Research roundup: Gender differences in health spending; How the states could fare under the new law; Increased Medicare premiums

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Dec 20 2010

Health Affairs: Pronounced Gender And Age Differences Are Evident In Personal Health Care Spending Per Person - This paper examines health care spending by men and women in 2004, including comparisons "by age group, goods and services consumed, and payers, and an analysis of some of the most frequently cited health conditions and treatments associated with that spending." The authors report, "Across all payers and services, females spent approximately $1,448 more per capita than males on health care in 2004. … In the working-age population, women outspent men on a per capita basis by 37% in 2004: $5,202 for women compared to $3,797 for men" - a difference the study authors largely attribute to "the high costs associated with maternity care that primarily affect the younger working-age female population" (Cylus et al., 12/9).

RAND: Health And Well-Being In The Home - This paper examines the potential - and challenges - of using home health care products to help ease the problems that consumers with chronic health problems in China, France, Germany, Singapore, the UK and U.S. may have in getting or affording care. Such products range from mobility support tools to basic diagnostic and therapeutic tools, such as glucose meters, to telemedicine options. The authors found that despite an eagerness from consumers for such solutions, widespread adoption of such technology is hampered by "a number of barriers" (Matke et al., 12/7).

Urban Institute/First Focus: Net Effects Of The Affordable Care Act On State Budgets - Although previous studies by the Urban Institute have estimated that because of expanded coverage mandated by the new health law, state Medicaid costs "will rise between $21.1 billion and $43.2 billion during 2014-2019," this paper looks at areas where the states will save money under the new law. It finds a potential net budgetary savings that ranges from between $40.6 billion to $131.6 billion during 2014-2019. The savings comes from "eliminating optional Medicaid coverage for adults over 133% of FPL, thus shifting them to federally-funded subsidies in the exchange," "replacing state and local spending on uncompensated care with federal Medicaid dollars," and "replacing state and local spending on mental health services with federal Medicaid dollars" (Dorn and Buettgens, 12/1).

Kaiser Family Foundation: The Social Security COLA And Medicare Part B Premium: Questions, Answers, And Issues - "For the second year in a row and only the second time in 35 years, Social Security recipients will receive a 0% cost-of-living adjustment (COLA) in 2011," according to this issue brief (.pdf) that examines the implications for people who are covered by Social Security and Medicare Part B. The brief describes the so-called "hold-harmless" provision, which "prevents the majority of Medicare beneficiaries from paying any increase in Part B premiums during" years where there is no cost-of-living increase and explains the implications for those not protected by the provision (Neuman, Cubanski and Huang, December 2010).

Center for Studying Health System Change/Robert Wood Johnson Foundation: Workplace Clinics: A Sign Of Growing Employer Interest In Wellness - "Interest in workplace clinics has intensified in recent years, with employers moving well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services," write the authors of this research brief (.pdf). Although such clinics have the potential to improve access to care, there are concerns that they may undermine primary care practices in the community and "exacerbate shortages of community-based primary care physicians and other providers in some areas" (Tu, Boukus and Cohen, December 2010).

Kaiser Family Foundation: Dual Eligibles: Medicaid Enrollment And Spending For Medicare Beneficiaries In 2007 - This paper (.pdf) examines Medicaid enrollment and spending attributed to dual eligibles - those entitled to Medicare who are also eligible to receive assistance from their state Medicaid program - using data through 2007. "Nearly 8.9 million older Americans and younger persons with disabilities participated in both the Medicare and Medicaid programs in Federal Fiscal Year (FFY) 2007," according to the brief. "Although these 'dual eligibles' accounted for only 15% of Medicaid enrollment in 2007, 39% of all Medicaid expenditures for medical services were made on their behalf. These same individuals also account for more than 25% of Medicare spending." The brief also provides a breakdown of "state-level estimates" of Medicaid enrollment and spending for dual eligibles (Rousseau et al., December 2010).

Urban Institute: America Under The Affordable Care Act - Using the institute's own modeling, the authors of this brief estimate how the new federal health law might affect insurance coverage and spending for acute care for people under the age of 65. "Health reform would cut the number of nonelderly persons without health insurance by more than half, from 49.9 million to 22.3 million. Of the 27.6 million who would gain insurance coverage under health reform, slightly more than half would gain public coverage through the Medicaid expansion; the rest would purchase private insurance," the authors report. Additionally, "[i]ndividual spending on health care would increase by 8.7% ... due mostly to spending on new health insurance by those uninsured before reform….[T]he increase in individual spending is less than one half of 1% of personal income" (Buettgens, Garrett and Holahan, December 2010).

The Commonwealth Fund: Realizing Health Reform's Potential: Adults Ages 50-64 And The Affordable Care Act Of 2010 - The new health law has potential to aid adults between the ages of 50 to 64 because that group suffers "from extended unemployment and a loss of employer health benefits." This issue brief (.pdf) reports that "of the 8.6 million 50-to-64-year-olds who were uninsured in 2009, up to 6.8 million would gain subsidized coverage once all the … provisions [of the new health law] go into effect in 2014. ... Prior to 2014, many adults in the 50-to-64 age group will benefit from early provisions in the law, many of which went into effect in 2010. These include preexisting condition insurance plans, which are available in all 50 states and the District of Columbia; new coverage of preventive care and flu vaccines without cost-sharing; and support to employers to help maintain health benefits for early retirees" (Collins, Doty and Garber, December 2010).

Kaiser Family Foundation: Income-Relating Medicare Part B and Part D Premiums: How Many Medicare Beneficiaries Will Be Affected? - This issue brief (.pdf) "examines the number of Medicare beneficiaries who will pay higher Part B or Part D premiums as a result of newly enacted provisions included the 2010 health reform law." The authors report that "3.5 million additional Medicare beneficiaries with incomes above $85,000/individual and $170,000/couple will be categorized as higher income by 2019, and thus subject to [a] higher income-related Part B premium by 2019. … In total, by 2019, we estimate that 7.8 million beneficiaries will pay the income-related Part B premium." Also, beginning in "2011, 1.2 million of the 2.4 million beneficiaries paying the income-related Part B premium will also pay the income-related Part D premium. … By 2019, an estimated 4.2 of the 7.8 million beneficiaries paying the income-related Part B premium will also be paying the income-related Part D premium - which together are estimated to range from $299 to $683 per month in 2019, depending upon income," they write (Cubanski et al., December 2010).

Center for Studying Health System Change: Who Are The Uninsured Eligible For Premium Subsidies In The Health Insurance Exchanges? - This paper (.pdf) examines the individuals who will be eligible to receive subsidies to purchase health insurance in the state-based exchanges, including their current health insurance coverage, health profiles and attitudes about health insurance, based on data from the 2007 Health Tracking Household Survey, the 2003 Community Tracking Study Household Survey and 2005-2007 Medical Expenditure Panel Survey-Household Component. Unlike the outreach efforts used to increase enrollment in Medicaid and CHIP, "outreach activities in the exchanges will have the … daunting challenge of ensuring sufficient enrollment of healthy and low-cost uninsured persons who have little or no contact with the health care system but would be expected to pay more than a nominal premium amount," writes the author of the brief. "Designating defined open-enrollment periods in the exchanges will help reduce the adverse selection created when people can wait to enroll until they need care," the author adds (Cunningham, December 2010).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.