Research roundup: Out-of-pocket costs on individual market; Federal spending on mental health care; Underused Medicare benefit

May 13 2013

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Some Families Who Purchased Health Coverage Through The Massachusetts Connector Wound Up With High Financial Burdens – Since many of the people who will gain insurance under the federal health law will likely get such individual plans through the state-based online marketplaces, or exchanges, researchers sought to identify the effects on vulnerable populations, some of whom with incomes above 400 percent of the poverty level and thus will not qualify for Medicaid or receive subsidies. After surveying families who participated in "unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority" - the state's exchange - they found that those with lower incomes, increased health care needs and more children will be at greater risk for financial burden and higher-than-expected out-of-pocket costs. They concluded: "In implementing the Affordable Care Act, policy makers will need to develop strategies to mitigate financial burden and facilitate discussion between patients and providers about the value of health care choices" (Galbraith et al., 5/6).

Health Affairs: Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance – In the recent recession, many Americans who became unemployed lost their health insurance coverage. Using data from the Substance Abuse and Mental Health Services Administration, researchers found that: "(The) average annual growth in spending for behavioral health treatment slowed during the recession, from 6.1 percent in 2004-07 to 4.3 percent during 2007-09." In contrast, the federal behavioral health spending growth went from 7.2 percent in 2004-07 to 11.1 percent during the recession, providing a "critical safety net," the authors write. "The Medicaid expansions in eligibility and health insurance marketplace subsidies made available through the Affordable Care Act will relieve some of the budget pressures faced by state mental health and substance abuse authorities in funding behavioral health treatment services," they conclude (Levit et al., 5/6).

JAMA Internal Medicine: Cognition And Take-Up Of Subsidized Drug Benefits By Medicare Beneficiaries –While many low-income beneficiaries are eligible for subsidies to help cover their out-of-pocket costs for prescription drugs in the Medicare Part D program, enrollment has been low.  Researchers analyzed 2006, 2008, and 2010 survey data from the nationally representative Health and Retirement Study and found that "Older age, poorer cognition, and poorer numeracy strongly and consistently predicted these apparent failures to take up fully subsided drug benefits." They offer several options for policymakers to improve participation in the subsidies and suggest broader implications as federal officials consider structural changes to the Medicare program: "This evidence suggests that policies that rely on seniors' choices to support efficient competition among plans may be less effective when not coupled with government efforts to regulate choice sets and guide beneficiaries to the best available options" (Kuye, Frank, and McWilliams, 5/6).

Urban Institute/Robert Wood Johnson Foundation: Limiting The Tax Exclusion Of Employer-Sponsored Health Insurance Premiums: Revenue Potential And Distributional Consequences – As officials seek to stabilize the federal budget and lower the deficit, one proposal often mentioned is to tax employer-provided health insurance coverage. The authors write: "In this brief, we provide estimates of the revenue potential and distributional consequences of limiting the exclusion from income and payroll taxes at the 75th percentile of 2013 premiums, indexing by GDP. The policy would produce $264.0 billion in new tax revenues over the coming decade while preserving 93 percent of the tax subsidies available under the current policy." While that tax threshold "would affect public-sector employers to a greater extent," they conclude that "limiting the tax exclusion for employer-sponsored insurance could be an important component of a broad-based federal debt-reduction package, while having minimum impacts on those with lower incomes" (Clemans-Cope, Zuckerman and Resnick, 5/8).

Here is a selection of news coverage of other recent research:

MedPage Today: Hospitals Move to Shut Down Elective Deliveries
Nearly two-thirds of all U.S. hospitals have instituted policies to eliminate non-medically indicated deliveries prior to 39 weeks' gestation and those policies may be having a positive impact on fetal outcomes, according to a pair of studies presented here at the annual meeting of the American Congress of Obstetricians and Gynecologists (Laino, 5/9).

Reuters: Insurance Law Tied To More Breast Reconstruction
Many more breast cancer patients had breast reconstruction following a 1998 federal law mandating insurance coverage for the procedure, according to a new study. … As a percentage of all the women treated for breast cancer in a given year, the number who got reconstructions rose from roughly 13 percent in 2000 to 36 percent in 2009, the team reports in the medical journal Cancer (Grens, 5/3).

Medscape: Little Benefit in Routine Imaging After Benign Breast Biopsy
Routine imaging studies that are conducted less than a year after a benign breast biopsy are unnecessary, according to a new study. "Our data do not support the routine use of interval imaging following benign concordant breast biopsy," said study author Demitra Manjoros, MD, a breast fellow at Bryn Mawr Hospital in Pennsylvania, during a press briefing at the 14th Annual Meeting of the American Society of Breast Surgeons, held in Chicago, Illinois (Nelson, 5/3).

Medscape: Pediatricians: Fewer Malpractice Claims, Equivalent Payments
Pediatricians have much lower rates of malpractice claims and indemnity payments than other physicians, but similar rates of payments that exceed $1 million, according to an analysis of the malpractice claims of 40,916 physicians (1630 pediatricians) from 1991 to 2005. Anupam B. Jena, MD, PhD, an assistant professor of health care policy and medicine at Harvard Medical School and an assistant physician and professor in the Department of Medicine at Massachusetts General Hospital in Boston, and colleagues present their findings in an article published online May 6 in Pediatrics (Brown, 5/6).

Reuters: Religious Support Tied To Intensive End-Of-Life Care
People with advanced cancer tend to get more aggressive care at the end of life and spend more time in the intensive care unit if they receive spiritual support from their religious communities, according to a new study [in JAMA Internal Medicine]. The report's lead researcher said in that finding was "quite the opposite" of what her team was expecting -- in part because of evidence that spiritual support coming from within a patient's medical team leads to less aggressive care and more use of hospice (Pittman, 5/7).