Half of Americans think the ACA marketplace is collapsing

Most Americans are happy with the insurance they buy on the individual market, yet those same people think the markets are collapsing before their eyes.

A poll by the Kaiser Family Foundation  (Kaiser Health News is an editorially independent program of the foundation), released Tuesday, found that 61 percent of people enrolled in marketplace plans are satisfied with their insurance choices and that a majority say they are not paying more this year compared with last year’s premium costs.

Yet, more than half of the overall public — 53 percent — also think the Affordable Care Act’s marketplaces are “collapsing.”

Experts have warned that some policy actions supported by the Trump administration would undermine the market, including repealing the penalty for going without insurance and giving people the option to buy short-term plans. Such plans are often less expensive but cover fewer benefits. They are not automatically renewable, and insurers are able to charge people with medical conditions more — or exclude them altogether.

But only about one-fifth of people who obtain coverage on the individual market were even aware that the mandate penalty had been repealed as of 2019, according to the poll. It is still in effect this year.

Nine in 10 enrollees said they would still buy insurance without the penalty, and 34 percent said the mandate was a “major reason” they chose to buy insurance at all.

“They may have been prompted to buy the coverage in the first place because of the mandate,” said Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute. “But now that they’ve got it, they clearly value it.”

Most of the people who buy plans because they don’t get coverage through work or the government, 75 percent, said they bought insurance to protect against high medical bills, and 66 percent said peace of mind was a major reason.

In February, President Donald Trump eased some of the restrictions on short-term insurance plans, allowing them to cover people for 12 months instead of three.

Critics worried this alternative would draw people away from traditional insurance plans and weaken the individual market. According to the poll, though, only 12 percent of respondents buying on that market said they’d be interested in buying one of the short-term plans.

Georgetown’s Corlette cautioned that these numbers could change when people are faced with an actual choice next open enrollment season.

“If you look at how these things are marketed, your average consumer will not be able to tell that these products are any different from a traditional health plan,” she said.

Most people said they didn’t face a premium increase this year. Thirty-four percent said their premiums were “about the same” as last year and 23 percent said they actually went down.

That’s not surprising, said Joseph Antos, a resident scholar at the conservative American Enterprise Institute who follows the health industry. Many consumers saw their premium subsidies rise too.

Thirty-five percent of people said one of the major reasons they bought insurance was because government subsidies made it affordable.

The subsidies that people receive, Antos noted, went up to offset the premium increase in many cases, especially if consumers took the advice of experts and shopped around for coverage.

“They’re buying because they feel they need insurance and that their net premiums and deductibles add up to something they’re willing to buy,” Antos said.

The poll was conducted Feb. 15-20 and March 8-13 among 2,534 adults. The margin of sampling error is +/-2 percentage points for the full sample, +/-7 percentage points for all non-group enrollees and +/-9 percentage points for marketplace enrollees.

Source: Kaiser Health News senior correspondent Julie Appleby contributed to this report.
By Rachel Bluth, Kaiser Health News | April 03, 2018 at 10:06 AM | Originally published on BenefitsPro


Direct Primary Care Begins to Change the Mindset Behind Healthcare

 

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A new kind of doctor's office that doesn't take insurance and charges a monthly fee is 'popping up everywhere' — and that could change how we think about healthcare

Bryan Hill spent his career working as a pediatrician, teaching at a university, and working at a hospital. But in March 2016 he decided he no longer wanted a boss. Soon after, Hill learned about a different way to run a doctor's office. "It's the most fun I've ever had," Hill said. Now almost 18 months into his practice, he said, "I couldn't imagine practicing any way else." Hill's practice is something known as direct primary care. Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices. Hill is part of a small but fast-growing movement of pediatricians, family-medicine physicians, and internists opting for this different model. It's happening at a time when high-deductible health plans are on the rise.

A survey in September 2016 found 51% of workers had a plan that required them to pay up to $1,000 out of pocket for healthcare until insurance picks up most of the rest. That means consumers have a clearer picture of how much they're spending on healthcare just as they're having to pay more. At the same time, primary-care doctors in the traditional system are feeling the pressure under the typical fee-for-service model in which doctors are pressured to see more patients. The direct primary-care movement — in which practices are set up on a doctor-by-doctor basis — has been slowly but steadily growing over the past few years, adding about 170 practices in the past year despite some larger practices shutting down.

Direct primary care has the potential to simplify basic doctor visits, giving doctors time to focus just on the patient and care for them in ways they might not have had time for otherwise. But there are also concerns from insurers about what separating insurance from primary care will mean for people who still ultimately need insurance. Members of direct primary-care practices pay a monthly fee, which, depending on the practice, your age, and the number of family members you have on the plan, can run from $50 to $150. Included in that monthly fee are basic checkups, same-day or next-day appointments, and — a boon to patients — the ability to obtain medications and lab tests at or near wholesale prices.

Direct primary care also comes with near-constant access to a doctor — talking via FaceTime while the family is on vacation, or taking an emergency trip to the office to get stitches after a bad fall on a Saturday night. Because direct primary care doesn't take insurance, there are no copays and no costs beyond the monthly fee. Doctors can also take the time to keep in touch with patients in between visits to see how they're doing. Paul Thomas, whose practice in Detroit has grown from 50 members to 250 in the past year, will text his patients once a week working on long-term goals like losing weight, eating better, or quitting smoking. He'll check in with the patient, initiating a conversation and keeping the goal in their mind in a way that an infrequent visit to the doctor's office might not. The number of people in a particular practice who have insurance varies, according to the 17 direct primary-care practices Business Insider spoke to. At some practices, all but a handful had some form of insurance, while at others a little more than half didn't have insurance. To describe how coverage functions under direct primary care, doctors use the example of car insurance.

You don't use your car insurance for small transactions like oil changes, but it's there for you if you get in a car accident. Likewise, health-insurance plans — especially those with high deductibles — can be there if you require healthcare beyond just a standard checkup. While the number of direct primary-care practices is growing, it's not exploding in the same way a national chain might be able to. For the most part, doctors build their own practice, which keeps it local.

—businessinsider.com


Could These 3 Reasons Be Behind Your Failing Employee Engagement?

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Encouraging employee engagement with health benefits

In a competitive economy, a robust package of employee health benefits is one of the key elements that employers need to attract and to retain a skilled, experienced workforce. In fact, according to statistics gathered by Collective Health and Harris Poll, 78% of adults in the U.S. say healthcare benefits strongly factor into their decision on where to accept a job. However, once employees have these benefits, most do not take full advantage of the complete range of services and support available. Only 25% of employees questioned in one survey said they have used all the preventive care benefits offered by their employer.

Another survey, conducted by the American Psychological Association, found that only 33% of employees report participating in employer-provided health promotion programs. The failure to engage with and use the benefits available can have an especially significant impact when employees or their family members face serious or complex medical issues, such as a cancer diagnosis or recommendation for surgery. When employees don’t use the full spectrum of benefits available to them, such as second opinions and case management, the risk of poorer health outcomes and higher employer and employee healthcare costs increases, with more than $210 billion a year spent on inappropriate and unnecessary treatment according to an Institute of Medicine report. Several factors contribute to employees’ failure to use all the health benefits available to them:

Problems with the benefits selection process: Although the choice of benefits can have wide ranging effects on both physical and financial health, 77% of employees spend 60 minutes or less choosing benefits, while 46% spend 30 minutes or less on this important decision, according to an Aflac poll. Another survey noted the high stress levels associated with making benefit decisions, finding that 49% of employees say making benefits decisions is always stressful.

Not understanding the options: A survey by the International Foundation of Employee Benefits Plans found that approximately 80% of organizations reported that employees do not have a high level of understanding of their benefits. This lack of understanding comes at a financial cost. According to 42% of employees in the Aflac survey, the estimated cost of errors employees make understanding and choosing benefits can cost them up to $750 per year.

Complexity of benefits: When faced with multiple benefit providers and contact points, employees often do not know where to find the information they need to understand the benefits available to them and how to access them. As a result, employees fail to access the information, resources and support that can help them make informed medical decisions. This can have a negative impact on health outcomes and healthcare costs.

—benefitnews.com