Consumers Unsure of Their Insurance Choices

A new survey by PolicyGenius, a digital insurance brokerage and multi-product shopping platform, finds most Americans (50 percent) are not sure if they have the right level of insurance, and they don’t consider it a high financial priority – which could prove to be a critical mistake. An additional seven percent of respondents have no idea what level of insurance they have.

Among other findings from the survey conducted last month were:

  • Nearly two thirds (59 percent) of consumers conduct online research as a first step when shopping for insurance.
  • Almost half (48 percent) feel they have less health insurance than they need and reported their last insurance experience was a negative one.
  • Women are less comfortable than men about their financial decisions, with 41 percent saying they are “not too confident” in contrast to 61 percent of men who say they are “pretty confident” in their choices.
  • Those ages 25 to 34 are least confident in their insurance decisions, with 54 percent reporting too much or not enough insurance.

“There’s a serious gap in insurance understanding, protection, and access in the U.S., which additional studies have shown lead to financial hardships including bankruptcy,” said Jennifer Fitzgerald, co-founder and CEO of the survey sponsor. “We hope to bring the nation closer to the help it needs to avoid these financial hardships and the disasters that underinsurance causes.”

QHP and Exchange Grades May Be Coming in 2015

Public health insurance exchange and Qualified Health Plan (QHP) user experience ratings may not be available until after open enrollment ends for 2015 coverage under the Affordable Care Act (ACA). That’s because rules established by the Centers for Medicare & Medicaid Services (CMS) set the beta testing of “enrollee experience surveys” from January 2015 through April 2015.

QHPs and exchanges have the option to do what they want with the data from the beta test period. CMS and the U.S. Department of Health & Human Services (HHS) have no current plans to post the results publicly. The data could be published by the exchanges or QHPs if they wish.

CMS is already working with one vendor on a psychometric test of the user experience based on a sample of 4,200 consumers. (Psychometrics is the study and objective measurement of skills, knowledge, abilities, attitudes, and validation of questionnaires, tests, and raters’ judgments.) CMS hopes to have 40 exchanges and QHPs conduct surveys in 2015. Results are scheduled for publication by HHS in 2016, including possible data from enrollees in off-exchange plans.

Open enrollment for 2015 coverage under the ACA is set to begin November 15, 2014 and will continue through February 15, 2015. The White House and HHS recently announced self-renewal for those who chose a qualified health plan through the HealthCare.gov website for 2014. That will likely relieve some of the pressure from what is expected to be a busy 2015 enrollment season – with some industry analysts forecasting 12 to 16 million enrollees, up from 8 million in 2014. 

Court Rulings Cloud Federal Subsidies for 2015 Enrollments

A three-judge panel for the U.S. Court of Appeals in Washington, DC, ruled last week that premium subsidies may not be offered in the federal health insurance exchange. The decision overturns a lower court ruling.

As reported by Kaiser Health News, a three-judge panel at the U.S. Appeals Court for the District of Columbia Circuit threw the fate of an important part of the Affordable Care Act (ACA) into doubt on July 22, 2014.

In a 2-1 decision in Halbig v. Burwell, the judges ruled the Internal Revenue Service lacked the authority to allow subsidies to be provided in exchanges not run by the states. That could put at immediate risk the coverage of millions of people who bought insurance in the 36 states where online insurance marketplaces are run by the federal government. (The California health exchange, Covered California, is run by the state and is not expected to be affected by the DC Appeals Court’s ruling.)

The Obama administration has said it will appeal. The Justice Department will ask the entire appeals court panel to review the decision; that panel is dominated by judges appointed by Democrats, 7-4, and the ruling could be reversed by the full panel. The matter is also under review in other courts around the country.

Hours later on July 22, the Fourth Circuit Court of Appeals in Virginia offered its own decision, which upholds the Obama administration's arguments that subsidies can be applied in the federal exchange.

It is likely each decision will be appealed to the U.S. Supreme Court, which could delay ruling until 2015, after open enrollment for 2015 ACA coverage has ended.

Patient Demand Not Up as Expected Under ACA

A new study by Athenahealth and the Robert Wood Johnson Foundation designed to measure the impact of the Affordable Care Act (ACA) on health care providers, patients, and physicians found no influx in new patient volume in the first five months of 2014. In a national sample of 14,300 providers across the Athenahealth network, patient volume actually dropped slightly as compared to the same period in 2013. These findings contradict forecasts of a potential doctor shortage and difficulty for patients seeking treatment under new coverage resulting from the ACA. So far, providers have not seen a big increase in new patient volume.

In states that are expanding Medicaid coverage under the ACA, data did show an overall increase in Medicaid beneficiary patient visits. In expansion states, on average, the percentage of Medicaid-covered patients being seen by primary physicians is on the rise – with Medicaid patients accounting for 12.3 percent of care in December 2013 as compared to 15.6 percent in May 2014. Conversely, states not expanding Medicaid coverage have seen physician visits remain flat.

“Health care leaders are unclear about how health reform ultimately impacts them and their patients, and they need more information on how new policies affect practices,” said Katherine Hempstead of the Robert Wood Johnson Foundation, which has worked for four decades to improve the health and health care of Americans. “The new ACAView study helps connect the dots. Already the data suggests some surprises. There hasn’t been an immediate increase in primary care utilization, and no major influx of chronically ill people into the system. These and other measures will be important to watch over time.”

40% Would Quit for Comparable Insurance

If you’ve discounted the idea that any of your employees – or your colleagues – consider themselves “job locked” for insurance benefits, think again. According to a study by Securian Financial Group, 40 percent of those surveyed said they would leave their jobs if they could purchase health insurance on the open market that is comparable to their existing coverage and out-of-pocket expenses.

The Securian study is based on a survey of 767 Americans employed full time (94 percent) or part-time (six percent) with health insurance as an employee benefit.  More than half (55 percent) hold managerial or professional positions. Fifty percent reported annual household incomes of $50,000-$99,999, and 23 percent reported yearly income of $100,000 or more.

The vast majority of respondents, 91 percent, say they like the work they do, while 83 percent say they are satisfied or somewhat satisfied with their current health insurance. However, many still dream about doing something else.

“More than half (56 percent) say they have considered leaving their jobs to do something more personal or meaningful, but they didn’t because they need the health insurance they currently purchase in the work place,” said Michelle Hall, manager of market research at Securian Financial Group. “Of that group, more than two-fifths (43 percent) say they would start their own business.”

Another 16 percent who have considered quitting say they would work in a field they prefer where jobs typically provide little or no health insurance. Forty-three percent of those taking part in the survey said they had turned down job offers because the health insurance benefit did not meet their needs. This was true for 46 percent of married respondents and 34 percent of single persons who took the survey.

California Offering Employers a Coverage Extension

California Governor Jerry Brown signed legislation early this month that gives small businesses additional time to comply with the Affordable Care Act (ACA). California Senate Bill (SB) 1446 permits employers with fewer than 50 employees to extend their current health plans until the end of 2015 subject to some plan limitations.

If SB 1446 had not been approved by the legislature and governor, employers would have been required to purchase new, ACA-compliant coverage by the end of 2014.

To qualify for the coverage extension, existing plans must have been in effect on December 31, 2013; still have been in force as of July 7, 2014 when the legislation was signed by the governor; and not qualify as a “grandfathered” plan under the ACA. A grandfathered plan is one that was in force on March 23, 2010 (when the ACA was signed into law) that has not been changed in ways that substantially cut benefits or increase costs for those persons insured under the plan.

The California Department of Insurance said in a statement the extension is “a victory for all California small businesses” by providing them with additional time to transition to Affordable Care Act-compliant policies. While the new law could benefit a substantial number of the estimated quarter-million California employers in the small group insurance market, the executive director of the California chapter of the National Federation of Independent Businesses (NFIB) still has reservations. John Kabateck told National Public Radio affiliate KPCC that an earlier version of the measure would have given small businesses a three-year reprieve from complying with the ACA.

Uninsured Remain Underserved by Health Exchanges

While the aim of the Affordable Care Act (ACA) is to reduce costs and increase access to health insurance, many Americans still are uninsured and underserved due to obstacles not based on cost, according to the inaugural J.D. Power 2014 Health Insurance Marketplace Shopper Study released earlier this month.

Satisfaction varies widely based on a variety of factors; however, cost is a key reason shoppers who have wanted health insurance in the past were unable to obtain it (89 percent). Other reasons include pre-existing conditions (26 percent) and not knowing where to buy insurance (10 percent).

Many shoppers who began the online application process had problems completing enrollment due to three primary reasons: a combination of technical problems (40 percent); the application process taking too long (19 percent); and the website not having enough information about the plans to make a selection (18 percent). Additionally, 49 percent of shoppers who did not complete enrollment did not choose a plan during their initial shopping experience because they had not decided which plan they wanted.

Designed to evaluate the health insurance shopping experience of the previously uninsured, the inaugural study examines enrollment satisfaction among 1,632 U.S. consumers who shopped for health insurance under the Affordable Care Act from November 2013 through April 2014. More information on the study is available here.

ACA Progress Report: 20 Million Covered So Far

A new Commonwealth Fund report published this month in the New England Journal of Medicine says about 20 million Americans have gained health insurance or enrolled in new insurance under the Affordable Care Act (ACA). That includes eight million who enrolled for coverage through the state and federal health insurance exchanges as well as an additional 12 million who gained coverage through other ACA provisions.

Authors of the study estimate 7.8 million individuals between the ages of 19 and 25 are now covered as dependents (until age 26) under their parents’ health insurance plans. (A federal survey suggests the number of young adults without health insurance has declined to three million since the ACA was enacted – a decline of one million.) Another five million who were previously uninsured because of age or pre-existing health conditions now have coverage under the ACA.

Six million gained health coverage through the ACA’s expansion of Medicaid and additional funding of the Children’s Health Insurance Program. A 2012 decision by the Supreme Court made state participation in the expansion of Medicaid discretionary; thus far, 28 states and the District of Columbia are moving ahead with expansion, including six states taking a more custom approach that still requires federal approval.

As far as the individual marketplaces, the current participation level of eight million is projected to balloon in the future. The Congressional Budget Office is forecasting 25 million enrolled through the individual marketplaces by 2017. The spike will come through the annual open enrollments as well as special enrollments throughout the year as a result of a qualifying event like marriage, divorce, or a job change.

Workers Concerned About Employer Health Plans

A new study by The Morning Consult finds two-thirds of employees surveyed are at least somewhat concerned about their employers moving them onto a public health insurance exchange.

When asked what effect a move to a public health exchange would have on their coverage, 27 percent say it would be somewhat negative and 24 percent say it would be very negative. Those numbers contrast sharply with the seven and nine percent who view the move to an exchange as potentially very positive or somewhat positive.

What may be a surprise to employers is the view expressed by a majority – 52 percent – who say they would seriously consider looking for a new job if they had to move to the state or federal exchanges.

Asked about the future of the Affordable Care Act (ACA) and what Congress might do about the health law, 36 percent would like to see changes made to improve the law and 14 percent would like to expand the ACA. One-fifth of those surveyed support the law as it is and would leave it alone, while 29 percent would like to the ACA further delayed, repealed, or defunded.

Most Americans Get a Failing Grade on Medical IQ

While most Americans like to think of themselves as savvy health care consumers, a new survey from the Vitals Index finds a majority don’t know basic quality information about their doctor. In fact, more than 60 percent of respondents didn’t know which medical school their doctor attended and 10 percent said it didn’t matter.

Besides not heeding quality indicators regarding their providers, consumers were also blind to cost-savings for their care. Just one-third said they negotiate bills with a doctor or hospital. Similarly, only one in three knows the cost of a medical service or procedure before receiving care. Women (39 percent) were more likely than men (29 percent) to know the cost of a procedure or doctor visit in advance of being treated.

Studies in the past have shown patients who are engaged and know more about their health care have lower costs and better health outcomes.  The Vitals Index survey found a direct correlation between health care understanding and income. Households with incomes at or below $50,000 were the least likely to know a doctor’s background or understand insurance terms. They were also 50 percent less likely to negotiate medical bills compared to higher-income households.

One bright spot is about 80 percent of consumers do regularly ask for generic equivalents of their prescriptions to save money. Sixty-seven percent of people know retail clinics offer flu shots at a lower cost than most doctor’s offices or hospitals.