Health Affairs has a new article by Griffith et al that looks at health insurance coverage changes from 2015-2017. It is what many expected:
Nationally, we estimated that uninsurance rates fell by 7.1 percentage points from 2013 to 2016 but rose by 1.2 points during 2017. Thus, roughly 17 percent of the adjusted change in coverage from the ACA’s early years had been reversed by the end of 2017.
Paul Shafer and I had estimated that the actions of the first ten days of the Trump Administration led to a loss of 24% to 30% of the expected last week enrollments on Healthcare.gov. Other research has shown a continual drop in the coverage rates since 2017. There is a large and growing literature on administrative burdens and frictions in both the Exchange space and the Medicaid space where people have to jump through more hoops to remain covered. The Exchanges have stabilized for subsidized enrollment but the non-subsidized enrollment has fallen off the cliff.
** https://doi.org/10.1377/hlthaff.2019.00904
Butch
Even with subsidies, if you’re over 40 and in an area with limited competition the policies are anything but “affordable.” It’s no surprise that non-subsidized policies have dropped; they will bankrupt you. (Spouse’s absolutely worthless bronze plan is $1,062 a month, which is why I’m still working at 67.)
daveNYC
Given the range of quality of policies, I don’t think that just looking at raw coverage percentages is super useful.
Steeplejack (phone)
@David Anderson:
“[. . .] and the Medicaid space where people.”
Something missing here.
p.a.
A tangental problem with the overall complexity of ACA is that the blame for making a kludgy but positive program much less positive is hidden. The Rethugs have, can, and will take advantage to blame the system for problems of their own creation. The FoxNews Pig People are already on board, but to a large part of the non-wonk electorate the thug p.r. will ring true. It’s the go-to for their response to any (potentially) positive gvt. action.
Yutsano
There is of course the obvious Republican sabotage. But it’s not just that. Beyond the complexity of the law there are lots of traps that the law really needs to adjust. For example, the repayment of the advanced premium tax credit if your credit goes over the maximum allowed in your market. That’s just sheer madness.
Ohio Mom
Off topic: Yesterday Ohio Dad and I met with a Medicare advisor, who is a volunteer certified by the state. He appeared to know his stuff and was able to explain most of it clearly. He gave us lots of tools to continue researching and deciding on our own.
I knew Medicare wasn’t free, that it was complicated, that Part D was a give-away to the pharmaceutical industry, and that Advantage plans were developed as a back-door privatizing effort — and yet, having everything spread out before me, all of that was bolded and underlined. And in a much bigger font, metaphorically.
When I was younger, before the ACA, and beginning to acquire my roster of pre-existing conditions, Medicare was something of a promised land where my health history would not be held against me.
Now (at least for the very near future) that there are no pre-existing condition exclusions, Medicare seems like a not so great deal. It is nothing more than health Insurance, with all the nickel-and-diming, land mines and gotchas that any plan has.
gene108
@Ohio Mom:
What gets me about traditional Medicare coverage is that it is age rated. The older you get, the more expensive the various parts get.
gene108
@p.a.:
It’s really up to newsrooms, if they want to hire someone, who can explain the complexity the public, or even dumb it down so far even a common Chuck Todd or Chris Cilliza could understand it.
Another Scott
@Ohio Mom: I’m glad you’re getting help. I’m sorry that it’s such a difficult process.
People screaming for M4A really need to understand that this stuff isn’t simple, that even the most generous system won’t cover everything, and that choices will have to be made. Do we want those choices to be made by Democrats or Republicans? Do we want incremental progress, or do we want the system to continue to get more complicated, more expensive for normal people, and all the rest.
(sigh)
Good luck.
Cheers,
Scott.
WhatsMyNym
@Butch: I’m in the same boat as your spouse, once you hit 55 the price skyrockets. At least for my $1,070, I get a good gold plan from a company that will talk to you when things go wrong and fix their their mistakes.
ETA: with my need for ongoing tests every year, gold was the best value for the money (the insurance company still makes plenty of money from me).
WhatsMyNym
@Ohio Mom:
I take care of my mother’s finances and usually get her meds from the store. I’ve found that QFC/Krogers discount medication card has better prices plenty of times than my mother’s Part D supplement.
Unless you’re on some high priced meds already, I would look at a cheaper Part D plan from a good company and use one of the big pharmacies that have their own discount card. You can always change the next year.
La Nonna
We decided to stay in Italy after Il Nonno’s experimental medical treatments, successful (and free, thank you very much ASL), when we saw how much Medicare would cost us if we returned to the US, with all the moving parts, about 20% of our pension income. We bailed out of the system, took some doing, but no deductions now from Social Security to pay for insurance that doesn’t cover everything. Socialism, yes, higher income taxes, yes, medical bankruptcies, NO.
Duane
Missouri dropped 133,000 people, mostly children, from Medicaid last year. Our Republican controlled government wants to blame it on an improved economy and people failing to enroll. I’ve had personal experience with it and know better. They purposefully and actively work to deny coverage. Our governor will be campaigning against expansion, which should be on the ballot this November.
Steeplejack
@Duane:
I’m sorry, according to the president last night, those people were “lifted” off of Medicaid, as part of our glorious economic boom. And the Republicans cheered.
Ohio Mom
WhatsmyNym@11: Thanks, I’ll look into that.
The volunteer advisor had asked for my medication list in advance, and had print-outs of the two cheapest plans, given the match of my meds, the plans’ formularies, and the pharmacies in my neighborhood.
The main hang-up are the two non-generic prescriptions. There isn’t a generic version (yet) of the eye drops, and I wrote my list to include the brand name asthma inhaler. I’ve been on the new generic for over two months now and it simply doesn’t work as well. Hmmm…breath easily or not?
Anyway, I think of the money that went into the software (and its continual updates) that crunched all the possibilities to come up with the cheapest plans and I’m irritated.
Ohio Mom
Gene108@8: Yes, Medicare will be a significant portion of our retirement expenses. We haven’t done all the math yet but won’t be surprised if it’s 20% like LaNonna’s would be (taking a moment to be jealous that she gets to live in Italy).
I’m reminded of the spend-down for Medicaid. The system is set up so ordinary families can’t accumulate any real wealth over the generations.
Ohio Mom
Another thing about Medicare that irked me: Pap smears and colonoscopies are free.
So generous! Pap smears are generally faded out before age 70 and IIRC, colonoscopies after 75 — and many people only get colonoscopies once every ten years.
So very unlikely very many people are going to benefit very much from these free benefits.
Meanwhile, it jumped out at me that tetanus and shingles vaccines are not covered. That’s backwards, not to promote effective and easy prevention.
Butch
@WhatsMyNym: We were actually denied reimbursement for something clearly coded as preventive and wellness, and when I appealed Blue Cross justified it based on a single sentence on page 28 of the policy. And then I discovered that the folks at the state agency supposedly set up to help the consumer in these situations seem to think their job consists of answering the phone and telling you there’s nothing they can do.