Here’s a nugget from the recently released ObamaCare regulations (on which I’ll coment more in a bit): the government figures there are about 10.8 million individual health plan members. That’s fewer than the 14 million to 17 million number sometimes referred to, which is based on Census Bureau data. It’s also right in line with CRG estimates. So kudos to us for once. (Lord knows, we get enough wrong).
We’re still catching up on 2012 membership data, but year-end 2011 shows a continued shift among major plans away from fully funded and toward self-insured. The data in the chart below is from 21 plans representing 130.5 million lives. The figures include commercial, Medicare Advantage and managed Medicaid.
From a new GAO study:
In calendar years 2008 and 2009, less than 4 percent of beneficiaries who had Medicaid coverage for a full year reported difficulty obtaining medical care, which was similar to individuals with full-year private insurance; however, more Medicaid beneficiaries reported difficulty obtaining dental care than those with private insurance….Medicaid beneficiaries reported delaying care for reasons such as long wait times and lack of transportation.
Profit projections from J.P. Morgan (which I’ve put into the chart below) provide some clues. WellPoint, with its heavy reliance on individual and small group business, is among the most vulnerable. So is Humana, with its heavy reliance on Medicare Advantage. Cigna appears to be the least vulnerable.
Sharon Cunninghis, U.S. business leader for health and benefits for Mercer, points to an interesting trend identified in the company’s annual survey of employers concerning healthcare benefits and costs.
[ObamaCare] requires that health plans cover, at a minimum, 60% of eligible health plan expenses…Some employers are resetting their health plan value to move closer to that minimum, and saving money as a result.
Said another way, employers are shifting costs to employees by raising deductibles and migrating toward consumer-directed health plans. That’s nothing new–but the notion that the healthcare reform law may be a driver is an interesting take.
Beth Umland, director of research for health and benefits at Mercer, elaborated in an email:
The typical CDHP meets the 60% plan value rule. The typical PPO offered by large employers generally has a higher value — closer to 80%. So moving employees out of PPOs into CDHPs, and raising cost-sharing in PPOs, would both be examples of resetting the plan value to get closer to the 60% minimum.
It would be ironic if the law most vilified by proponents of consumer choice and free markets turns out to be a key factor in pushing consumer-directed healthcare over the tipping point.
“The economy,” stupid. According to a Kaiser Family Foundation survey, 19% of voters say the economy was the biggest factor in deciding who to vote for president.
Tied for second with 15% each, “The direction the country is headed” and “President Barack Obama’s job performance over the last four years.” Fourth at 9%, “The candidate’s ability to relate to the middle class.” Fifth at 6%, “The candidate’s views on women’s health issues.”
And in sixth place at just 5%, “The 2010 health care law.” Said another way, when asked what was the “biggest factor” in deciding on who to vote for president, 95% didn’t say ObamaCare.
That doesn’t mean it wasn’t a big factor. In fact, 69% said it was a “major factor,” again behind the economy (87%), the country’s direction (87%), Obama’s job performance (78%) and the future of Medicare (70%).
Still, you’d think ObamaCare would be the “biggest factor” for more people–especially the way the law is sometimes portrayed by opponents as the end of America as we know it. Even women’s health was the “biggest factor” in the election for more voters than ObamaCare.
One of two things can be concluded from these numbers. 1. Maybe the law isn’t as unpopular as some might think. (The survey also shows fewer people are calling for repeal). 2. THE POLLS ARE WRONG!!!
The good news is healthcare costs for employers rose just 4.1% in 2012, the lowest rate of increase in 15 years, according to an annual Mercer study. The rate of increase is projected to be just 5% in 2013.
The bad news is that without changes to benefits and other cost containment efforts, the rate of increase would be 7.4% in each year. For example, employers continue to shift costs to employees through higher PPO deductibles, and enrollment in consumer-directed high-deductible health plans and even defined contribution plans continues to rise. Notes Sharon Cunninghis, U.S. business leader for health and benefits at Mercer:
Over the past decade, employers have figured out how to stabilize health benefit cost increases through cost-shifting and other cost management techniques. Now we’re seeing a move toward even greater control through defined contribution strategies.