HEALTH INSURANCE: 30.4 million uninsured in US as of 2018 according to NCHS estimates

In 2018, 30.4 million persons of all ages (9.4%) were uninsured at the time of interview – not significantly different from 2017, but 18.2 million fewer persons than in 2010.”

The number of people without health insurance in 2018 was 30.4 million, or 9.4 percent of the civilian noninstitutionalized population, according to national estimates from the U.S. National Center for Health Statistics.  This compares with estimates of 48.6 million uninsured, or 16 percent of the population in 2010, when the Affordable Care Act was passed.  During the same period, the number of uninsured children decreased by 2 million or a decrease from 7.8 to 5.2 percent of children.

Source: Cohen, R.A., Terlizzi, E.P., and Martinez, M.E. (2019, May). Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2018. National Health Interview Survey Early Release Program. Click here for free full text:  https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

State Telehealth Laws & Reimbursement Policies

The Center for Connected Health Policy, the National Telehealth Policy Resource Center, has released its latest biannual update on state telehealth laws, regulations, and policies, with a primary focus on Medicaid fee-for-service programs. However, managed care/private payer laws are also covered when available.

Telehealth policy trends are briefly summarized from a national perspective, followed by detailed state profiles. Each state profile on telehealth reimbursement includes:

• Key state agencies/organizations
• State policy overview
• Definitions
• Live video, store-and-forward, and remote patient monitoring
• Eligible providers, sites, geographic limits, facility/transmission fees, services/specialties
• Consent
• Professional regulation/health and safety, including cross-state licensing and online prescribing

States vary considerably on telehealth policies. Overall, the report noted live video Medicaid reimbursement is far more prevalent than reimbursement for store-and-forward and remote patient monitoring. Other trends noted for some states are specific documentation and/or privacy and security guidelines; the addition of home and schools as eligible originating sites; and the inclusion of teledentristy and substance abuse services as qualifying specialties.

State telehealth laws & reimbursement policies; a comprehensive scan of the 50 states & the District of Columbia. Center for Connected Health Policy, Spring 2019. https://www.cchpca.org/sites/default/files/2019-05/cchp_report_MASTER_spring_2019_FINAL.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BCBS Association: The Health of America Report Understanding Health Conditions Across the U.S.

In partnership with Moody’s Analytics, the Blue Cross Blue Shield Association has published a report on understanding health conditions across the U.S. The report sets out to address these questions:

• Why are some communities healthier than others?
• Which factors are most important in keeping a population healthy: economics, healthy behaviors, or access to quality care?
• How does the importance of these factors change when measuring different health conditions?

The report analyzes and scores the impact of population demographics, socio-economic factors, healthy behaviors, and access to care and other health care considerations for each of the following conditions:

• Substance abuse
• Depression
• Hypertension
• High cholesterol
• Coronary artery disease
• Chronic obstructive pulmonary disease (COPD)
• Hyperactivity
• Breast cancer
• Lung cancer

Source: Blue Cross Blue Shield Association: Health of America Report-Understanding Health Conditions across the U.S. December, 2017. https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/BCBS.HealthOfAmericaReport.Moodys_02.pdf.

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

The Importance of Health Insurance Coverage

Why is health insurance coverage important?

• It improves access to care
• It’s associated with improved health outcomes
• It supports appropriate health care utilization
• It improves individuals’ and families’ financial well-being

A new briefing from the American Hospital Association discusses each of these facets on the impact of health coverage on consumers and the overall health system. The report also provides recent data trends on the number of insured and uninsured and a reference list for further information.

Source: The importance of health coverage. American Hospital Association, Nov. 2017. http://www.aha.org/content/17/importance-of-health-coverage-report.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

How Well Does Insurance Coverage Protect Consumers from Health Care Costs?

In 2016, over a quarter of insured adults in the U.S. were underinsured — more than double the 2003 rate and and currently an estimated 41 million people. This is the finding from the latest Commonwealth Fund’s biennial health insurance survey that looked at the number of insured adults that had high out-of-pocket expenses and deductibles relative to their incomes.

The underinsured rates were highest [44-47%] for those purchasing individual coverage directly or through a Marketplace exchange and for the disabled under age 65 covered by Medicare.

The share of privately insured adults that had health plans without deductibles has shrunk by nearly half since 2003, while deductible amounts have increased. The number of insured adults with deductibles of $3000 or more has grown from 1% in 2003 to 13% in 2016.

Underinsured adults may defer needed medical care because of the costs and/or face medical debt and long term financial issues.

The survey report also discusses health policy implications of its findings.

Source: Collins SR and others. How well does insurance coverage protect consumers from health care costs? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016. Commonwealth Fund Issue Brief, Oct. 2017. http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/oct/collins_underinsured_biennial_ib.pdf 

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

UNINSURED: 28.1 million lack health insurance in 2017

The number of Americans of all ages who do not have health insurance coverage has decreased from 48.6 million in 2010 to 28.1 million in early 2017, according to survey data collected each year by the National Center for Health Statistics.  This represents a decrease from 16 percent of the population in 2010 to 8.8 percent in 2017.

About 2 million children (aged under 18 years) gained health insurance coverage in this same time period — 5.8 million had no health insurance coverage in 2010 compared to 3.9 million in early 2017.

Comparative figures going back to 1997 are also provided in this report.

Source: Norris, T., Clarke, T.C., and Schiller, J.S. (2017, September). Early release of selected estimates based on data from the January-March 2017 National Health Interview Survey. National Health Interview Survey early release program. National Center for Health Statistics. Click here: https://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201709.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HOSPITALS: How many DSH hospitals are there?

Hospitals that serve a higher proportion of low-income patients are eligible to receive disproportionate share payments from state Medicaid programs.

DSH hospital: A hospital that receives disproportionate share hospital (DSH) payments and meets the minimum statutory requirements to be eligible for DSH payments: a Medicaid inpatient utilization rate of at least 1 percent and at least two obstetricians with staff privileges that treat Medicaid enrollees (with certain exceptions” (page 57)

In this report from the Medicaid and CHIP Payment and Access Commission (MACPAC), there is a table that quantifies the number of disproportionate share hospitals (DSH) in the United States as of 2012.

DSH Hospitals: Counts by Type of Hospital

• 1,865 (55 percent) of Short-term acute care hospitals
•    565 (42 percent) of Critical access hospitals
•    129 (26 percent) of Psychiatric hospitals
•      47 (58 percent) of Children’s hospitals
•      32 (  7 percent) of Long-term hospitals
•      32 (13 percent) of Rehabilitation hospitals

Counts by Location

• 1,681 (40 percent) of urban hospitals
•    989 (54 percent) of rural hospitals

Counts by Teaching Status

• 1,921 (39 percent) of non-teaching hospitals
•    392 (59 percent) of “low-teaching” hospitals
•    357 (79 percent) of “high-teaching” hospitals

Source: Medicaid and CHIP Payment and Access Commission. (2017, March). Report to Congress on Medicaid and CHIP (pp. 57, 59). Washington, D.C.: MACPAC.  Click here for access: https://www.macpac.gov/wp-content/uploads/2017/03/March-2017-Report-to-Congress-on-Medicaid-and-CHIP.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

30 Largest Accountable Care Organizations

SK&A has released an updated ranking of the largest accountable care organizations based on the number of participating physicians. The marketing contacts firm has identified 703 ACOs involving 479,000 healthcare providers and business personnel aligned with ACOs. Topping its published list of the 30 largest ACOs are:

1. HealthCare First South Los Angeles, a Medicaid ACO with 7,237 participating physicians and 2,668 health facilities
2. Heritage Provider Network & Anthem Blue Cross of California, a commercial ACO with 7,207 physicians and 4,177 facilities
3. Heritage California ACO, a Medicare Shared Savings Program with 6,876 physicians and 3,905 facilities
4. Tenet Healthcare & Humana, a commercial ACO with 6,644 physicians and 1,963 facilities
5. Hill Physicians/Dignity Health/University of California, San Francisco & Health Net, a commerical ACO with 5,883 physicians and 2,118 facilities

Source: Top 30 accountable care organizations. SK&A, Feb. 2017. http://www.skainfo.com/reports/top-accountable-care-organizations [free registration required to view/download]

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

UNINSURED: 48.3 million in 2010 dropped to 28.7 million in 2015 (U.S. national data for non-elderly population)

In 1972, the earliest year shown in this source, there were 30.7 million Americans under age 65 who did not have health insurance.  This number has varied somewhat from year to year – sometimes dropping, sometimes rising – but reached the highest number (48.3 million) in 2010.  In 2015, the number of uninsured Americans under 65 who were uninsured dropped to 28.7 million.  Here are some of the years shown in this source:

Number of Persons Uninsured (under 65 years old)

• 30.7 million  1972 (the earliest year)
• 23.0 million  1978 (the lowest year)
• 48.3 million  2010 (the highest year)
• 28.7 million  2015 (the most recent year)

Source: U.S. National Center for Health Statistics. (2017, February). National Health Interview Survey: Long-term trends in health insurance coverage. Click here: https://www.cdc.gov/nchs/data/nhis/earlyrelease/trendshealthinsurance1968_2015.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Health Innovations State Law Database

The Health Innovations State Law Database created by the National Conference on State Legislatures is  a resource for identifying over 800 recently enacted state laws and regulations that address health policy innovations related to access, Medicaid, private and commercial insurance markets, the Accountable Care Act and social determinants of health.. The database supports searching by keyword, state, legislative status, bill number, sponsor, and/or these topics:

• Exchanges and Health Marketplaces
• Free Market; Challenges and Alternatives
• Market-Cost Containment
• Market-Coverage
• Market-Delivery Reform [includes accountable care]
• Market-Health Insurance Reforms
• Market-Mandates and Essential Health Benefits
• Market-Network Adequacy
• Market-Other
• Market-Payment Reforms
• Market-Price Transparency
• Medicaid Expansion and Waivers
• Medicaid Payment Reform
• Medicaid-General
• PPACA – ACA-Health Reforms
• State-Run Programs
• Telehealth Programs

However, the full-text of the legislation located is restricted to NCLS members.

Source: Health innovations state law database: tracking state laws for health care transformation, 2015-2016. National Conference of State Legislatures, accessed Jan. 27, 2017. http://www.ncsl.org/research/health/health-innovations-database.aspx

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org