Two reports have come out of the Commonwealth Fund this week, both addressing important reasons we need health care reform now. One (Failure to Protect: Why the Individual Insurance Market is not a Viable Option for Most US Families) is about the failures of the individual market and the kind of reform that is needed to keep these families covered and provided for. This report describes the status of the 16 million Americans (6% of the under 65 population) who have individual-market health insurance coverage. The study found that 64% of those in the individual market spend $3,000 or more per year on premiums and out-of-pocket costs, as opposed to 20% of those with employer-sponsored health insurance. In addition, 51% of those in the individual market spend 10% or more of their yearly income on premiums and out-of-pocket costs compared to 29% of those with employer-provided insurance. Adults who have individual-market insurance have less comprehensive coverage (they are more likely to not have prescription coverage or dental insurance) and they have higher rates of benefit restrictions and problems with coverage. They are significantly less satisfied with their insurance in comparison to populations with other kinds of insurance.
This study is important because recently due to the economic slow-down more employers have been dropping coverage for employees or moving to lower cost plans for their employees. Since most states limit public insurance to children, pregnant women, those with low incomes, and the elderly, many individuals need to strike out on their own and find coverage in the individual insurance market. They then end up having to pay more out-of-pocket costs and higher premiums, in addition to higher deductibles. According to the Commonwealth Fund;
“These findings indivate that the individual insurance market in its current form does not provide a viable alternative to employer-based group coverage.”
The survey found that 47% of those that went into the individual market to find coverage said it was very difficult or impossible to find a plan that fit their needs. This was even higher for the group that had poor health (60%). Also, 57% of people found it very difficult or impossible to find a plan they could afford (again, higher in the population with poorer health – 70%). 73% of those surveyed in the study did not end up buying a plan due to the barriers.
The other report released recently (How Health Care Reform Can Lower the Costs of Insurance Administration) offers insight into the problem of private insurance costs, specifically administrative costs. The report states that $265 billion could be saved over ten years with the proposed national health care exchange and the increased utilization and availability of public plans. This money would be saved because there would be less marketing and underwriting, less claims administration, less time spent negotiating provider payment rates, and lower commissions to insurance brokers.
“The McKinsey Global Institute estimates that the US spends $91 billion more per year on health insurance administrative costs than it should, given its size and wealth.”
Most of this money is spent by private health insurance companies, where 12.4% of costs are administrative compared to 6.1% by public plans. In addition to reducing these administrative costs, the national health exchange would help lower this huge amount by increasing the transparencies of insurance products and streamlining the plan purchase/enrollment process.
A study in the Journal of Women’s Health found that women with depression or depression symptoms are much more likely to give birth preterm. This trend is much more pronounced in communities of color, with the risk for black women twice that of white women. You can read the abstract here, and the summary article from the National Partnership for Women and Families here. This is evidence that health disparities are alive and well in our health care system and is one of the reasons we need to continue to fight for the rights of women of color and other marginalized groups.
Slowing the spread of HIV among pregnant women has been cited as the priority of the US global AIDS coordinator, Eric Goosby. He made a few comments in an interview stating what he hopes for global AIDS awareness and reduction – stressing the roles of education and prevention. He also stated that he is committed to getting antiretrovirals to pregnant women who need them. In addition, Goosby is interested in getting other nations more involved in the effort. Read the article from the National Partnership for Women and Families here.
This column about maternal and infant health outlines the various studies that have happened recently that dissect the decline in hospital-based obstetric care available to rural American populations. The total number of hospitals has declined since the 1980s, and a number of factors have caused decreases in doctors and institutions offering obstetric care. Difficulties in the staffing of health care professionals, rising malpractice insurance premiums, and disparities in payments due to a high proportion of rural communities being on Medicaid are all reasons hospitals cut down on obstetric care. Read the full article here.
Bonnie Erbe writes a blog entry for the US News & World Report about a survey of clinical trials (governmental and private) that proves a clear under representation of women in medical research. This has negative consequences for women’s health. Read the full blog entry here.
The group Operation Rescue has released some statements saying they are interested in buying the late Dr. George Tiller’s women’s health clinic. The building and surrounding land has been appraised for almost $800,000, and the head of Operation Rescue has stated that they “need a bigger office”. Read the article at Salon.com.
Pennsylvania fighting to insure young adults
Those 18 to 35 are among those with least coverage in Pennsylvania, and elected officials are fighting right now to pass a law that would require insurance companies to offer parents the option of keeping their children on their health insurance until age 29. Especially in the current economy, students are graduating college without secure jobs and therefore no certain health coverage. However, the Kaiser Family Foundation finds faults with the proposed law and with similar mandates in other states. Read the full article from Pittsburgh Tribune here.
Option for college graduates in Illinois
The Chicago Tribune outlines all the options for young people just out of school. As with most other states and most other populations, young adults covered by their parents insurance are set, but those with pre-existing conditions face a whole bunch of challenges.
Health Affairs publishes an article about uninsurance and affordability
“Based on simulated bill paying, this paper examines trends in comprehensiveness of coverage, out-of-pocket spending for medical services, underinsurance, and the affordability of employer-based insurance from 2004 to 2007.”
Want to know more? Check out RWV’s fact sheet on this issue – it includes a checklist of things to consider if you’re young and uninsured.
The New England Journal of Medicine published yesterday an article by Elliott Fisher, M.D., M.P.H. et al. outlining the steps physicians can take at all levels of health care provision to encourage and aid in health care reform. The four levels described are defining aims, handling design of care processes, the effective working of health care organizations, and the support of legal, payment, regulatory, and environmental environment around health care. Fisher explains how doctors can be advocates for change, and the article outlines the challenges faced by health care reform (doctrine differences in congress about how to structure health care insurance and financing of this insurance). The article describes the conflict that even though there are commitments by key players (the American Medical Association, for example) in health care reform, there is aversion from these important entities to the proposed 1.5% decrease in annual spending growth. For the full article, click here.
On the heels of an earlier post about unexpected and hidden costs of child birth care, comes a discussion about transparency and standardization of coverage facts. The Center for American Progress released a report detailing how little consumers understand about what their insurance will pay for and how difficult it is to take advantage of the much touted choice in plans when insurance companies play so many games to hide the large gaps in coverage that they build into policies.
In marketing their plans, insurance companies leave a lot of information undisclosed and the nature of the product — in part, a protection against unforseeable future events — makes it difficult for consumers to compare prices and quality as they would other products. Consumers need to know that the insurance options are not always equal and greater transparency in coverage policies is essential if we are to believe that individual choice among plan options is beneficial to the American people. The report suggests a new method for developing benchmarks to more clearly communicate types and cost of care in a variety of medical scenarios.
We recommend developing standardized health plan comparison tools—patterned on the U.S. Food and Drug Administration nutrition label, but for health insurance—that could help consumers appreciate the kinds of medical events for which health insurance may be needed and relative levels of protection provided under different policies.
As Amy Allina of National Women’s Health Network said, “they focus particularly on how terribly expensive it can be if you become seriously sick — but it would be interesting to see a similar analysis of the degree to which prevention services are covered or not.”
The Centers for Disease Control and Prevention has tracked a slight reduction in the proportion of women getting annual mammograms in almost every state. In some parts of the country, out-of-pocket costs for routine mammograms range from $135 to $270 and, although under most insurance coverage the co-pay tends to be only $10 to $35, Mark Rukavina, executive director of the Access Project, a health reform advocacy organization, says, “even that small fee could seem insurmountable stacked against other costs right now.”
One breast cancer specialist, Christine Pellegrino of Montefiore-Einstein Cancer Center in the Bronx, believes the lower rate of mammograms is a reflection of cost affordability right now, noting that there has been no signs of declining mammogram rates among her patients, who are largely insured through Medicaid which covers the full cost of routine and follow-up mammograms. Such patients, Pellegrino says, ”are not really affected by the bigger financial issues that end up causing other women to have to choose between their health care and more routine things, such as paying for food, housing, utilities or even the health care of their kids and spouses.”
And the Commonwealth fund released a study titled Women at Risk: Why Many Women Are Forgoing Needed Health Care, revealing that 52% of working-age women, compared to just 39% of men, report problems such as not being able to fill a prescription, go to the doctor, or get a medical test. The study focuses on the unmanageable costs of health care as they affect underinsured women.
Women who are insured but have inadequate coverage are especially vulnerable: 69 percent of underinsured women have problems accessing care because of costs, compared with half (49%) of underinsured men. Women are more affected by high health care costs because they have lower average incomes and use the health care system more frequently, and therefore face higher out-of-pocket health costs than men.
What’s more is that the conclusions of this study are based on data collected in 2007, long before the economic recession and related loss of coverage hit the country. A more recent Gallup survey polled 1,031 women, ages 18 to 44, of which 15% reported they have recently stopped taking medications due to cost, and one in seven reported putting of routine gynecological exams for the same reason.