Research roundup: Early retiree insurance; high deductible plans and skipped care; innovation and FDA

Dec 7 2010

Archives of Internal Medicine: Health Care Use And Decision Making Among Lower-Income Families In High-Deductible Health Plans - This study examines the health care experiences of lower-income families (those with incomes that were less than 300% of the federal poverty level) with high-deductible health plans (HDHPs) compared to higher-income families. "[L]ower-income families with at least $500 in annualized out-of-pocket expenditures in an HDHP were more likely than higher-income families to delay or forego health care services owing to cost. However, respondents from lower-income families were no more likely to report difficulty understanding and using their health plans, and might be more likely to question the value of services requiring out-of-pocket expenditures," the study authors report (Kullgren et al., 11/22).

Health Affairs/Robert Wood Johnson Foundation: Early Retiree Insurance - "The number of employers offering health insurance coverage to early retirees-former employees older than 55 but not yet eligible for Medicare-has dropped sharply over the past two decades" and those who do offer coverage "have increased the share of premiums and other costs paid by enrollees," according to this brief that examines how a temporary program under the new federal health law aims to keep such programs in place. From June 2010 through the end of 2013, the federal government will reimburse retiree health plans "for 80 percent of each claim that exceeds $15,000, up to $90,000." The brief highlights the requirements plan sponsors must meet to receive the reimbursement and predictions that the $5 billion appropriated by the health care law will be exhausted before the program expires in 2013 (Merlis, 11/23).

Kaiser Commission on Medicaid and the Uninsured and the Urban Institute: The Uninsured: A Primer - "The number of nonelderly uninsured Americans rose to 50.0 million in 2009—an increase of 4.3 million people—amidst rising unemployment rates and an economic recession," according to this updated primer, which explores who the uninsured are and why, as well as how and why the number of uninsured has changed over the past decade and year. The primer also notes the payment sources for uncompensated care and the role of Medicaid in providing health coverage to millions of low-income Americans (Schwartz et al., 12/1).

UCLA Center for Health Policy Research: One-Fifth Of Nonelderly Californians Do Not Have Access To Job-Based Health Insurance Coverage - According to a 2007 California Health Interview Survey, this brief report, 5.7 million Californians under 65 in households with at least one employed family member did not have access to job-based coverage. "Among the 4.1 million adults with no access to job-based coverage through their own job, less than one-fifth obtained job-based coverage through their spouse (18.6%). Slightly more than one-tenth were able to gain coverage through Medi-Cal (11.3%), and a similarly small proportion bought their own coverage (10.6%), leaving over half of these workers uninsured" (Lavarreda and Cabezas, 11/30).

SCAN Foundation: Transforming California's System Of Care For Older Adults: Considerations For The Next Administration - "California's long-term care system is broken- it operates in silos and it is not person-centered." And, over the next 20 years, the number of older adults living in the state will increase "from 4.41 million in 2010 to 8.84 million in 2030,"  according to this brief  that offers several recommendations for Governor-elect Jerry Brown and the Health and Human Services Agency on how to move California toward a "more stable, integrated, efficient, and person-centered system that can meet the needs" of the aging population (November 2010).

Georgetown University Health Policy Institute/Kaiser Family Foundation: Rate Review: Spotlight On State Efforts To Make Health Insurance More Affordable - The Patient Protection and Affordable Care Act (ACA) "requires HHS to work in collaboration with state insurance departments to conduct an annual review of 'unreasonable increases in premiums' for 'nongrandfathered'  health plans" yet "does not alter states' existing regulatory authority over health insurance rates," notes this brief. Based on a survey of 50 state review statutes and interviews with insurance regulators in 10 states, the authors conclude, "states with prior approval authority over rates appear to be better positioned to negotiate reductions in rate requests filed by carriers. In states that do not have this type of authority, it generally takes an egregious and unjustified rate increase for them to ask for reductions. Policymakers interested in assuring that rate increases are reviewed for reasonableness and accuracy need to look not only at the state laws that govern rate filings and approvals, but also at how rates are reviewed by states in practice" (Corlette and Lundy, 12/2). KHN summarized news coverage of this study (12/3).

Commonwealth Fund: State Trends In Premiums And Deductibles, 2003-2009: How Building On The Affordable Care Act Will Help Stem The Tide Of Rising Costs And Eroding Benefits - This issue brief examines private health insurance. "In the six years from 2003 to 2009, total family premiums for employer-sponsored plans rose a cumulative average of 41 percent. The six-year increase in family premiums ranged from about 21 percent in the lowest-growth state (Delaware) to 59 percent in the highest-growth state (Louisiana). Seven states saw increases of 50 percent or more, and 23 states saw increases of 40 percent or more, well above the rate of income growth" (Schoen et al., December 2010). KHN summarized news coverage of this brief (12/2).

New England Journal of Medicine: Innovation, Regulation, and the FDA - This speech, delivered by FDA Commissioner Margaret Hamburg in May 2010, reflects on the history of the regulatory agency, recent lawsuits that "have challenged the FDA's authority to review the safety and effectiveness of products before they are marketed," and debates over whether the FDA review process should be replaced with a peer review process. "Regulatory science is a field that must be widely embraced as an essential and dynamic component of the broader biomedical research enterprise. As we look to the new and emerging challenges of the 21st century, we require, now more than ever, an invested industry, an engaged academy, a strong FDA, and most of all, the recognition that together we can harness scientific progress for patients and for public health," Hamburg writes (12/2).

Kaiser Family Foundation: Women And HIV In The United States  - This updated factsheet examines the impact of HIV/AIDS on populations of women living in the U.S., including health care use and coverage. The foundation also released updated factsheets that examine the impact of HIV/AIDS on Black and Latino groups in the U.S. (11/24).