THE MEDICAL JOURNAL Health costs rise and 50 million Americans have no insurance
November 17, 2010
Today, health care is looking anything but secure. A report released this week by the federal Centers for Disease Control and Prevention calculates that 50 million Americans ages 18 to 64 and surveyed between January and March went without health insurance for at least part of the past year. More than half of them had no usual source of medical care. Among adults with at least one disability and no insurance, 61 percent said they had skipped or delayed recommended medical care in the past year due to concern about cost. But so did 16 percent of disabled adults with health coverage. For those who have insurance, particularly through an employer, the costs are going up, either through a bigger share of higher premiums or bigger deductibles, co-payments and other cost-sharing, and usually both. And a survey of employer health benefits for 2010 released in September showed that workers on average are paying nearly $4,000 a year toward the cost of family coverage that carried a total average tab of $13,770 (3 percent more than in 2009), and that workers were contributing 14 percent more than what they paid in 2009. More than a quarter of all covered workers now must pay deductibles of $1,000 or more, with almost half of workers at smaller firms (under 200 workers) under such plans. The survey, done for the Kaiser Family Foundation and Health Research and Educational Trust in each of the past 12 years, shows that worker contributions to health premiums have gone up 47 percent since 2005, while premiums rose 27 percent, wages increased just 18 percent and overall inflation rose 12 percent. Although preferred-provider plans still cover most workers, the only type of coverage that actually increased were high-deductible plans coupled with health-savings accounts, which now cover 13 percent of all employees, up from 8 percent in 2009. "With the economy struggling, businesses have been shifting more of the costs of health insurance to workers through premiums, deductibles and other cost-sharing," said Kaiser President Drew Altman. While those changes may help keep premiums from rising as steeply, "it also means that employer coverage is less comprehensive." No one knows just how costs will change for 2011 -- still three years away from the premium subsidies and purchasing exchanges and expanded coverage promised under the Affordable Care Act approved earlier this year. One survey done by the William Mercer consulting firm in late summer found employers anticipating health-premium costs to rise by 9 percent to 12 percent, and that they would again seek to have workers pay a greater share of those costs -- something many workers with fall health-plan-enrollment periods are already seeing. Employers in the survey attributed a couple of percentage points of the premium boosts to the added benefits mandated under the health-reform bill, such as the elimination of lifetime limits on basic benefits and guaranteed coverage of dependents through age 26 and greater coverage of preventive services. It's unclear to what extent attempts by newly empowered congressional Republicans to repeal, alter or de-fund the health plan might have on the health-care market during 2011 and beyond, but most companies and insurers are preparing for continued compliance with the law. While some workers will simply opt out of coverage because of higher premiums, most will try to keep paying their share and maintain coverage, but may find high deductibles or co-pays daunting and opt to delay or skip medical appointments, tests and filling prescriptions. And that's where the scrimping noted in the CDC survey comes into play. Two studies published in the November issue of Health Affairs illustrate the impact of co-pays for drugs. Both showed that when employers or insurers dropped co-pays, patients were between 2 percent and 4 percent more likely to stay on track in taking life-saving drugs to prevent strokes, heart attacks, diabetes and high blood pressure. What the research could not show is how much expensive hospital care those patients avoided because they took their drugs as prescribed. Most of the next decade is going to be spent figuring out what health-coverage doctrines will work best to save both money and lives.
Contact Lee Bowman at BowmanL(at)shns.com
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