USA FOR PROFIT HEALTH CARE
Helping people save for health costs: Poll finds tax-free accounts used less by those who may need them most
1 in 5 people over 50 not confident they can pay for health costs; those who are older, have lower incomes or less education, less likely to have health account
Reports and ProceedingsIMAGE: KEY FINDINGS FROM THE NATIONAL POLL ON HEALTHY AGING POLL OF OLDER ADULTS ABOUT WHETHER AND HOW THEY SAVE FOR FUTURE HEALTH CARE COSTS. view more
CREDIT: UNIVERSITY OF MICHIGAN
Most older adults are not using tax-advantaged savings accounts to save for future health expenses, a new poll of people age 50 to 80 suggests, and those who do are more likely to have high incomes and education levels, and to be in good health and under Medicare eligibility age.
At the same time, 18% of people age 50 to 80 are not at all confident that they’ll have enough money to pay their share of health costs in the next year, and 15% have had trouble paying for health care in the past year, according to a new report from the National Poll on Healthy Aging. Some said that worries about costs made them delay seeking care in 2020 (13%), or kept them from seeking care they needed (12%).
In all, 29% of older adults say they’re specifically saving money for future health costs. Among those who aren’t, 40% say they have enough to pay for health costs without having to set aside money just for this purpose, but 27% said they can’t afford to save for future health costs.
Most of the older adults who are saving for health costs say they’re using a regular bank account, which doesn’t offer a tax advantage for health-related spending. Just 12% said they have a flexible spending account, or FSA, which allows tax-free savings and withdrawals for health costs. Less than half (45%) of those who may qualify to open a tax-free health savings account, or HSA, because of the high deductible on their health insurance plan had actually opened one.
Having an FSA was much more common among those age 50-64, those with incomes over $100,000, and those with at least a four-year college degree compared with those over 65, with incomes under $30,000, and with a high school diploma or less. Similar trends were seen for HSAs and Health Reimbursement Accounts, another tax-free option offered by some employers. People who said they were in fair or poor health were less likely to have either.
The findings suggest that more should be done to help older adults understand and use accounts that, if they qualify to open one, can save them money by reducing taxes on the dollars they use for health care. The authors also note that other efforts, such as insurance coverage for essential services before a person meets the deductible on their plan, could be needed to remove cost-related barriers to care for the lowest-income older adults.
The poll is based at the University of Michigan’s Institute for Healthcare Policy and Innovation and receives support from AARP and Michigan Medicine, U-M’s academic medical center. The new report is based on answers from a national sample of more than 2,000 adults aged 50 to 80 to a poll taken in January 2021.
Tax breaks to encourage wise health saving and spending
“As health insurance plans ask people to pay for more of their health care out of their own pockets, such as through high deductibles, tax-free accounts can help people avoid getting shocked by a sudden health care expense or having to choose between health care and other demands for their dollars,” said Jeffrey Kullgren, M.D., M.P.H., M.S., associate director of the poll and first author of the new report. “But these findings suggest we have a way to go in encouraging the use of these accounts, especially by those most sensitive to out-of-pocket costs because of income or health status.” Kullgren is an associate professor of internal medicine at U-M and an internist at the VA Ann Arbor Healthcare System.
“As we age, we tend to need more health care, and having to pay more out of pocket for essential services can deter access, worsen health care disparities and in some circumstances lead to higher costs down the road,” said A. Mark Fendrick, M.D., who advised the poll team and heads the Center for Value-Based Insurance Design. “These findings should inform efforts to promote the use of these accounts and encourage designers of high-deductible health plans (HDHPs) to remove cost barriers to high value services.”
In addition to special accounts, insurance plans can reduce or eliminate the co-pays and cost-sharing for the types of care that provide the highest value for the individual patient. The Affordable Care Act made some preventive care free to all in insurance plans run by private companies. Fendrick advocated for a 2019 guidance issued by the U.S. Department of Treasury that allowed HSA-HDHPs to cover chronic disease services on a pre-deductible basis.
CAPTION
Key findings from a National Poll on Healthy Aging report about why older adults said they weren't saving for future health care costs.
CREDIT
University of Michigan
Patients and providers should speak up
Poll director Preeti Malani, M.D. also notes the key role of open communication between patients and health providers if they have any concerns about affording the medications, tests, scans and procedures being recommended to them. “If a patient doesn’t raise these concerns, and a physician or other provider doesn’t ask, we can have a situation where necessary care is delayed, problems go undiscovered or untreated, and health worsens,” she said.
Even if someone does not currently have an FSA, an HSA or an HRA, the fall Open Enrollment time is approaching for most employers’ job-related health insurance, as well as for Medicare and individual plans bought on www.healthcare.gov. That makes September and early October a great time to find out what you might be eligible for.
“High medical costs can lead to worse health outcomes for older adults, who may delay care or not properly manage their chronic conditions,” said Alison Bryant, Ph.D., senior vice president of research for AARP. “While high deductible health plans paired with an HSA and other savings accounts are a good option for some, they aren’t for everyone – particularly lower income workers who cannot afford to save for future care. AARP believes all Americans should have access to adequate, affordable health care, and that financial assistance should be available to consumers with low incomes to ensure they can get the care they need.”
AARP offers resources about affording health care, including a calculator to help individuals determine if a HDHP with an HSA is right for them, compared to a conventional health plan with a lower deductible but higher monthly costs. The healthcare.gov site offers more information about FSAs and HRAs for small businesses or employees who buy their own insurance.
The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 2,074 adults aged 50 to 80 who answered a wide range of questions online in January 2021. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have them. A full report of the findings and methodology is available at www.healthyagingpoll.org, along with past National Poll on Healthy Aging reports.
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
Health insurance coverage declined during the pandemic
2.7 million Americans lost health insurance over a 12-week period in Spring and Summer 2020
Peer-Reviewed PublicationDURHAM, N.C. -- Nearly 2.7 million people in the U.S. lost their health insurance over a 12-week period in the spring and summer of 2020 during the COVID-19 pandemic, according to a new study led by researchers at Duke University and Indiana University-Purdue University Indianapolis.
However, a different pattern emerged in fall 2020. While rates of employer-based coverage continued to decline during the fall and winter, people increasingly enrolled in government health insurance programs to fill the coverage gap.
The study appears in the September issue of the JAMA Health Forum.
“We wanted to do this research because there was a lot of uncertainty about the impact of the pandemic on the loss of health insurance,” said M. Kate Bundorf, J. Alexander McMahon Distinguished Professor of Health Policy and Management at Duke’s Sanford School of Public Policy.
”While the study shows that people lost employer-sponsored coverage, which is not surprising given the magnitude of the job loss, we also find that many people gained coverage through public programs. Many of these programs are newly available through the Affordable Care Act, indicating that recent policy changes created a safety net that has been supporting many people during the pandemic.”
The early days of the COVID-19 pandemic saw a huge and rapid decline in employment, with the unemployment rate peaking at 14.7 percent in April 2020. Employment drops during a recession typically play out over months, not days or weeks, said Bundorf. The initial two-month employment decline during 2020 was about 50 percent larger than the two-year decline in the Great Recession.
The primary source of health insurance coverage for U.S. working-age adults is through their employer, so losing a job not only leads to loss of income, but loss of health insurance. The high cost of COVID-19-related health care increased the possible negative consequences of being uninsured.
The researchers used data from the 2020 Household Pulse Survey, a U.S. Census Bureau survey of over 1.2 million adults across all states and Washington, D.C. They analyzed data and documented the change in insurance coverage from April 23 to Dec. 21, 2020.
From April 23 through July 1, 2020, the number of uninsured increased by 1.4 percentage points, representing more than 2.7 million people. The decline in overall coverage was driven by a decline in rates of employer-sponsored coverage that was only partially offset by an increase in other sources of coverage, at least initially.
While employer-sponsored coverage continued to decline between August and December, 2020, increases in other sources of coverage fully offset the decline, resulting in stable rates of overall coverage during that time period.
“Some expected many more people would have lost their insurance coverage given the enormous decline in employment,” she said. “However, our study found that, while employer-sponsored insurance did indeed decline during the COVID-19 pandemic, many people enrolled in coverage from other sources, primarily government programs.”
The increase in numbers of uninsured people in the spring and summer was concentrated in states that had not expanded Medicaid. Early in the pandemic, the decline was also concentrated among men, people aged 27 to 50 years, Hispanics and low-income families. For these groups, employer-sponsored insurance declined and increases in other sources of coverage did not fully offset the decline.
“It does appear that the mechanisms put in place by the Affordable Care Act played an important role in insulating people from the impact of losing their health insurance,” Bundorf said.
The results suggest that Medicaid in particular provided a safety net for a broad population. The Affordable Care Act expanded Medicaid coverage to all low-income adults in many states, and The Families First Coronavirus Response Act prevented states from terminating Medicaid coverage during the pandemic.
The researchers found that enrollment in public programs increased throughout the year, but found no evidence of increases in individual private insurance.
“It may be that as the pandemic progressed, people became more aware of the options for coverage,” said Bundorf. “We hope that people continue to assess their options if they lose their employer-sponsored coverage. There are alternatives but the system is complicated. In some cases, people need to act promptly during a pre-specified open enrollment period.”
Insurance coverage trends for 2021 are not yet clear, Bundorf said.
“The labor market has improved, hopefully leading to increases in employer-based coverage and reductions in the number of people without coverage,” Bundorf said. “Policies also promoted enrollment in ACA Marketplace coverage with expanded open enrollment periods and increases in subsidies suggesting that more people may have turned to private insurance during 2021.”
While unemployment rates are now much lower, at 5.6 percent in May of 2021, employment recovery has lagged among racial and ethnic minority populations. That points to the continued importance of safety-net programs, both in providing coverage and addressing disparities, the authors said.
As the economy continues to improve and employment increases, it will be important to track whether rates of employer-sponsored coverage recovered in 2021 or people continued to rely on public programs or remain uninsured, the authors added.
CITATION: “Trends in U.S. Health Insurance Coverage during the COVID-19 Pandemic,” by M. Kate, Bundorf, Sumedha Gupta and Christine Kim, September, JAMA Health Forum.DOI:10.1001/jamahealthforum.2021.2487.
JOURNAL
JAMA Health Forum
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Trends in U.S. Health Insurance Coverage during the COVID-19 Pandemic
ARTICLE PUBLICATION DATE
8-Sep-2021
Republicans less likely to accept ACA subsidies to purchase health insurance
Annual financial loss tied to political affiliation is $800
Peer-Reviewed PublicationRepublicans who buy individual health plans may be less likely to shop through marketplaces created under the federal Affordable Care Act, leading to them to forgo subsidies provided by the federal government, according to a new study.
Examining the behavior of enrollees of a large health plan in New England, researchers found that Republicans who bought individual plans were less likely than Democrats to make use of subsidies that they were eligible to receive – forgoing an average of about $800 annually as compared to similar Democrats.
Neither Republican nor Democratic subscribers fully took advantage of all the subsidies that were available to them. But researchers found that the overall financial impact of not making use of subsidies was roughly double for Republicans as compared to Democrats.
The study is published in the September edition of the journal Health Affairs.
“These findings suggest that political polarization may lead some individuals to not make full use of federal programs intended to make health care coverage more affordable for Americans,” said Joachim O. Hero, the study’s lead author and an associate policy researcher at the RAND Corporation, a nonprofit, nonpartisan research organization.
“With the size of federal health care subsidies growing, it will be a challenge for policymakers to develop marketing and education programs that avoid labels and language that bring to mind contentious political battles at the national level,” Hero said.
Researchers say that one approach to improve uptake of health care subsidies may be to make the assistance available to eligible consumers who use alternatives to the publicly run health insurance exchanges operated under provisions of the Affordable Care Act.
The analysis was conducted within a larger study examining consumers’ preferences and behaviors in the nongroup insurance market.
Two surveys, a baseline in 2017 and a follow-up in 2018, were sent to a random sample of nongroup plan subscribers aged 18 to 63 from a single health insurer serving New Hampshire, Maine and Massachusetts. During the study period, potential subscribers in New Hampshire and Maine used the federal marketplace platform (HealthCare.gov) to enroll in Marketplace plans, while potential subscribers in Massachusetts used a state marketplace platform.
A total of 1,223 people completed both surveys, which asked participants about sociodemographic and clinical information, education, income, family composition and a number of questions about party affiliation and political views.
Information from the survey was merged with health insurance enrollment records, including source of enrollment (on versus off government marketplace), federal subsidies applied to plan premiums and health plan characteristics.
The study found Republican subscribers in nongroup health plans generally were less likely to enroll through the ACA Marketplaces than Democratic subscribers with the same sociodemographic profile.
However, there was no difference in ACA Marketplace participation or subsidy take-up by party among people in the lowest income groups (those with less than 250% of the federal poverty level), who were eligible for subsidies worth thousands of dollars.
Similarly, no party differences were observed among those who had chronic illnesses, who typically have higher overall health care spending.
Examination of write-in responses on the surveys found expressions of both support and opposition to the Affordable Care Act as the reasons for or against enrolling through the government-run Marketplaces.
“Coordination with individual carriers and brokerage networks or greater ability to enroll through private websites, may expand opportunities for eligible subscribers to enroll in subsidized plans via avenues that feel more comfortable or less politicized,” Hero said.
Support for the project was provided by the federal Agency for Healthcare Research and Quality. Other authors of the study are Anna D. Sinaiko of the Harvard T. H. Chan School of Public Health, Alon Peltz and Alison A. Galbraith, both of the Harvard Medical School and the Harvard Pilgrim Health Care Institute, and Jon Kingsdale of the Boston University School of Public Health.
RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.
Annual financial loss tied to political affiliation is $800
Republicans who buy individual health plans may be less likely to shop through marketplaces created under the federal Affordable Care Act, leading to them to forgo subsidies provided by the federal government, according to a new study.
Examining the behavior of enrollees of a large health plan in New England, researchers found that Republicans who bought individual plans were less likely than Democrats to make use of subsidies that they were eligible to receive – forgoing an average of about $800 annually as compared to similar Democrats.
Neither Republican nor Democratic subscribers fully took advantage of all the subsidies that were available to them. But researchers found that the overall financial impact of not making use of subsidies was roughly double for Republicans as compared to Democrats.
The study is published in the September edition of the journal Health Affairs.
“These findings suggest that political polarization may lead some individuals to not make full use of federal programs intended to make health care coverage more affordable for Americans,” said Joachim O. Hero, the study’s lead author and an associate policy researcher at the RAND Corporation, a nonprofit, nonpartisan research organization.
“With the size of federal health care subsidies growing, it will be a challenge for policymakers to develop marketing and education programs that avoid labels and language that bring to mind contentious political battles at the national level,” Hero said.
Researchers say that one approach to improve uptake of health care subsidies may be to make the assistance available to eligible consumers who use alternatives to the publicly run health insurance exchanges operated under provisions of the Affordable Care Act.
The analysis was conducted within a larger study examining consumers’ preferences and behaviors in the nongroup insurance market.
Two surveys, a baseline in 2017 and a follow-up in 2018, were sent to a random sample of nongroup plan subscribers aged 18 to 63 from a single health insurer serving New Hampshire, Maine and Massachusetts. During the study period, potential subscribers in New Hampshire and Maine used the federal marketplace platform (HealthCare.gov) to enroll in Marketplace plans, while potential subscribers in Massachusetts used a state marketplace platform.
A total of 1,223 people completed both surveys, which asked participants about sociodemographic and clinical information, education, income, family composition and a number of questions about party affiliation and political views.
Information from the survey was merged with health insurance enrollment records, including source of enrollment (on versus off government marketplace), federal subsidies applied to plan premiums and health plan characteristics.
The study found Republican subscribers in nongroup health plans generally were less likely to enroll through the ACA Marketplaces than Democratic subscribers with the same sociodemographic profile.
However, there was no difference in ACA Marketplace participation or subsidy take-up by party among people in the lowest income groups (those with less than 250% of the federal poverty level), who were eligible for subsidies worth thousands of dollars.
Similarly, no party differences were observed among those who had chronic illnesses, who typically have higher overall health care spending.
Examination of write-in responses on the surveys found expressions of both support and opposition to the Affordable Care Act as the reasons for or against enrolling through the government-run Marketplaces.
“Coordination with individual carriers and brokerage networks or greater ability to enroll through private websites, may expand opportunities for eligible subscribers to enroll in subsidized plans via avenues that feel more comfortable or less politicized,” Hero said.
Support for the project was provided by the federal Agency for Healthcare Research and Quality. Other authors of the study are Anna D. Sinaiko of the Harvard T. H. Chan School of Public Health, Alon Peltz and Alison A. Galbraith, both of the Harvard Medical School and the Harvard Pilgrim Health Care Institute, and Jon Kingsdale of the Boston University School of Public Health.
RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.
JOURNAL
Health Affairs
Health Affairs
DOI
METHOD OF RESEARCH
Survey
Survey
SUBJECT OF RESEARCH
People
People
ARTICLE TITLE
In New England, Partisan Differences In ACA Marketplace Participation And Potential Financial Harm
In New England, Partisan Differences In ACA Marketplace Participation And Potential Financial Harm
ARTICLE PUBLICATION DATE
8-Sep-2021
8-Sep-2021
BU study explores the effect of consumer advertising of cosmetic procedures on patients
Peer-Reviewed Publication(Boston)—Direct to consumer (DTC) advertising is a common form of healthcare communication and pharmaceutical marketing in the United States. Throughout the last few decades, pharmaceutical expenditures have shifted from targeting physicians to targeting select consumers.
Now a new study finds that while DTC advertisements provide meaningful information to patients and promote communication between patients and physicians, they also appear to exaggerate benefits while making procedures appear simple and without risks, suggesting trained medical professionals are not needed to perform procedures.
“Not only do DTC advertisements urge patients to actively seek information about products after viewing them, but they also encourage discussion between patients and physicians, however these commercials occasionally create a dichotomy between providing patient education and misinformation,” explained corresponding author Neelam Vashi, MD, associate professor of dermatology at Boston University School of Medicine and director of the Boston University Cosmetic and Laser Center at Boston Medical Center.
In 2016, drug companies spent $9.6 billion on DTC advertisements and the typical American was exposed to an average of nine drug advertisements daily. Only a few studies have been conducted to examine the impact of DTC advertisements on cosmetic procedures, however little research exists about cosmetic procedures ads and the inclusion of health risk information with regards to how they impact consumer opinions.
A total of 203 participants were recruited from dermatology clinics at an urban academic medical center to view two DTC advertisements. Questionnaires were administered to assess opinions towards cosmetic procedures both before and after the viewing.
After watching the advertisements, the researchers found an 18.8 percent and 24.6 percent increase in participants reporting a desire to view commercials as an information source and seeking out additional medical knowledge, respectively. Also after watching the advertisements, there was a 14.4 percent increase in participants who believed advertisements facilitate better discussions between patients and physicians and a 33 percent increase in patients reporting they would discuss the procedures with their doctors. Sixty percent of participants felt the advertisements did not provide enough information about the possible risks of the product while 39.4 percent believed a physician was not required to perform cosmetic procedures.
Vashi stresses that it is important to educate patients that cosmetic procedures are not, in fact, simple and risk free and should be performed by board-certified individuals who are properly educated and trained.
These findings appear online in the journal Dermatologic Surgery.
JOURNAL
Dermatologic Surgery
METHOD OF RESEARCH
Case study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Impact of Direct-to-Consumer Advertising of Cosmetic Procedures on Consumers
ARTICLE PUBLICATION DATE
4-Sep-2021
