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The American College of Physicians states that the U.S. needs a healthcare system that covers healthcare for everyone either through a universal health insurance system (like the UK NHS) or a pluralistic system with the government and private organizations.
1. A single payer system that is run by the government would expand to everyone. These single payer systems are more equitable, have lower administrative costs, higher consumer satisfaction, and better quality as well as access. Some cons to this system would be restricted spending, shortages of services, elective treatment delays, and limits on choices.
2. A pluralistic system that involves the government and other profit/nonprofit organizations could allow universal access and simultaneously give users the freedom to buy private supplemental coverage. Furthermore, this system would have a guarantee that everyone has access to coverage as well as government subsidies for those who cannot afford coverage. Some cons to this pluralistic system is that it is more likely to create inequities in coverage and result in higher administrative costs.

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US National Library of Medicine National Institutes of Health

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US National Library of Medicine National Institutes of Health

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US needs universal access to health care, American College of Physicians says

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The American College of Physicians says that the United States needs a healthcare system that provides care for everyone, either through a universal health insurance system, such as the UK NHS, or through a pluralistic system that involves the government and private organisations. The college's three-part position paper was published on its website (www.annals.org).

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Speakers at the West Health summit came up with 5 possible solutions to lower health care costs:
1. Give patients and health care consumers more information. Many patients don't know about local price variations because they are not given that information by health care providers or insurers. For example, a colonoscopy in one place could cost way more than another. However, cost should not be the only thing that is discussed, rather value for cost should be the topic of discussion.
2. Give patients and Health Care Consumers More Power.
3. Lower the number of medical tests for patients.
4. Increase competition among health care providers. Physician practices have been consolidating and the number of hospital mergers have grown to be high. Without competition, prices are higher, and quality doesn't improve as rapidly and intensely.
5. Let Medicare negotiate prescription drug costs for consumers to bring down prices.

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As nearly everyone knows, America's health care costs are astronomical and likely to continue rising. A Health Affairs study just projected national health care spending will grow an average of 5.5 percent every year through 2026. As Martin Gaynor, an economics professor at Carnegie Mellon University said at last week's West Health Institute 2018 Healthcare Costs Innovation Summit in Washington, D.C.: "Health care spending is high and it is ultimately unsustainable."

What can be done about it?

The answer to that question is critically important to all Americans, but especially to those in their 50s or 60s who "are some of the hardest hit by this health care cost crisis," said West Health CEO and President Shelley Lyford. They tend to have high out-of-pocket costs; health care expenses can be a huge outlay in retirement, too. "For so many, one severe illness could mean financial ruin or even bankruptcy," Lyford said. A recent RBC Wealth Management study estimated that a healthy 65-year-old couple today can expect to spend more than $400,000 on health care in retirement.

At the West Health summit, which drew around 500 attendees, Gaynor and numerous experts offered recommendations to bring health care costs down. (West Health is a family of nonpartisan nonprofits focused on health care research, policy and philanthropy.) Said Lyford: "We have a health care system that is draining our resources, weakening our country and limiting our ability to fulfill our most basic responsibilities to our citizens. It doesn't have to be this way. We must do better."

Here are five solutions the summit speakers proposed to lower health care costs:

1. Give Patients and Health Care Consumers More Information

Several panelists talked about the wide variation in price for the same medical treatment in the same metropolitan area. In Atlanta, Gaynor said, it can cost 600 percent more to have a colonoscopy in one location than another. The problem is that patients usually don't know about local price variations because they're generally not given cost information by health care providers or insurers.

That's not true in other countries. "There are prices on walls in doctors' offices in France. In Australia, people are entitled to binding estimates before they go in for elective surgery," said Dr. Elisabeth Rosenthal, editor-in-chief of Kaiser Health News.

Carol Raphael, senior adviser, Manatt Health Solutions and former board chair of AARP said, "I think we shouldn't only talk about cost, because if you just tell people to go to the lowest cost option, that can be frightening. We have to talk about value. And where are you going to get the best results, the most effective outcomes for the lowest costs? And we have to enable people to figure that out."

Dr. Mark Smith, clinical professor of medicine at University of California, San Francisco and co-chair of the Guiding Committee of the Health Care Payment Learning and Action Network, said that in order for health care consumers to make smarter choices and save money, the health care system needs a "greater availability of usable data on cost and quality than we have now."

One recent example of this kind of usable data: Kaiser Health News and NPR just began offering a new feature, Bill of the Month. Its dissection of real medical bills educates consumers (and shames some providers.)

2. Give Patients and Health Care Consumers More Power

"Most patients I speak to in this system feel powerless," said Rosenthal. "And that's what I think we have to change."

Smith told the audience: "It is important for patients and consumers to vote with their feet and with their wallets for high-value plans and providers, because that creates an incentive for plans and providers to create greater value."

He also said he'd like to see more "self-care," and thinks we will, with improved health care technology. Referring to patients on dialysis, Smith said: "There's a whole world of possibilities of how we could substitute patient-driven care for expensive, professionally-driven care."

Dr. Mark McClellan, director of the Robert J. Margolis Center for Health Policy at Duke University and a former commissioner of the Food and Drug Administration said "there are programs not only outside the U.S., but in the U.S., that are doing self-administered dialysis at home. That leads to better control of the progression of the disease, is more convenient for the patient and is less costly."

3. Lower the Number of Medical Tests for Patients

Dr. Atul Gawande, a surgeon, writer, public health researcher and Next Avenue's 2015 Influencer of the Year, mentioned a study of more than 1 million Medicare patients asking how often they received one of the 26 tests or treatments that were "widely recognized to be of no benefit or to, in fact, be of outright harm." Up to 42 percent of patients received unnecessary tests in one year, Gawande said. His mother was one of them.

Rosenthal said doctors must convince patients not to expect, or feel they need, to get a test during every medical visit.

That could be difficult. Raphael called the current culture of medicine "the rescue culture," saying: "You come in and you have an infection. You don't want to hear that it's a viral infection, go home and rest. You want it to be fixed."

But, Raphael added, "if we have the space, the reimbursement system and to some extent, the technique to have conversations with patients that explain what the risks are, the potential benefits, the dangers with unnecessary radiation, they would make different choices."

4. Increase Competition Among Health Care Providers

Gaynor explained that physician practices have been consolidating and the number of hospital mergers has been high.

A recent study by two Federal Trade Commission economists, he said, looked at the merger of six physician practices in Pennsylvania a few years ago "and they found price increases of up to 25 percent and 15 percent for different insurers."

Gaynor estimated that about 1,700 hospital mergers have occurred over the past 20 years; most urban areas now have just one to three dominant hospital systems. The "lack of competition has a large part to do with" why health care costs are high and rising, Gaynor said.

If hospitals have no local competition, he added, research has found that prices are 12.5 percent higher, on average. "Evidence shows across the board when there's less potential competition in a market, hospital prices are higher," Gaynor said. And, he added, "if prices are high, they stay high."

Gaynor also noted that a study of Medicare beneficiaries who had heart attacks discovered that "those treated at a hospital that didn't face a lot of competition were 1.46 percentage points more likely to die in the year following the heart attack than if they had been treated in a hospital in the area that faced a lot of competition. So monopoly kills."

What's more, Gaynor said, the largest four health insurers have 76 percent of the fully-funded market nationally and the largest two insurers have more than 70 percent of the market in half of the nation's metro areas.

He said he sees no signs of health care industry consolidation slowing down.

"I think the strongest studies show that quality suffers when there's less competition," Gaynor said. "More competition leads to better quality of care." And less competition leads to "substantially worse patient outcomes."

5. Let Medicare Negotiate Prescription Drug Costs for Consumers

Numerous speakers called for allowing Medicare to negotiate prescription drugs for Americans 65 and older. That might happen soon.

"There is growing consensus to allow Medicare, the largest purchaser of prescription drugs, to negotiate on price," Lyford told me. "This will help bring prices down tremendously."

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How to Lower Health Care Costs in America

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As nearly everyone knows, America's health care costs are astronomical and likely to continue rising. A Health Affairs study just projected national health care spending will grow an average of 5.5 percent every year through 2026.

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The new repeal plan would replace ACA programs with a state block grant. However, states could not realistically use block grant funding to continue current coverage programs or create similar programs, because the financial risk would be too great. Cuts would be much too large in the states that have done the most to expand coverage. States could no longer obtain more federal funding to increase coverage. States would also have the ability to use resources in less effective/completely ineffective ways in providing coverage.

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Center on Budget and Policy Priorities (CBPP) 

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Center on Budget and Policy Priorities (CBPP) 

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The latest proposal to repeal the Affordable Care Act (ACA) - released June 19 by a group of prominent conservatives and conservative organizations - would have similar harmful impacts on health insurance coverage, access to care, health, and financial security as last year's repeal bills. Modeled on legislation that Senators Bill Cassidy, Lindsey Graham, Dean Heller, and Ron Johnson proposed last September ("Cassidy-Graham"), the new plan would:

eliminate the ACA's expansion of Medicaid to low-income adults and its subsidies that help moderate-income consumers afford individual market coverage, replacing them with a flawed and inadequate block grant to states;

severely disrupt the individual market for health insurance, potentially causing markets in some states to collapse; and

end critical ACA protections for people with pre-existing conditions, including the requirement that plans cover essential health benefits, such as mental health and substance use treatment, prescription drugs, and maternity care.

Given its similar structure to Cassidy-Graham, it is clear the new plan would have similar harmful impacts on coverage, access to care, and health as that earlier proposal.The new plan provides limited detail, failing to specify, for example, the total funding levels for the proposed block grant or how funding would be allocated across states. Nonetheless, given its similarity to Cassidy-Graham, it is clear the new plan would have similar harmful impacts on coverage, access to care, and health as that earlier proposal, which experts projected would have caused about 21 million people to lose coverage. That would have resulted in a non-elderly uninsured rate of about 18 percent - almost 50 million people - in 2026, a large increase from 2017's rate of 10.7 percent, or about 29 million people. If anything, the new proposal - coupled with the repeal of the individual mandate already enacted by Congress last year - would likely result in a higher uninsured rate than the earlier bill, since it appears to provide less federal funding for coverage.

The new proposal comes on the heels of the Administration's decision not to defend the ACA against a lawsuit from state attorneys general, instead asking the courts to eliminate the ACA's protections for people with pre-existing conditions, and it was released the same day the Administration finalized rules that will expand the availability of plans exempt from many ACA consumer protections. Together, the new plan and the Administration's actions show that, despite last year's congressional rejection of ACA repeal, eliminating the ACA's core provisions remains at the top of the Administration's and many leading conservatives' agenda.

New Repeal Plan Eliminates Medicaid Expansion and ACA Subsidies

Today, about 12 million people in 31 states and the District of Columbia are covered as a result of the ACA's expansion of Medicaid to low-income adults, and about 10 million people across all states get help paying for individual market coverage from the ACA's premium tax credits and cost-sharing reductions. The new repeal plan would completely eliminate these programs.

It would replace them with a state block grant. As discussed below, while not specified in the proposal, total funding for the block grant would likely fall below the already inadequate levels proposed in last year's Cassidy-Graham bill. But the block grant also suffers from severe structural flaws that would prevent it from replacing the coverage provided through Medicaid expansion and the ACA's individual market subsidies, even if funding levels were higher.

States could not realistically use block grant funding to continue current coverage programs or create similar programs, because the financial risk would be too great. Under the proposal, a state that tried to use block grant dollars to offer Medicaid-like coverage or ACA-like subsidies that keep pace with health insurance premiums would expose itself to massive financial risk. Unlike current-law federal funding for Medicaid expansion and ACA subsidies, block grant amounts would not adjust for enrollment increases due to recessions or for higher costs due to public health emergencies, new breakthrough treatments, demographic changes, or other cost pressures - leaving states on the hook for 100 percent of those costs. The plan sponsors tout this cost shift to states as a benefit, noting that the plan eliminates "open-ended subsidies."

To manage the resulting risk, states would likely avoid creating programs that guarantee coverage or robust financial assistance based on need. Instead, they might do one or more of the following: cap enrollment; offer very limited benefits; charge unaffordable premiums, deductibles, or copayments; limit assistance to fixed dollar amounts that would put coverage out of reach for most low- and moderate-income people; or redirect federal funding from providing coverage to other purposes, like reimbursing hospitals for uncompensated care.

Cuts would be much larger in the states that have done the most to expand coverage. Like Cassidy-Graham, the new proposal would base the initial allocation of state grants on current federal funding, but "over time, the grant would be based on a state's number of low-income residents." This approach penalizes states that have adopted Medicaid expansion or were more successful at enrolling eligible low- and moderate-income people in subsidized individual market coverage under the ACA, because such states have a higher ratio of people currently enrolled in ACA-funded coverage programs to low-income residents. As a result, the proposed formula would leave the states that are likely the most motivated to maintain current coverage levels with the least resources to do so. It would also penalize states with particularly high per-person health care costs, which similarly have high ratios of federal funding to low-income residents.

Nearly all current Medicaid expansion states have above-average ratios of current spending to low-income residents, putting them at risk for especially deep cuts under the new plan. States that would have seen especially deep cuts under Cassidy-Graham, with its similar funding formula, include Alaska, California, Connecticut, Delaware, the District of Columbia, Hawaii, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New York, North Dakota, Oregon, Rhode Island, Vermont, and Washington.

States could no longer obtain additional federal funding to expand coverage. Under current law, additional states that choose to take up the ACA's Medicaid expansion - as Maine voters opted to do last year, as Virginia policymakers just opted to do, and as Utah, Idaho, and Nebraska voters may decide to do this fall - can automatically draw down federal funding to do so. Likewise, states that take action to increase ACA marketplace enrollment - for example, by investing state funds in outreach or adopting a state individual mandate - can automatically draw down additional federal funding for subsidies. By replacing these programs with a block grant, with capped total federal funding, the latest repeal plan would make federal funding for coverage a zero-sum game, where any additional funding for one state comes at the expense of other states.

States would be free to spend resources in ways that would be less effective (or entirely ineffective) in providing coverage. Like the earlier Cassidy-Graham bill, the new proposal includes few guardrails to prevent states from using federal block grant funding to supplant current state funding for health programs, such as state programs that provide substance abuse and mental health services or fund public hospitals and other safety net providers. As the Congressional Budget Office (CBO) noted in its analysis of the earlier bill, states would be free to use block grant dollars to "fund some of their programs that would have operated under current law," and some states, especially those that chose not to expand Medicaid, would likely do so. Using federal funds to replace state funding for existing health programs would do nothing to mitigate the coverage losses that would result from eliminating Medicaid expansion and marketplace subsidies. It would merely free up state dollars for other purposes (such as tax cuts).

Proposal Would Create Massive Individual Market Disruption

Replacing the ACA coverage provisions with a flawed block grant would not just cause large coverage losses among Medicaid and marketplace enrollees. In some states, it could cause the individual market for health insurance to collapse. In its analysis of the Cassidy-Graham bill, CBO concluded that most states "would choose to provide little support to people in the nongroup [individual] market" and certainly would not be able to replace the ACA's subsidies, which target assistance based on income and adjust based on individual market premiums. With neither an individual mandate nor robust subsidies to draw healthier consumers into the individual market risk pool, markets in some states could unravel.

In the near term, more states would likely experience very large premium increases or individual market instability. Like Cassidy-Graham, the new plan would leave 50 states and the District of Columbia on their own to redesign coverage programs from scratch, without federal guidance, standards, or administrative infrastructure. The plan would also allow states to eliminate or change many of the ACA's consumer protections and other market rules (see below). As a result, if the new plan became law, insurers would initially have no idea how the individual market in any state would operate, and it could be years before they had clarity about the state of the risk pool.

In the interim, insurers would almost certainly impose large premium increases to account for uncertainty, and some would likely withdraw from the individual market altogether, at least temporarily. As 36 current and former insurance regulators wrote regarding Cassidy-Graham, the massive uncertainty created by that plan's - and the new proposal's - complete overhaul of the individual market would "severely disrupt states' individual insurance markets, with sharp premium increases and insurer exits likely to occur in the short term and over time."

Proposal Ends Key Protections for People with Pre-Existing Conditions

Like Cassidy-Graham, the new plan would eliminate various ACA consumer protections especially crucial for people with pre-existing health conditions. The plan authors note that "states would no longer be bound by Obamacare's mandates such as essential health benefits [the requirement that plans cover various services], minimum loss ratio requirements [the requirement that plans spend at least a specified fraction of premium dollars on medical care and improving health quality], single risk pools [the requirement that insurers set premiums for all plans based on the assumption that enrollees are part of a single risk pool], and 3:1 age rating requirements [a limitation on the amount by which premiums for older people can exceed those for younger people]." The plan leaves ambiguous whether states could also eliminate the ACA's prohibitions on denying coverage or charging higher premiums based on health status, specifying neither that these provisions could be dropped nor that they would remain in place. But its stated goal of lowering premiums for the young and healthy, its suggestion that states may need to take action to protect sicker individuals from higher premiums, and its clear statement that single risk pool requirements could be dropped indicate that states could likely drop these protections, as under Cassidy-Graham.

Before the ACA, when decisions about pre-existing conditions protections were last left up to states, the large majority of states let insurers charge people more based on health status. Consistent with that history, CBO concluded that under Cassidy-Graham, "most states" would ultimately modify market rules and "coverage for people with pre-existing conditions would be much more expensive in some of those states than under current law." Similarly, in an unusual joint statement, America's Health Insurance Plans, the Blue Cross Blue Shield Association, the American Medical Association, the American Academy of Family Physicians, the American Hospital Association, and the Federation of American Hospitals wrote, "the bill [Cassidy-Graham] will ... undermine safeguards for those with pre-existing conditions. Without these guaranteed protections, people with significant medical conditions can be charged much higher premiums and some may not be able to buy coverage at all."

Even if the new repeal plan maintains the ACA's ban on charging higher premiums based on health status, its consequences for people with pre-existing conditions would be similar, due to the other protections it eliminates. In particular, absent essential health benefit standards, insurers would likely drop coverage of expensive services - for example, high-cost prescription drugs - as a way to discourage enrollment by sicker, costlier enrollees. Or, if some plans did cover costly treatments, they would charge exorbitant premiums, set based on the assumption that only people needing these services would enroll. Either way, people with pre-existing conditions would be left bearing the full or close to the full expected cost of their conditions - easily tens of thousands of dollars per year - or, in some cases, would be unable to access the health care they need.

Overall, New Proposal Would Cause Millions to Lose Coverage

Because the proposed block grant could not replace the ACA coverage programs the plan would eliminate, the Cassidy-Graham bill would have resulted in large coverage losses. CBO was not given time to analyze Cassidy-Graham in full, but its preliminary analysis concluded the bill would cause millions to become uninsured. Drawing on CBO's analyses of earlier bills, independent analysts at the Brookings Institution estimated that the September 13, 2017 version of Cassidy-Graham would have caused about 21 million people to lose coverage in the years when its block grant was in full effect. That would have resulted in a non-elderly uninsured rate of about 18 percent (about 50 million people), versus 10.7 percent (29 million people) in 2017. (See Figure 1.)

Since last September, Congress enacted one provision of Cassidy-Graham, repeal of the ACA's individual mandate, as part of the 2017 tax bill. The combination of the new proposal and the already-enacted repeal of mandate would likely result in an even higher uninsured rate than would have resulted under last year's Cassidy-Graham bill. That's because, assuming its sponsors do not intend to increase federal deficits, it would likely provide less federal funding for coverage than Cassidy-Graham, for two reasons.

First, Cassidy-Graham funded its block grants in part with the savings from repealing the ACA's individual mandate. But when Congress repealed the mandate as part of the tax bill, it diverted the resulting hundreds of billions in savings to help pay for tax cuts. That leaves less funding available for the block grants in the new plan.

Second, the new proposal would use some of the remaining resources from repealing ACA coverage programs to pay for a massive expansion of health savings accounts. That would further reduce the funding available for block grants and would do nothing to mitigate coverage losses from eliminating Medicaid expansion and individual market subsidies, although it would provide high-income people with additional tax sheltering opportunities.

Seniors, People with Disabilities, and Families With Children Still at Risk

The new repeal plan does not include Cassidy-Graham's provision - also included in other repeal bills last year and in the Trump Administration's 2018 and 2019 budgets - to impose a per-enrollee cap ("per capita cap") on federal Medicaid spending for seniors, people with disabilities, and families with children; under these proposals, the cap would grow more slowly than projected current-law Medicaid spending, resulting in growing cuts to the program over time. Already, several major conservative organizations have weighed in to urge that this provision be incorporated in any repeal proposal, and the new plan does not rule out such an addition.

But even without a Medicaid per capita cap, the new proposal still puts older people, people with disabilities, and families with children at risk. First, deep cuts in total federal funding for coverage would create significant financial pressure on states that could lead them to make cuts to their pre-expansion Medicaid programs, reducing benefits, eligibility, or both. Second, millions of older people, people with disabilities, and parents are covered through the ACA Medicaid expansion or receive help from the ACA's marketplace subsidies, which the proposal would eliminate. Overall, uninsured rates for people ages 50 to 64 fell 37 percent as the ACA's major coverage provisions took effect; uninsured rates for people with a self-reported disability fell 41 percent, and uninsured rates for parents fell 33 percent (likely helping drive coverage gains among children as well). The new repeal plan, like the earlier Cassidy-Graham proposal and other repeal bills, would likely cause large coverage losses among virtually all demographic groups.

Moreover, the new proposal includes a major change to the Medicaid and Children's Health Insurance Program (CHIP), one not included in Cassidy-Graham, that could also pave the way for a per capita cap. Under the proposal, states would be required to let any Medicaid or CHIP enrollee "use their government assistance to buy a private health plan of their choice," including limited-benefit plans. Presumably, states would have to let any enrollee claim premium assistance equal to the average cost of Medicaid for those in their enrollment group (e.g., seniors, people with disabilities, or parents) and use it to purchase individual market coverage.

The plan's argument for the proposal is that Medicaid offers low-quality care at high cost. In fact, research consistently finds that Medicaid coverage improves access to care, health, and financial security and that Medicaid costs less than comparable private coverage for comparable populations. Nonetheless, in the largely unregulated individual market the plan would create, healthier-than-average enrollees likely could find individual market plans with a lower cost than the average per-enrollee cost of Medicaid and with some attractive features. And since the healthiest enrollees would be the most likely to take up the option to enroll in individual market coverage, per-enrollee costs for those still enrolled in traditional Medicaid would rise, as would total program costs (counting the costs for premium assistance). That, in turn, would lead to calls to cap and cut federal Medicaid funding - as the Cassidy-Graham bill, every other repeal proposal Congress considered, and the Administration's budget all proposed to do.

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Latest Republican ACA Repeal Plan Would Have Similar Harmful Impacts on Coverage and Health as All the Others

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The latest proposal to repeal the Affordable Care Act (ACA) - released June 19 by a group of prominent conservatives and conservative organizations - would have similar harmful impacts on health insurance coverage, access to care, health, and financial security as last year's repeal bills.[1] Modeled on legislation that Senators Bill Cassidy, Lindsey Graham, Dean Heller, and Ron Johnson proposed last September ("Cassidy-Graham"), the new plan would: eliminate the ACA's expansion of Medicaid to low-income adults and its subsidies that help moderate-income consumers afford individual market cove

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Repealing ACA would result in around 29.8 million people losing health insurance. The loss of health insurance would also result in devastating damages to family finances as well as the economy. People would have less money to spend on other basic necessities like food and rent. Less spent at grocery stores and other businesses would mean 1.2 million jobs would be lost.

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Across the country, 29.8 million people would lose their health insurance if the Affordable Care Act were repealed-more than doubling the number of people without health insurance. And 1.2 million jobs would be lost -not just in health care but across the board.

Losing health insurance

Map is colored to illustrate relative impact by showing the percent increase in the number of uninsured.

Losing jobs

Losing health insurance would also be devastating for family finances and hurt the economy. By helping pick up the tab for individual insurance and expanding coverage on Medicaid, the ACA has helped millions of Americans afford their care. If this support were withdrawn, people would have less money to spend on other basic necessities like food and rent. Fewer dollars spent at grocery stores and other businesses means 1.2 million jobs would be lost.

Map is colored to illustrate relative impact by showing job loss as a share of total state employment.

Source: Spending cut and coverage loss numbers are from Linda Blumberg, Matthew Buettgens, and John Holahan, Implications of Partial Repeal of the ACA through Reconciliation, Urban Institute, 2016. The job loss analysis is from Josh Bivens, Repealing the Affordable Health Care Act would cost jobs in every state, Economic Policy Institute, 2017.

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How would repealing the Affordable Care Act affect health care and jobs in your state?

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ShareTweet Across the country, 29.8 million people would lose their health insurance if the Affordable Care Act were repealed-more than doubling the number of people without health insurance. And 1.2 million jobs would be lost-not just in health care but across the board. Losing health insurance How many people would lose their health insurance if...

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The passage of the Affordable Care Act (ACA) in 2010 led to federal and state-run insurance exchanges becoming another avenue for getting health insurance. These plans often don't cover all the costs and have a large deductible (the amount an individual pays out-of-pocket for covered services before insurance steps in.

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Employer-sponsored insurance (ESI) covers the majority of nonelderly Americans, however the escalating costs faced by those with ESI have not been brought up as much as costs on the individual marker or in public programs. Kaiser Health News profiled a family of 3 earning $100,000 annually, but who accumulated $12,000 in medical debt despite having ESI, working 4 jobs, and lacking any serious health issues. This is not uncommon for American families.

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In 2018, 1/4 of American adults said that cost was the nation's #1 health care issue. 61% said that paying higher premiums or a greater portion of medical expenses was a major concern. 50% of American adults worry that they do not have enough money to afford care. Therefore, the burden of health care costs is heavy and growing.

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If the address matches an existing account you will receive an email with instructions to reset your password.

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Healthcare spending on outpatient care increased 85% from 1996 to 2013 b/c of more use of services. Spending on inpatient care grew 59% b/c of price increases and service intensity. Therefore, increased health care spending is driven more by how care is prices and delivered to patients than by population size or age.

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There are five main factors that contribute to the rising cost of health care:
1. More people (+23%)
2. Aging population (+12%)
3. Changes in disease prevalence/incidence
4. Increase in how often people use health care services
5. Growth in the price and complexity of services (+50%)

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A study published in JAMA discovered that health care costs grew nearly $1 trillion from 1996 to 2013. Price and intensity of services account for 50% of the increase.

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The Institute for Health Metrics and Evaluation (IHME)

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The Institute for Health Metrics and Evaluation (IHME)

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Institute for Health Metrics and Evaluation

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SEATTLE - A new study finds that the cost of health care in the United States increased nearly $1 trillion from 1996 to 2013 and measures the causes behind this immense growth.

The study, published today in JAMA, reveals that price and "intensity" (variety and complexity) of services accounted for 50% of the increase.

"Part of the reason we spend more on health care each year is the nation's growing and aging population," said Dr. Joseph Dieleman of the Institute for Health Metrics and Evaluation at the University of Washington and lead author of the study. "But factors relating to the health system, such as increased price, intensity, and utilization, are driving most of the spending increase."

Five factors contribute to the rise in health care costs in the US: (1) more people; (2) an aging population; (3) changes in disease prevalence or incidence; (4) increases in how often people use health care services; and (5) increases in the price and intensity of services. This research measures the impact of these different drivers on the total increase in health care spending and for the increases caused by specific health conditions and types of care.

An in-depth data visualization is available at: https://vizhub.healthdata.org/dex/

The study covers health care spending for individuals and includes spending on inpatient care, outpatient care, nursing facilities, emergency departments, dental care, and prescribed pharmaceuticals. It also includes funding from all payers, such as private insurance, Medicare, Medicaid, and households' own spending.

"When we added up all the health conditions, increasing population size led to a 23% increase in health care spending," Dr. Dieleman said. "People getting older led to a 12% increase in spending, and increases in price and service intensity, that is the variety and complexity of services, led to a 50% increase in spending."

Most importantly, increases in spending also vary dramatically depending on people's conditions and types of care, such as inpatient, outpatient, pharmaceuticals, and others, he said.

Health care spending on outpatient care increased a dramatic 85% between 1996 and 2013, largely due to increasing use of services. Spending on inpatient care grew 59% because of price increases and service intensity.

"These findings offer insight into why the US spends so much on health care," said Dr. Jay Want, executive director of the Peterson Center on Healthcare, which funded the study. "Increased health care spending is driven more by how care is priced and delivered to patients than by the population's size or age. The research suggests the need for more efforts to address those forces that control pricing."
Media contacts:
IHME: Kelly Bienhoff, +1-206-897-2884 (office); +1-913-302-3817 (cell); [email protected]

About the Institute for Healthcare Metrics and Evaluation
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to improve population health.

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New study explains why US health care spending increased $1 trillion

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SEATTLE - A new study finds that the cost of health care in the United States increased nearly $1 trillion from 1996 to 2013 and measures the causes behind this immense growth. The study, published today in JAMA , reveals that price and "intensity" (variety and complexity) of services accounted for 50% of the increase.

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Republicans have tried to repeal ACA, the Affordable Care Act that has expanded health care coverage to around 30 million of Americans who were previously uninsured. Although the Trump administration has failed to repeal ACA, the tax overhaul in 2017 had a provision to repeal the individual mandate, which required all Americans to carry health insurance or pay a tax penalty. 

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Issues: Understanding Controversy and Society - Username

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Welcome to Issues: Understanding Controversy and Society

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For those over 65, and low income people, Medicare and Medicaid have been the major source of coverage for health care expenses since 1965. Those who did not have employer-provided health care or qualify for government programs, private insurance IS the only option available. Those who could not afford private insurance are left with no coverage whatsoever. 

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The costs of healthcare are so high that people are unable to pay with their own income. Contributing factors to the astronomical costs of healthcare are the aging population, fragmented system that results in high administrative costs, and power of health care providers to set prices in many situations. 
Many individuals don’t have access to insurance, and furthermore, insurance plans don’t always cover all the costs of healthcare. 

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The privilege that some people have over others by being able to afford healthcare has serious impacts on the lives of those who are less fortunate. Even those with access to insurance often have to pay out of pocket expenses that are still too much, therefore only those who are extremely privileged in terms of wealth are able to get medical aid without any issue when they need it.