the uninsured, would qualify for Medicaid under the Affordable Care Act.

However, millions who are poor will not have any new coverage options. In states choosing not to expand Medicaid, more than 15 million underinsured and uninsured people have incomes below poverty—earning less than $23,550 a year for a family of four

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Implementing the Affordable Care Act: Key Design Decisions for State-Based Exchanges

September 12, 2013 Comments off

Implementing the Affordable Care Act: Key Design Decisions for State-Based Exchanges
Source: Commonwealth Fund

The Affordable Care Act requires the establishment of new health insurance marketplaces—known as exchanges—in every state by October 1, 2013. This report examines key design decisions made by the 17 states and the District of Columbia that chose to establish a state-based exchange. The analysis finds that states made significant progress in structuring their exchanges, with states varying in their design decisions. Many states expect to exceed some federal requirements—to collect and display quality data, for instance—for 2014. These findings suggest that states capitalized on the flexibility provided by the Affordable Care Act to tailor their exchanges to their unique needs and made decisions with an eye towards outcomes, such as enrollment, consumer experience, and sustainability. These findings also suggest that states’ initial decisions will inform future exchange implementation and that states will adjust their decisions while continuing to adopt innovative approaches to accomplish policy goals.

Covering Young Adults Under the Affordable Care Act: The Importance of Outreach and Medicaid Expansion

August 21, 2013 Comments off

Covering Young Adults Under the Affordable Care Act: The Importance of Outreach and Medicaid Expansion (PDF)
Source: Commonwealth Fund

There is concern that many young adults (ages 19–29) will remain without health insurance in 2014 despite the Affordable Care Act’s reforms, including subsidized private coverage offered in new state marketplaces and expanded Medicaid eligibility. How things turn out will likely depend on outreach efforts and states’ decisions on expanding Medicaid. Commonwealth Fund Health Insurance Tracking Survey data from 2011 and 2013 show increasing awareness among young adults of the 2010 requirement that health plans cover children under age 26. Of the estimated 15 million young adults enrolled in a parent’s plan in the prior 12 months, 7.8 million would not likely have been eligible to enroll prior to the law. Still, only 27 percent of 19-to-29-year-olds are aware of the marketplaces. Meanwhile, most uninsured young adults living below poverty will not have access to subsidized public or private insurance in states opting out of the Medicaid expansion.

Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality

June 3, 2013 Comments off

Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality
Source: Commonwealth Fund

This analysis 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.

Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping

July 24, 2012 Comments off

Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping
Source: Commonwealth Fund

An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States—both with and without health insurance— are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.

Gaps in Health Insurance: Why So Many Americans Experience Breaks in Coverage and How the Affordable Care Act Will Help

April 23, 2012 Comments off

Gaps in Health Insurance: Why So Many Americans Experience Breaks in Coverage and How the Affordable Care Act Will Help
Source: Commonwealth Fund

The Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults finds that one-quarter of adults ages 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. Losing or changing jobs was the primary reason people experienced a gap. Compared with adults who had continuous coverage, those who experienced gaps were less likely to have a regular doctor and less likely to be up to date with recommended preventive care tests, with rates declining as the length of the coverage gap increases. Early provisions of the Affordable Care Act are already helping bridge gaps in coverage among young adults and people with preexisting conditions. Beginning in 2014, new affordable health insurance options through Medicaid and state insurance exchanges will enable adults and their families to remain insured even in the face of job changes and other life disruptions.

First Ever Local Area Health System Scorecard Finds Significant Differences in Access, Costs, Quality, and Outcomes Within States and Among Nation’s Biggest Cities

March 19, 2012 Comments off
Source:  Commonwealth Fund
Health care access, cost, quality, and outcomes can vary greatly from one community to the next—both within states and across states—depending on the performance of the health care system available to residents, according to a new report from the Commonwealth Fund Commission on a High Performance Health System. In the first scorecard measuring how 306 local U.S. areas are doing on key health care indicators such as insurance coverage, preventive care, and mortality rates, researchers at The Commonwealth Fund found significant differences between the best- and worst-performing localities. Major U.S. cities also showed wide disparities on many key measures of health care, with San Francisco and Seattle ranking among the top 75 local areas in the country, and Houston and Miami ranking in the bottom 75. An interactive map accompanying the report allows comparison of cities and communities across the U.S.
The stark differences in health care add up to real lives and dollars. According to the scorecard, 66 million people live in the lowest-performing local areas in the country. If all local areas could do as well as the top performers, 30 million more adults and children would have health insurance, 1.3 million more elderly would receive safe or appropriate medications, and Medicare would save billions of dollars on preventable hospitalizations and readmissions.
The report, Rising to the Challenge: Results from a Scorecard on Local Health System Performance, 2012, and online interactive map rank local areas on 43 performance metrics grouped into categories that include access to health care, health care prevention and treatment, potentially avoidable hospital use and cost, and health outcomes. The 43 metrics include potentially preventable deaths before age 75, prevalence of unsafe medication prescribing, the proportion of adults who receive recommended preventive care, and the percentage of uninsured adults. The report finds that there is room to improve everywhere, with no community consistently in the lead on all of the factors that were measured. However, there were geographic patterns—local areas in the Northeast and Upper Midwest often ranked at the top, while local areas in the South, particularly the Gulf Coast and southern central states, tended to rank at the bottom on many measures.

Full Report (PDF)

New 2011 Survey of Patients with Complex Care Needs in Eleven Countries Finds That Care Is Often Poorly Coordinated

November 14, 2011 Comments off

New 2011 Survey of Patients with Complex Care Needs in Eleven Countries Finds That Care Is Often Poorly Coordinated
Source: Commonwealth Fund

An international survey of adults living with health problems and complex care needs found that patients in the United States are much more likely than those in 10 other high-income countries to forgo needed care because of costs and to struggle with medical debt. In all the countries surveyed, patients who have a medical home reported better coordination of care, fewer medical errors, and greater satisfaction with care than those without one.

Key Findings

  • Sicker adults in the U.S. stood out for having cost and access problems. More than one of four (27%) were unable to pay or encountered serious problems paying medical bills in the past year, compared with between 1 percent and 14 percent of adults in the other countries. In the U.S., 42 percent reported not visiting a doctor, not filling a prescription, or not getting recommended care. This is twice the rate for every other country but Australia, New Zealand, and Germany.
  • In the U.S., cost-related access problems and medical bill burdens were concentrated among adults under age 65. Compared with Medicare-aged adults 65 or older, adults under 65 were far more likely to go without care because of the cost or to have problems paying bills.
  • Adults with complex care needs who received care from a medical home—an accessible primary care practice that knows their medical history and helps coordinate care—were less likely to report experiencing medical errors, test duplication, and other care coordination failures. They were also more likely to report having arrangements for follow-up care after a hospitalization and more likely to rate their care highly.
  • Sicker adults in the U.K. and Switzerland were the most likely to have a medical home: nearly three-quarters were connected to practices that have medical home characteristics, compared with around half in most of the other countries.

Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011

October 19, 2011 Comments off

Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011
Source: Commonwealth Fund

The National Scorecard on U.S. Health System Performance, 2011, updates a series of comprehensive assessments of U.S. population health and health care quality, access, efficiency, and equity. It finds substantial improvement on quality-of-care indicators that have been the focus of public reporting and collaborative initiatives. However, U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Overall, the U.S. failed to improve relative to these benchmarks, which in many cases rose. Costs were up sharply, access to care deteriorated, health system efficiency remained low, disparities persisted, and health outcomes failed to keep pace with benchmarks. The Affordable Care Act targets many of the gaps identified by the Scorecard.

+ Commission Report (PDF)
+ Chartpack (PDF)

See: National Health Care Scorecard: United States Scores 64 out of 100 (Science Daily)

New Study: U.S. Ranks Last Among High-Income Nations on Preventable Deaths, Lagging Behind as Others Improve More Rapidly

September 28, 2011 Comments off

New Study: U.S. Ranks Last Among High-Income Nations on Preventable Deaths, Lagging Behind as Others Improve More Rapidly
Source: Commonwealth Fund (Health Policy)

The United States placed last among 16 high-income, industrialized nations when it comes to deaths that could potentially have been prevented by timely access to effective health care, according to a Commonwealth Fund–supported study that appeared online in the journal Health Policy this week and will be available in print on October 25th as part of the November issue. According to the study, other nations lowered their preventable death rates an average of 31 percent between 1997–98 and 2006–07, while the U.S. rate declined by only 20 percent, from 120 to 96 per 100,000. At the end of the decade, the preventable mortality rate in the U.S. was almost twice that in France, which had the lowest rate—55 per 100,000.

In “Variations in Amenable Mortality—Trends in 16 High Income Nations,” Ellen Nolte of RAND Europe and Martin McKee of the London School of Hygiene and Tropical Medicine analyzed deaths that occurred before age 75 from causes like treatable cancer, diabetes, childhood infections/respiratory diseases, and complications from surgeries. They found that an average 41 percent drop in death rates from ischemic heart disease was the primary driver of declining preventable deaths, and they estimate that if the U.S. could improve its preventable death rate to match that of the three best-performing countries—France, Australia, and Italy—84,000 fewer people would have died each year by the end of the period studied.

“This study points to substantial opportunity to prevent premature death in the United States. We spend far more than any of the comparison countries—up to twice as much—yet are improving less rapidly,” said Commonwealth Fund Senior Vice President Cathy Schoen. “The good news is we know lower death rates are achievable if we enhance access and ensure high-quality care regardless of where you live. Looking forward, reforms under the Affordable Care Act have the potential to reduce the number of preventable deaths in the U.S. We have the potential to join the leaders among high-income countries.”

+ Variations in Amenable Mortality—Trends in 16 High-Income Nations

New Report: Three Quarters of Those Who Have Lost Jobs and Health Insurance Are Skipping Needed Medicine and Health Care; Many Struggling with Medical Debt

August 27, 2011 Comments off

New Report: Three Quarters of Those Who Have Lost Jobs and Health Insurance Are Skipping Needed Medicine and Health Care; Many Struggling with Medical Debt
Source: Commonwealth Fund

Nearly three-quarters (72%) of people who lost their health insurance when they lost their jobs over the last two years said that they skipped needed health care or did not fill prescriptions because of cost, according to a new Commonwealth Fund report. The same proportion is also struggling with medical bills or medical debt, compared to about half (49%) who lost jobs but not their health insurance.

Six in 10 working Americans rely on health insurance obtained through their employer, and when an estimated 15 million working-age adults lost their jobs and their employer-based insurance between 2008 and 2010, 9 million became uninsured. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), people employed by companies with 20 or more workers and have health insurance sponsored by that company can keep their health insurance for up to 18 months if they lose their job. However, because unemployed workers must pay the full premium, few people elect to continue their coverage through COBRA.

The report finds that once the major coverage provisions of the Affordable Care Act are implemented in 2014, job loss will not automatically mean going without health insurance, because the newly unemployed will have greatly expanded health insurance options, including subsidies to purchase insurance through exchanges, and expanded access to Medicaid coverage.

+ Full Report

Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief—Findings from The Commonwealth Fund Biennial Health Insurance Survey of 2010

March 23, 2011 Comments off

Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief—Findings from The Commonwealth Fund Biennial Health Insurance Survey of 2010
Source: The Commonwealth Fund

Using data from the Commonwealth Biennial Health Insurance Survey of 2010 and prior years, this report examines the effect of the recession on the health insurance coverage of adults between the ages of 19 and 64 and the implications for their finances and access to health care. The survey finds that in the last two years a majority (57%) of men and women who lost a job that had health benefits became uninsured. Both insured and uninsured Americans struggled to pay medical bills and faced cost-related barriers to getting needed care. When fully implemented in 2014, the Affordable Care Act will bring relief: nearly all of the 52 million working-age adults who were without health insurance for a time in 2010 will be covered, most with subsidized premiums and reduced cost-sharing. No one who is legally present will have to go without insurance when they lose their job, and no one will be charged a higher premium because of a health problem, have a problem excluded from coverage, or be denied coverage.

Full report, chartpacks and audio available.

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