Research roundup: Predicting the health law's effects on small business, uninsured, disparities

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Health Affairs: Small Firms' Actions In Two Areas, And Exchange Premiums And Enrollment Impact -- Using a RAND assessment tool, researchers aimed to "predict the effects of self-insurance and grandfathering exemptions on coverage and premiums available" on policies for small businesses sold in the insurance exchanges (which the health law requires in 2014).  They conclude: "The Affordable Care Act regulations restricting employers' ability to offer grandfathered plans will result in lower premiums on plans available through the exchanges and will have small negative effects on enrollment in the exchanges. Our results suggest that these regulations are essential to keeping premiums on the Small Business Health Options Program (SHOP) exchanges affordable" (Eibner et al., February 2012).

New England Journal of Medicine: Sources of Regional Variation in Medicare Part D Drug Spending -- The authors analyzed 2008 Medicare spending on three types of drugs for 4.7 million beneficiaries to see if regional variation in spending reflected "differences in health status, use of effective treatments, or selection of branded drugs over lower-cost generics." The found that the average adjusted per capita pharmaceutical spending ranged from $2,413 in the lowest to $3,008 in the highest quintile of hospital referral regions and concluded that the variation "results largely from differences in the cost of drugs selected rather than prescription volume. A reduction in branded-drug use in some regions through modification of Part D plan benefits might lower costs without reducing quality of care" (Donohue et al., 2/9).

Kaiser Family Foundation: Income-Relating Medicare Part B and Part D Premiums Under Current Law And Recent Proposals: What Are The Implications For Beneficiaries? -- In light of "proposals to raise premiums for higher-income Medicare beneficiaries" currently being discussed in Washington, this issue brief "describes current law with respect to the income-related Medicare premiums ... as well as how the new proposals would increase the number and share of beneficiaries who would pay the higher premium, and the amounts that they would pay." The authors raise concerns that "given the relatively low incomes of most people on Medicare, significant savings from such proposals are only possible by going relatively far down the income scale at which point the affordability of these additional costs could be called into question" (Cubanski, Neuman, Jacobson and Smith, 2/8).

Commonwealth Fund: The Income Divide In Health Care: How The Affordable Care Act Will Help Restore Fairness To The U.S. Health System -- "Nearly three of five (57 percent) adults with income below 133 percent of poverty were uninsured for some time during the past year," according to the authors who write that "uninsured lower-income adults were more likely than insured adults in the same income group to cite factors other than medical emergencies as reasons for going to the emergency room. These included needing a prescription drug, not having a regular doctor, or saying that other places cost too much." They conclude that the Affordable Care Act will "substantially narrow these inequities through an extensive set of affordable coverage options starting in 2014" (Collins et. al., February 2012).

Related KHN story: Nowhere To Go But Up For The Poor Lacking Insurance, Says Study (Rau, 2/7)

UCLA Center For Health Policy Research: The State Of Health Insurance In California: Findings From The 2009 California Health Interview Survey -- This report found that 7.1 million Californians were uninsured in 2009, more than 21 percent of nonelderly Californians. The authors focused on medical debt, which was "was highest among those uninsured all of the year (of whom 18.4 percent had debt) and among those uninsured for part of the year (23.2 percent). But even 9.1 percent of those with employment-based coverage reported some kind of medical debt." The authors noted that Latinos and African Americans will have more access to health services after the implementation of the ACA, though "only three-fourths of uninsured Latinos will be able to gain coverage ... The rest will be ineligible to participate in the coverage expansions due to their citizenship status" (Lavarreda et. al., 2/6).