High Deductible Plans Hit Chronically Ill Low-Income Patients Hardest

MedicalResearch.com Interview with:

Salam Abdus, PhD Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality Department of Health and Human Services Rockville, Maryland

Dr. Abdus

Salam Abdus, PhD
Division of Research and Modeling,
Center for Financing, Access, and Cost Trends,
Agency for Healthcare Research and Quality
Department of Health and Human Services
Rockville, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings? 


Response:
High deductible health plans are more prevalent than ever.

Previous research showed that adults in low-income families or with chronic conditions are more likely to face high financial burdens when they are enrolled in high-deductible health plans, compared to adults in higher income families or healthier adults.

In this study we examined the financial burden of high-deductible health plans among adults who are both low income and chronically ill. We used AHRQ’s Medical Expenditure Panel Survey Household Component (MEPS-HC) data from 2011 to 2015 to study the prevalence of high out-of-pocket health care spending burden of high deductible health plans among adults enrolled in employer-sponsored insurance. We included family out-of-pocket spending on premiums and health care services.

We found that among adults who had family income below 250% of Federal Poverty Level (FPL), had multiple chronic conditions, and were enrolled in high-deductible health plans, almost half (46.9%) had financial family out-of-pocket health care burden exceeding 20 percent of family disposable income.

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Decreased Cost-Sharing Increased Patient Adherence

MedicalResearch.com Interview with:

A. Mark Fendrick, M.D. Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy Director, University of Michigan Center for Value-Based Insurance Design Ann Arbor, Michigan 48109-2800

Dr. Fendrick

A. Mark Fendrick, M.D.
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy
Director, University of Michigan Center for Value-Based Insurance Design
Ann Arbor, Michigan 48109-2800

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As Americans are being asked to pay more for the medical care, in terms of copayments and deductibles, one in four Americans reports having difficulty paying for their prescription drugs. One potential solution is “value-based insurance design,” or V-BID. V-BID, is built on the principle of lowering or removing financial barriers to essential, high-value clinical services. V-BID plans align patients’ out-of-pocket costs, such as copayments and deductibles, with the value of services to the patient. They are designed with the tenet of “clinical nuance” in mind— in that the clinical benefit derived from a specific service depends on the consumer using it, as well as when, where, and by whom the service is provided.

According to a literature review published in the July 2018 issue of Health Affairs,  The researchers found that value-based insurance design programs which reduced consumer cost-sharing for clinically indicated medications resulted in increased adherence at no change in total spending. In other words, decreasing consumer cost-sharing meant better medication adherence for the same total cost to the insurer. Continue reading

Both State and Federal Marketplaces Expanded Medicaid/Chip Coverage to Eligible Patients

MedicalResearch.com Interview with:

Julie L. Hudson, PhD Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality Rockville, Maryland

Dr. Hudson

Julie L. Hudson, PhD
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality
Rockville, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Since 2013, public coverage has increased not only among low-income adults newly eligible for Medicaid but also among children and adults who were previously eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Recent research has shown that growth in public coverage varied by state-level policy choices.

In this paper we study the growth in public coverage (Medicaid/CHIP) for three population samples living in Medicaid Expansion states between 2013 and 2015: previously eligible children, previously eligible parents, and newly eligible parents by state-level marketplace policies (Note: eligibility refers to eligible for Medicaid/CHIP, eligibility for marketplace subsidized coverage). All marketplaces are required to assess each applicants’ eligibility for both the marketplace and for Medicaid/CHIP. States running state-based marketplaces are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage (Medicaid or CHIP), but states using federally-facilitated marketplaces can opt to require their marketplace to forward these cases to state Medicaid/CHIP authorities for final eligibility determination and enrollment. We study the impact of marketplace policies on public coverage by observing changes in the probability Medicaid-/CHIP-eligible children and parents are enrolled in public coverage across three marketplace structures: state-based marketplaces that are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage, federally-facilitated marketplaces in states that enroll Medicaid-/CHIP-eligible applicants directly into public coverage, and federally-facilitated marketplaces with no authority to enroll Medicaid-/CHIP-eligible applicants into public coverage.

Supporting the existing literature, we find that public coverage grew between 2013-2015 for all three of our samples of Medicaid-/CHIP-eligible children and parents living in Medicaid expansion states. However, we show that growth in public coverage was smallest in expansion states that adopted a federally-facilitated marketplace and gave no authority to the marketplace to enroll Medicaid-/CHIP-eligible applicants directly into public coverage. Additionally, once we account for enrollment authority, we found no differences in growth of public coverage for eligible children and parents living in expansion states that adopted a state-based marketplace versus those in states that adopted a federally-facilitated marketplaces with the authority to directly enroll Medicaid-/CHIP-eligible applicants Continue reading

Hospital Utilization Patterns For Medicaid and Uninsured Patients Differ From Insured

Raynard E. Washington, PhD, MPH Center for Delivery, Organization, and Markets Agency for Healthcare Research and Quality Rockville, MD 20850MedicalResearch.com Interview with:
Raynard E. Washington, PhD, MPH

Center for Delivery, Organization, and Markets
Agency for Healthcare Research and Quality
Rockville, MD 20850

Medical Research: What is the background for this study? What are the main findings?

Dr. Washington: Many individuals with low income who require a hospital stay are uninsured or covered by Medicaid, a joint Federal-State health insurance program for eligible individuals and families with low income. The difference in hospital utilization among patients covered by Medicaid and those who are uninsured may reflect differences in the characteristics of these populations and their level of access to health care. This HCUP Statistical Brief describes 2012 hospital stays with a primary expected payer of Medicaid and stays that were uninsured.

Of the 36.5 million total hospital inpatient stays in 2012, 20.9 percent had an expected primary payer of Medicaid and 5.6 percent were uninsured; 30.6 percent were covered by private insurance. Patients covered by Medicaid were on average younger and more likely to live in low-income areas than were patients with private insurance. Patients who were uninsured were more likely to be male and to live in low-income communities than were patients with private insurance. The majority of the top 10 diagnoses for Medicaid hospitalizations were ambulatory care sensitive conditions. Cholecystectomy (gall bladder removal) was the most common operating room procedure for Medicaid and uninsured stays.

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Insurance Status May Predict Cancer Outcome in Young Adults

Ayal A. Aizer, MD, MHS Harvard Radiation Oncology Program Boston, MAMedicalResearch Interview with:
Ayal A. Aizer, MD, MHS
Harvard Radiation Oncology Program
Boston, MA

MedicalResearch: What are the main findings of the study?

Dr. Aizer: We studied Americans between the ages of 20-40 using the SEER Database (a national cancer registry) and found that patients who had insurance were more likely to present with localized (curable) versus metastatic (generally incurable) cancer. Patients with localized tumors were more likely to receive the appropriate treatment and, most importantly, survived longer than patients without insurance. Our analysis accounted for demographic and socioeconomic differences between patients who were insured versus uninsured. Our results indicate that insurance status is a powerful predictor of outcome among young adults with cancer. The Affordable Care Act, which will likely improve insurance coverage nationally, may yield improved cancer outcomes among Americans.

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