Private Insurance: Affordability
Affordability of Coverage includes studies and other materials that document the rising costs of coverage and ways to address this problem for Americans.
From Families USA
Wellness Programs: Evaluating the Promises and Pitfalls presents an overview of current programs, identifies how their role could soon change, explains how certain programs can limit access to coverage and care, and provides recommendations for policies that will help prevent these programs from limiting access. (June 2012)
Good Business Sense: The Small Business Health Care Tax Credit in the Affordable Care Act provides national and state-level estimates of the number of small businesses that will be eligible for this tax credit and of how much the credits will be worth. It also includes data on how many workers could benefit as a result, broken down according to racial and ethnic group. (Done in collaboration with Small Business Majority, May 2012)
Getting Covered: Finding Health Insurance When You Lose Your Job is designed to help consumers who've lost their health coverage sort through possible options for new coverage, including COBRA, Medicaid, CHIP, other federal and state programs, and the individual market. (Updated February 2012)
Designing Consumer-Friendly Beneficiary Assignment and Notification Processes for Accountable Care Organizations discusses the challenges advocates will face when developing these processes, and it recommends certain notification requirements and beneficiary protections. (January 2012)
Putting the Accountability in Accountable Care Organizations: Payment and Quality Measurements examines some of the challenges that advocates will face when working with policy makers, insurers, and providers to develop mechanisms that ensure that beneficiaries receive high-quality care at a lower cost. | Determining Shared Savings or Losses (January 2012)
The Bottom Line: How the Affordable Care Act Helps America's Families shows the net financial effects of the Affordable Care Act on family budgets. We found that lower- and middle-income families, both uninsured and insured, will be financial winners. | State Reports (October 2011)
States Making Progress on Rate Review highlights state efforts to protect consumers from unreasonable increases in insurance premiums. It also explains provisions of the Affordable Care Act that encourage improvements to states' rate review processes. (October 2011)
The Basic Health Option: Will It Work for Low-Income Consumers? provides a framework for advocates to think about whether this option, created by the health care law, will work for their state. It covers program basics, discusses the problems it might address, and raises key issues that can affect the direction such a program might take. (July 2011)
Why We Need a Health Insurance Exchange is a one-page handout that cites several reasons why consumers will benefit from the new exchanges, including competition, affordability, and quality. Advocates can modify this version to fit their needs. (June 2011)
The Affordable Care Act: Patients' Bill of Rights and Other Protections is a compilation of all of our fact sheets to date on consumer rights and protections. (April 2011)
Worry Less Spend Less: Out-of-Pocket Spending Caps Protect America's Families examines how the Affordable Care Act will protect insured people from high medical costs through new caps on out-of-pocket spending. It provides estimates of how many Americans will have spending that exceeds these caps and by how much, and it looks at how many of those people work for small businesses. | State Reports (March 2011)
States Are Benefitting from Provisions of the Affordable Care Act lists the number of people in each state who are already benefiting from each of five provisions. The provisions include measures that are helping small businesses provide coverage to their workers, helping seniors get free preventive care, and protecting children with pre-existing conditions. | Table (March 2011)
Implementing Health Insurance Exchanges: A Guide to State Activities and Choices describes the requirements in the Affordable Care Act that exchanges must meet and outlines key questions that states and consumer advocates will need to consider as the exchanges are designed. (October 2010)
Families USA had prepared a series of fact sheets on the Patients' Bill of Rights and other consumer protections in the Affordable Care Act that took effect on September 23. (September 2010)
Lower Taxes, Lower Premiums: The New Health Insurance Tax Credit examines how this tax credit will help both insured and uninsured Americans. It provides data on the number of people eligible, the total dollars available, and on how it will help working families in particular. | State Reports (September 2010)
A Helping Hand for Small Businesses: Health Insurance Tax Credits analyzes the health reform provision that provides tax credits to small employers to help them buy health coverage for their workers. This report, which was commissioned along with Small Business Majority, provides national and state-level data on the number of small businesses eligible for the credit in 2010, as well as the number eligible for the maximum tax credit. (July 2010)
Rate Review: Holding Health Plans Accountable for Your Premium Dollars discusses common problems with the process of reviewing health insurance premium rates, the lessons learned from state rate review procedures, and how health reform will address these problems. (March 2010)
Expiration of COBRA Subsidy: Millions of Unemployed Workers and Their Dependents Are at Risk; Many Will Lose Their Subsidy as of December 1, 2009 provides state-specific data on what will happen to family COBRA premiums when the subsidy ends, and it argues for extending the COBRA assistance. (December 2009)
Costly Coverage: Premiums Outpace Paychecks examines how the combination of stagnant wages and skyrocketing health insurance costs is placing a growing strain on family budgets. These state-specific reports show how health insurance premiums for families and individuals have risen over the last decade compared to earnings. (September 2009)
Understanding the Role of the "Exchange" or "Gateway" discusses the new health insurance marketplace, or exchange, that is being developed in national health reform proposals. This short piece looks at how an exchange would work and how it could help middle-class and low-income families find and keep the affordable, quality health care they deserve. (July 2009)
Why Employers Should Share the Responsibility of Paying for Health Care discusses five reasons why it makes sense to require employers to contribute to the cost of health coverage, known as an "employer responsibility requirement." (June 2009)
Hidden Health Tax: Americans Pay a Premium discusses how private health insurance premiums are higher, in part, because the costs of uncompensated care for the uninsured are shifted to those who have insurance, a "hidden health tax." The report quantifies this "tax" for family and individual coverage. (May 2009)
Health Care Must Be Affordable for All Families, Regardless of Income presents crucial arguments for why health reform must ensure that health care is truly affordable. It proposes placing reasonable limits on out-of-pocket costs and providing subsidies, especially for those with low and moderate incomes. (April 2009)
States Act to Help People Laid Off from Small Firms: More Needs to Be Done discusses how, in response to pressure from advocates, some states are taking steps toward passing "mini-COBRA" laws to help laid off workers from small firms get the federal subsidy guaranteed through the American Recovery and Reinvestment Act (ARRA). (April 2009)
Too Great a Burden: Americans Face Rising Health Care Costs reveals how many Americans face very high health care costs and shows the magnitude of the health care cost crisis. The report provides data on how many people are in families that will spend more than 10 percent or 25 percent of their pre-tax income on health care in 2009. (April 2009)
Have health insurance? Think you're well protected? Think Again! This one-page fact sheet provides quick stats on how health care expenses overwhelm even insured working families, forcing many into bankruptcy. (March 2009)
Squeezed! Caught between Unemployment Benefits and Health Care Costs examines COBRA coverage and unemployment benefits and finds that, to maintain their employer-based coverage under COBRA, most unemployed workers would have to devote an unrealistically high proportion of their unemployment check to health insurance. (January 2009)
Premiums versus Paychecks: A Growing Burden for Workers: Over the last eight years, health care costs have skyrocketed, while working families’ wages have stood still, putting a significant strain on family budgets. This series of state-specific reports examine what these trends mean for working families. (October 2008)
Empty Promise: Searching for Health Insurance in an Unfair Market discusses how the individual health insurance market differs from the employer market and examines what happens to consumers who seek coverage in the individual market. Problems in the individual market include policies that don't provide quality coverage; policies that are very expensive or that cost more than advertised; and the fact that many applicants cannot obtain a policy at any price. (August 2008)
Failing Grades: State Consumer Protections in the Individual Health Insurance Market. Laws protecting consumers purchasing health coverage in the individual market vary across the country. In many states, insurance companies can deny coverage, raise premiums significantly, refuse to cover treatment for certain conditions, and even revoke the coverage of policyholders who have been paying premiums for years. (June 2008)
Medical Loss Ratios: Evidence from the States presents the results of a 50-state survey we conducted in March and April 2008 that determined which states have laws or regulations that establish a minimum "medical loss ratio" (a percentage of premium dollars that must be spent on medical care). (June 2008)
The Facts about Prior Approval of Health Insurance Premium Rates discusses several insurance industry myths about the consequences of prior approval. The prior approval process is used by most states to make sure that insurance companies' proposed premium increases are not excessive. 4 pp. Free (June 2008)
Too Great a Burden: America's Families at Risk finds that more and more American families are spending a substantial share of their incomes on health care costs, and most of these families have insurance. Faced with high health care costs and tight budgets, families are turning to credit cards to finance their care, and many are falling into medical debt. (December 2007)
Premiums versus Paychecks: A Growing Burden for State Workers. A series of state-specific reports detailing the increased cost of health care premiums versus stagnant pay. (December 2006).
Understanding How Health Insurance Premiums Are Regulated discusses the state and federal regulation of health insurance premiums. (September 2006)
Paying a Premium: The Added Cost of Care for the Uninsured quantifies, for the first time, the dollar impact on private health insurance premiums of care provided to the uninsured. (June 2005)
Health Care: Are you better off today than you were four years ago? Health care has emerged as one of the top concerns of Americans in recent years. To understand what forces are driving this change, Families USA posed a variation of a question raised by Ronald Reagan more than two decades ago: When it comes to health care, are we better off today than we were four years ago? The results of our analysis show that the answer is a clear no. | en espanol (September 2004)
Protecting Consumers from Unfair Rate Hikes: The Need for Regulation of Health Insurance Renewal Premium IncreasesThis Issue Brief examines the insurance industry practice of re-underwriting at renewal and discusses current efforts to regulate the practice at the federal and state levels. (February 2003)
Healthy Pay for Health Plan Executives The managed care industry claims that the cost of patients' rights legislation will make families lose health insurance coverage--a charge that is both misleading and self-serving. This report examines the compensation for the highest-paid executives of 10 for-profit, publicly traded companies that own health plans serving multiple states. A Special Report. (June 2001)
Premium Pay II: Corporate Compensation in America's HMOs This updated report examines 1997 executive compensation for the 15 for-profit, publicly traded companies that owned HMOs with enrollments over 100,000. These 15 companies owned 75 of the nation's largest HMOs in 1997. (September 1998)
Premium Pay: Corporate Compensation in America's HMOs This report examines the 1996 costs of compensation for top level executives of some of the nation's most profitable HMOs (April 1998)
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From Other Organizations
A Comparison of the Availability and Cost of Coverage for Workers in Small Firms and Large Firms: A View from the 2012 Employer Health Benefits Survey compares whether firms offer coverage, how much plans cost, and how much cost-sharing workers are responsible for. It finds that workers in small firms generally pay a higher share of premiums and higher cost-sharing than workers in large firms. (Kaiser Family Foundation, December 2012)
Insurers’ Responses to Regulation of Medical Loss Ratios finds that, although insurers reduced administrative costs in response to the medical loss ratio rule in the Affordable Care Act, these reduced costs were offset by increased profits for insurance companies. (Commonwealth Fund, December 2012)
State Trends in Premiums and Deductibles, 2003-2011: Eroding Protection and Rising Costs Underscore Need for Action explains that premiums for job-based family coverage increased by 62 percent, employee premium contributions increased by 74 percent, and deductibles more than doubled. It includes state-level data on premiums for family coverage and a map that shows the increase in the cost of premiums as a percentage of household income across the states. (Commonwealth Fund, December 2012)
Jobs without Benefits: The Health Insurance Crisis Faced by Small Businesses and Their Workers explains how the Affordable Care Act will help small business employees, who are more likely to be uninsured than workers in large firms, with new coverage options, tax credits, the medical loss ratio rule, and protection from coverage denials for pre-existing conditions. (Commonwealth Fund, November 2012)
The Prevalence and Cost of Deductibles in Employer Sponsored Insurance: A View from the 2012 Employer Health Benefit Survey presents a series of graphs that show the growth in deductibles over the past several years. The average deductible for individual coverage is now $1,097, up from $584 in 2006. (Kaiser Family Foundation, November 2012)
Quantifying the Effects of Health Insurance Rate Review compares the average rate changes that insurers requested to the rates that were ultimately implemented. It finds that, on average, approved rate increases were 1.4 percentage points lower than what insurers initially requested. It also includes an overview of the rate review information that is available for each state and links to view rate information online. (Kaiser Family Foundation, October 2012)
Selling Health Insurance across State Lines: An Assessment of State Laws and Implications for Improving Choice and Affordability of Coverage analyzes the implementation of laws in six states (GA, KY, ME, RI, WA, and WY) that allow the sale of insurance across state lines. Although these laws were designed to enhance consumer choice, to increase competition, and to make insurance more affordable, the complexities of how insurance is sold and regulated have deterred insurance companies from entering new markets, thereby undermining the laws’ goals. (Center on Health Insurance Reforms, October 2012)
Health Care in the 2012 Presidential Election: How the Obama and Romney Plans Stack Up compares the potential outcome of the two candidates’ plans with respect to the following: the number of Americans with health coverage, affordability of coverage, consumer protections, consumer choice, help for small businesses, improvements to Medicare, health care quality, and controlling growth in health spending. The report finds that the Affordable Care Act would likely outperform Romney’s proposals in each of these areas. (Commonwealth Fund, October 2012)
Despite Criticism, the Affordable Care Act Does Much to Contain Health Care Costs describes the provisions of the law that address spending growth, including cuts in payments to Medicare providers, the managed competition structure of the exchanges, and the excise tax on high-cost insurance plans. It also discusses provisions that seek to change the way health care is delivered, such as the establishment of medical homes and accountable care organizations (ACOs), penalties for hospital readmissions, and experiments with bundled payments. (Urban Institute, October 2012)
2012 Annual Rate Review Report: Rate Review Saves Estimated $1 Billion for Consumers discusses the benefits of rate review, which is the provision in the Affordable Care Act that requires insurance companies to justify premium increases of 10 percent or more. Since its implementation in September 2011, rate review has saved consumers money, and it has increased transparency in the insurance market. (HealthCare.gov, September 2012)
Visualizing Health Policy: Costs is an infographic that illustrates the surge in health care spending over the past 50 years, the uneven distribution of costs among the U.S. population, the rise in premiums over the past decade, and the fact that more than half of American families have delayed care because of high costs. (Journal of the American Medical Association, September 2012)
Employer Health Benefits: 2012 Summary of Findings provides a detailed look at trends in job-based health coverage, including premiums, employee contributions, and cost-sharing. It includes data that are broken down by firm size and plan type, and it also includes information on participation in wellness programs. (Kaiser Family Foundation and the Health Research Educational Trust, September 2012)
A Systemic Approach to Containing Health Care Spending outlines methods for controlling health costs that are recommended by several noted health policy experts, including Stuart Altman, Donald Berwick, Ezekiel Emanuel, Peter Orszag, John Podesta, Uwe Reinhardt, and Neera Tanden. The proposed solutions, such as using competitive bidding and finding alternatives to fee-for-service payments, can be implemented separately or as part of an integrated approach. (New England Journal of Medicine, August 2012)
Health Reform Law Makes Clear that Subsidies Will Be Available in States with Federally Operated Exchanges explains that the idea that premium tax credits will not be available to consumers in states with federally operated exchanges is incorrect. It cites sections of the Affordable Care Act that indicate that the federally facilitated exchanges will need to adhere to the same requirements as state-based exchanges, and it argues that it would be inconsistent with the purpose of the law to limit the availability of tax credits to people in certain states. (Center on Budget and Policy Priorities, July 2012)
After the Ruling: A Consumer’s Guide is a user-friendly explanation of how the Supreme Court’s decision will affect people without insurance, consumers who get insurance through their jobs, people who want insurance but cannot afford it, people with health problems, small business owners, and seniors. It also explains parts of the law that are already in place. (Kaiser Family Foundation, June 2012)
Young, Uninsured, and in Debt: Why Young Adults Lack Health Insurance and How the Affordable Care Act Is Helping finds that, between September 2010 and June 2011, the number of insured young adults increased by 2.5 million as a result of the dependent coverage provision. It also finds that most young adults do enroll in coverage when it is accessible and affordable, and only 6 percent of those surveyed said they do not need coverage. (Commonwealth Fund, June 2012)
Workplace Wellness Programs explains why wellness programs are popular, but it emphasizes the following concerns: The programs may shift health care costs from the healthy to the sick, wellness incentives might be unfair because people cannot control all health-related factors, and tying the cost of coverage to health goals could discriminate against low-income individuals or racial and ethnic minorities. (Health Affairs, May 2012)
Estimating the Impact of the Medical Loss Ratio Rule: A State-by-State Analysis estimates that consumers would have received almost $2 billion in rebates this year if the medical loss ratio rules had been in effect in 2010. It also breaks down the rebates consumers would have received by state and by insurance market. (Commonwealth Fund, April 2012)
Insurer Rebates under the Medical Loss Ratio: 2012 Estimates finds that consumers and businesses are expected to receive an estimated $1.3 billion in rebates from health insurers who spent more on advertising, administrative expenses, and profits than allowed by the Affordable Care Act. (Kaiser Family Foundation, April 2012)
States and the Affordable Care Act is a series of state reports that analyze the effects of the Affordable Care Act on coverage, health expenditures, affordability, access, and premiums. It also assesses state’s progress with implementation of the law. The reports examine the following states: CO, MD, NY, OR, and RI. (Urban Institute, April 2012)
Financial Burden of Medical Care: Early Release of Estimates from the National Health Interview Survey, January—June 2011 finds that, among many statistics, one in three people was in a family that experienced a financial burden because of medical bills. (Centers for Disease Control and Prevention (CDC), March 2012)
The Individual Mandate in Perspective estimates the number of Americans who would be subject to this provision in the Affordable Care Act, identifies their insurance status without the law, and simulates their eligibility for Medicaid or premium tax credits. It finds that 94 percent of people would not be required to newly purchase coverage or pay a fine. (Robert Wood Johnson Foundation and the Urban Institute, March 2012)
Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (National Health Law Program, March 2012)
Turning to Fairness: Insurance Discrimination against Women Today and the Affordable Care Act discusses the practice of gender rating, in which insurance companies charge women different premiums than men. Gender rating costs women about $1 billion a year, but the Affordable Care Act will outlaw this practice in 2014. (National Women's Law Center, March 2012)
Health-Insurance Coverage for Low-Wage Workers, 1979-2012 and Beyond discusses the steady decline in coverage for low-wage workers over the past three decades, but it also explains that the experience with health reform in Massachusetts suggests that the Affordable Care Act may reverse this trend. (Center for Economic and Policy Research and Georgetown University, February 2012)
Mapping the Effects of the ACA’s Health Insurance Coverage Expansions allows you to enter a zip code and get an estimate of the share of the population in that region that will benefit from the Affordable Care Act through either Medicaid or tax credits for private insurance in the exchanges. (Kaiser Family Foundation, February 2012)
ACA Implementation in Oregon—Monitoring and Tracking is the first of 10 state reports that analyze the effects of the Affordable Care Act on coverage, health expenditures, affordability, access, and premiums. It also assesses Oregon’s progress with implementation of the law. The remaining nine reports will examine the following states: AL, CO, MD, MI, MN, NM, NY, RI, and VA. (Robert Wood Johnson Foundation and the Urban Institute, February 2012)
Employers and the Exchanges under the Small Business Health Options Program: Examining the Potential and the Pitfalls introduces a collection of articles in the February issue of “Health Affairs” that discuss the need for small business exchanges and how they will function. It also examines the difficulties that exchanges will face and the opportunities they will offer to states, employers, and individuals. (Health Affairs, February 2012)
Georgia’s Tax Breaks to Increase Use of Health Savings Accounts Did Not Expand Health Coverage: Plan Promoted by Gingrich Group Has Failed to Deliver explains how this approach, which was designed to reduce the number of uninsured Georgians by 500,000, has actually increased the number of uninsured people by 319,000. (Center on Budget and Policy Priorities, February 2012)
The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System explains that the law will narrow the income divide in health coverage and access through expanded Medicaid eligibility, state insurance exchanges, premium tax credits, cost-sharing protections, and the individual mandate. (Commonwealth Fund, February 2012)
Explaining Health Care Reform: How Will the Affordable Care Act Affect Small Businesses and Their Employees? explains the provisions of the law that relate specifically to small businesses, including exchanges, penalties for not providing affordable coverage, and tax credits to assist with insurance costs. (Kaiser Family Foundation, January 2012)
Spending Adjustments Made by Older Americans to Save Money examines the percentage of older Americans that have made changes in prescription drugs or skipped doctor appointments to save money. It finds that one in five adults over age 50 has adopted these spending cuts involuntarily. (Employee Benefit Research Institute, January 2012)
Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-Offs examines decisions that state governments will face regarding standardization of premiums and benefits in their exchanges. States must find the right balance between simplicity and flexibility to promote competition among insurers, maximize the quality of health care, and minimize costs. (The National Institute for Health Care Reform, November 2011)
State Trends in Premiums and Deductibles, 2003-2010: The Need for Action to Address Rising Costs notes that total premiums for family coverage increased by 50 percent, and the employee share of premiums increased by 63 percent. It also explores the potential for the Affordable Care Act to reduce this growth while improving financial protections. (The Commonwealth Fund, November 2011)
Massachusetts Health Reform: A Five-Year Progress Report examines major components of the law, such as expanding eligibility for Medicaid and CHIP, requiring all adults to obtain health insurance, and creating a health insurance exchange. It looks at how these provisions are working, the challenge of rising health care costs, and how health reform has affected coverage and access to care. (The Blue Cross Blue Shield of Massachusetts Foundation, November 2011)
The State of Young America: Health Care and Coverage describes the difficulties young adults face in obtaining health insurance and paying for medical services. It notes that provisions of the Affordable Care Act have started to reverse the trend of rising uninsurance among young adults. (Demos and Young Invincibles, November 2011)
Implementing Health Insurance Exchanges: State Profiles examines each state’s progress in setting up the exchanges that were mandated by the Affordable Care Act. The state-specific briefs cover where states are in the legislative process, whether states have received federal funding, and their next steps. (The Kaiser Family Foundation, October 2011)
Employer Health Benefits 2011 Annual Survey looks at trends in job-based health coverage, including premiums, employee contributions, and cost-sharing. The survey found that average annual premiums for family health coverage are 9 percent higher than they were in 2010. (The Kaiser Family Foundation, September 2011)
The Role of Exchanges in Quality Improvement: An Analysis of the Options explains that, because an exchange can aggregate the purchasing power of individuals and small groups, it could improve health care quality as well as payment and delivery. The piece describes options that states could pursue to use their exchanges to drive these improvements. (The Robert Wood Johnson Foundation and the Georgetown University Health Policy Institute, September 2011)
When Unemployed Means Uninsured: The Toll of Job Loss on Health Coverage, and How the Affordable Care Act Will Help discusses the difficulty people face finding and paying for insurance if they lose their jobs. Although the Affordable Care Act will provide affordable insurance in 2014, this report suggests that policy makers should help the recently unemployed now by offering COBRA subsidies or extending unemployment benefits. (Commonwealth Fund, August 2011)
Mapping Premium Variation in the Individual Market includes state-specific data and a map detailing the variations in average premium rates across the country for 2010.The nationwide average monthly premium per person was $215, with state averages ranging from $136 in Alabama to more than $400 in Massachusetts and Vermont. (Kaiser Family Foundation, August 2011)
Will Health Insurance Ever Get Cheaper? addresses the problems with rate review, noting that too many states lack or fail to exercise the authority to guarantee that health insurance premiums are affordable. Under the health care law, the federal government offered most states a $1 million grant to improve their rate review capabilities. (Stateline, July 2011)
The Effects of Health Reform on Small Businesses and Their Workers estimates the impact on offers of health coverage, the coverage itself, and the costs to the employers. (Urban Institute and the Robert Wood Johnson Foundation, June 2011)
Women at Risk: Why Increasing Numbers of Women Are Failing to Get the Health Care They Need and How the Affordable Care Act Will Help finds that rising health care costs, combined with slow income growth, have contributed to the decrease in health insurance among women. The health care law will help make coverage more affordable by requiring that plans offer free preventive care, banning gender rating, and offering premium subsidies. (Commonwealth Fund, May 2011)
HCAN Analysis Shows Health Insurers Pocketed Huge Profits in 2010 despite Weak Economy finds that insurers have increased premiums but spent less on actual medical coverage. By serving fewer consumers and imposing higher deductibles, large insurers have been able to raise their profits significantly. (Health Care for America Now (HCAN), March 2011)
Help on the Horizon: How the Recession Has Left Millions of Workers without Health Insurance, and How Health Reform Will Bring Relief examines the effect of the recession on the health coverage of adults between the ages of 19 and 64 and the implications for both their finances and their access to health care. The Affordable Care Act will greatly reduce the impact on health coverage and will protect workers from becoming uninsured. (Commonwealth Fund, March 2011)
Opinion Survey: Small Business Owners’ Views on Key Provisions of the Patient Protection and Affordable Care Act looks at how small business owners view the small business tax credits and health insurance exchanges. Roughly one-third of employers who don’t currently offer insurance said they would be more likely to do so because of the tax credits. However, less than 50 percent of respondents were familiar with either provision. (Small Business Majority, January 2011)
Employer-Based Health Coverage Declined Sharply over Past Decade discusses how the health reform law will reverse this trend by giving tax credits to small businesses to help them provide coverage, fining large employers that do not offer affordable coverage to their employees, and encouraging workers to take up employer coverage through the individual responsibility provision. (Center on Budget and Policy Priorities, December 2010)
Rate Review: Spotlight on State Efforts to Make Health Insurance More Affordable provides the results of a survey of 50 state rate review statutes and follow-up interviews with insurance regulators in 10 states (AK, CT, CO, ID, LA, ME, OH, PA, SC, and WI) to find out how rate regulation works in practice. (Kaiser Family Foundation, December 2010)
State Trends in Premiums and Deductibles, 2003-2009: How Building on the Affordable Care Act Will Help Stem the Tide of Rising Costs and Eroding Benefits finds that family premiums for job-based coverage increased by 52 percent, while per-person deductibles rose by 77 percent. Without the Affordable Care Act, average family premiums would rise to more than $23,000 by 2020. (Commonwealth Fund, December 2010)
Young Adults and the Affordable Care Act of 2010 discusses the provisions that will benefit young adults, including the ability to stay on a parent’s health plan until age 26, the Medicaid expansion, and subsidies in the exchanges. More than 12 million young adults may gain subsidized coverage by 2014, and 7.2 million may gain coverage under Medicaid. (Commonwealth Fund, October 2010)
Realizing Health Reform’s Potential: Small Businesses and the Affordable Care Act of 2010 discusses the provisions designed to help small businesses pay for and maintain health coverage for their workers. The provisions include a tax credit to make coverage more affordable, exchanges to lower administrative costs and pool risk more broadly, and new market rules and benefit standards to protect smaller firms from second-rate health plans. (Commonwealth Fund, September 2010)
How Will the Patient Protection and Affordable Care Act of 2010 Affect Young Adults? describes how different elements of health reform will help young adults, specifically the Medicaid expansion, subsidies for private insurance, the expansion of dependent coverage, and insurance market reforms. (Urban Institute and the Robert Wood Johnson Foundation, July 2010)
Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010 looks at how women will benefit from provisions that improve coverage and reduce premiums, eliminate pre-existing condition exclusions, eliminate gender rating, and others. Given that women, on average, use more health services over their lifetimes, the new law is likely to greatly improve women’s experience with the health care system. (The Commonwealth Fund, July 2010)
Patients' Bill of Rights: President Obama has released new rules to implement key consumer protections that were part of the new Patient Protection and Affordable Care Act. (The White House, June 2010)| Families USA Press Release
Survey of People Who Purchase Their Own Insurance looks at the types of people who purchase individual insurance, how much they are spending on premiums and out-of-pocket costs, and their experiences with and responses to premium increases. (Kaiser Family Foundation, June 2010)
What Women Need to Know about Health Reform: Improving Access to Affordable Preventive Care looks at how women will benefit from provisions in health reform that expand coverage for preventive care in private plans, Medicare, and Medicaid, and that eliminate cost-sharing for those services. (National Women’s Law Center, June 2010)
What Women Need to Know about Health Reform: Making Health Care More Affordable explains that, on average, women are poorer and spend a greater share of their income on care than men. Therefore, provisions aimed at preventing medical bankruptcy and increasing access to affordable coverage, whether through public programs or the private market, will greatly benefit women. (June 2010)
Early Benefits from the Affordable Care Act of 2010 Reinsurance Program for Early Retirees explains why early retiree insurance is important, how the program will work, and answers some frequently asked questions, including about what types of plans are eligible and what types of services will qualify for reimbursement. (White House, May 2010)
Making Health Care More Affordable: The New Premium and Cost-Sharing Credits explains what these credits are, who is eligible for them, how much they’re worth, and how they can be used. (Center on Budget and Policty Priorities, May 2010)
Rite of Passage: Young Adults and the Affordable Care Act of 2010 discusses provisions in the new law that will help young adults gain health coverage. Key provisions include dependent coverage up to age 26, a Medicaid expansion, new health insurance “exchanges,” and subsidies to help people purchase private insurance. (Commonwealth Fund, May 2010)
Near-Term Changes in Health Insurance: Newly Enacted Health Reform Legislation Mandates Dozens of Health Insurance Changes details the provisions that go into effect during the first two years. Some of the early changes include requiring new health plans to eliminate cost-sharing for preventive services, create internal and external appeals processes, and ban pre-authorization requirements for emergency services. (Health Affairs, April 2010)
The Growing Financial Burden of Health Care: National and State Trends, 2001-2006 shows that escalating health care costs affect people at all socioeconomic levels, including middle- and higher-income people. National and state data show that this growing burden was driven by the fact that out-of-pocket spending for premiums and health care rose faster than family incomes. (Health Affairs, March 2010) Subscription Required
Health Insurers Break Profit Records as 2.7 Million Americans Lose Coverage compares the recent rise in profits for the largest insurance companies with the concurrent rise in uninsurance. While the five largest insurers saw a 56 percent increase in profits from 2008 to 2009, they provided coverage to 2.7 million fewer people. These companies also raised rates and cost-sharing and decreased the share of premiums they spent on medical care. (Health Care for America Now, February 2010)
Insurance Companies Prosper, Families Suffer: Our Broken Health Insurance System discusses the disturbing trend of insurance companies raising their premiums even while they’re making record profits. States that are seeing the highest premium increases include California (39 percent), Maine (23 percent), and Michigan (56 percent). According to the report, premiums will continue to rise by 20 or even 30 percent. (Department of Health and Human Services, February 2010)
COBRA Subsidies for Laid-Off Workers: An Initial Report Card indicates that enrollment in COBRA coverage has increased substantially, and reports show that most eligible people have heard about the subsidy. Unfortunately, many eligible people still can't afford COBRA coverage. In order to further increase enrollment, Congress should consider raising subsidies and further simplifying enrollment procedures. (Commonwealth Fund and the California HealthCare Foundation, December 2009)
The Extension of the COBRA Subsidy: An Update reviews the COBRA subsidy and key changes made since its extension in December 2009. The brief looks at the options available for people who may have dropped coverage in anticipation of the end of the subsidy or who paid the full premium after their nine months of receiving the subsidy expired. (Kaiser Commission on Medicaid and the Uninsured, December 2009)
Health Care and the Middle Class: More Costs and Less Coverage examines the availability, affordability, and stability of health coverage of families with incomes of $44,000 to $88,000 for a family of four. Overall, health insurance and medical care have become less affordable for the middle class, and one in 10 middle-class, working-age adults have lost health insurance. (Kaiser Commission on Medicaid and the Uninsured, July 2009)
Trends in Underinsurance and the Affordability of Employer Coverage, 2004-2007 focuses on cost increases for the 161 million Americans who have job-based health coverage. Over the period studied, for all adults, expected medical spending rose by 34 percent, or $729. The study also explores the relationship between rising out-of-pocket costs for adults with job-based coverage and rising health care costs overall. (Health Affairs, June 2009) Subscription Required
Women at Risk: Why Many Women Are Forgoing Needed Health Care examines how rising health care costs coupled with eroding health benefits are having a substantial effect on Americans' ability to get health care, particularly women. In 2007, 52 percent of women reported having problems obtaining needed care due to cost, and 45 percent had accrued medical debt or reported having problems with medical bills. (The Commonwealth Fund, May 2009)
Health Care Costs: A Primer examines recent trends in health care costs and the factors that contribute to the rapid rise in these costs. This updated primer includes information on the types and sources of health care spending, the demographic factors associated with higher or lower levels of spending, and the impact of higher premiums and out-of-pocket costs on families and employers. (Kaiser Family Foundation and Health Research and Educational Trust, March 2009)
Snapshots from the Kitchen Table: Family Budgets and Health Care shows the central role of health care costs and coverage in a household’s economic stability. It finds that health care costs were of particular concern, with many families forgoing doctor visits, skipping prescription medications, and postponing needed care. Even those with health insurance reported delaying care in order to avoid copayments, rising deductibles, and out-of-pocket costs. (Kaiser Commission on Medicaid and the Uninsured, February 2009)
Closing the Gap: 2008/2009 Employee Perspectives on Health Care finds that employees are significantly less willing to select health plans with higher premiums and lower-out-of-pocket costs than last year. Higher health costs are forcing many workers to decrease their retirement savings plan contributions as they increasingly experience difficulty paying for basic needs, depleted personal savings, or the need to borrow money. (Watson Wyatt, December 2008)
Key Findings from Qualitative and Quantitative Research among America's Small Business Owners is a national survey that presents the top concerns of small business owners regarding health coverage. It examines how likely small businesses are to continue providing insurance for employees and their views on various health reform measures. Results are broken down by business size and party identification, showing the top five policies for health reform favored by small businesses and what kinds of messages would be most effective in gaining support for health reform. (Robert Wood Johnson Foundation, December 2008)
2007 Health Insurance Survey of Farm and Ranch Operators examines health care costs and their consequences for farm and ranch families in the Great Plains states. The majority of respondents had health insurance, yet one in four reported that their health care expenses contributed to financial problems. In addition, farmers and ranchers who purchased insurance in the non-group market were at greater risk of financial hardship than those who obtained insurance through government-sponsored programs or through off-farm or off-ranch employment. (The Access Project, September 2008)
Nowhere to Turn: How the Individual Health Insurance Market Fails Women looks at the experiences of women seeking coverage in the individual insurance market between July and September, 2008. The report finds that many women face obstacles obtaining comprehensive, affordable health coverage. These challenges include being charged higher premiums than men, a practice known as “gender rating,” and being unable to find affordable maternity coverage. (National Women’s Law Center, September 2008)
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Trade-Offs Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007 estimates that 14 million more people had problems paying medical bills in 2007 compared to 2003. Among the non-elderly insured and uninsured, 2.2 million were in families that filed for bankruptcy as a result of medical debt, while a much larger number reported other financial consequences, such as difficulties paying for necessities or having to borrow money. (The Center for Studying Health System Change, September 2008)
Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families reports that the proportion of working-age Americans who struggled to pay medical bills and accumulated medical debt climbed from 34 percent to 41 percent between 2005 and 2007. Families with low or moderate incomes were particularly hard hit, as were the uninsured and adults who had gaps in health coverage. Those experiencing financial hardship due to medical debt reported that they used up all their savings, incurred large credit card debt, or were unable to pay for basic necessities. (The Commonwealth Fund, August 2008)
Employer Health Insurance Costs and Worker Compensation analyzes what it costs employers to provide health insurance and the rate at which these costs are growing. Employers’ costs as a percentage of payroll vary across work settings, which makes it challenging for policymakers to establish equitable standards. The report also notes that employees are suffering: Insurance premiums have risen by 78 percent over the last six years while wages have risen by only 19 percent. (Kaiser Family Foundation, March 2008)
How Non-Group Health Coverage Varies with Income examines how often people at different income levels buy individual health coverage when they cannot obtain coverage through their jobs or through public programs. It found that few people at lower incomes buy individual coverage and that, as income increases, coverage rates increase as well. (Kaiser Family Foundation, February 2008)
Financial Burden of Health Care, 2001-2004 presents an analysis of data that shows an increase in out-of-pocket health care cost as incomes remain the same, especially for the privately insured. For a growing number of families, private Insurance no longer provides adequate financial protection. (Health Affairs, January 2008) Subscription Required
On Their Own: Far from a Remedy, Individual Health Insurance Is a World of Pain details an investigation of individual health insurance and found that regulation of this market varies from state to state. Expenses normally run higher than insurance available through an employer. The investigation also found that 76 percent of uninsured adults said that they could not afford individual insurance. (Consumer Reports, January 2008)
Overburdened and Overwhelmed: The Struggles of Communities with High Medical Cost Burdens: The number of people with potentially high medical cost burdens varies widely across the nation. Some of these people lack insurance, while others are insured but are paying a high portion of their income to get that coverage. Federal support will be critical to addressing this problem. (The Commonwealth Fund, November 2007)
Rising Health Costs, Medical Debt and Chronic Conditions About 57 million working-age Americans (18-64 years old) live with chronic conditions such as diabetes or depression. In 2003, more than one in five—12.3 million people with chronic conditions—lived in families that had problems paying their medical bills. Rising health costs have hit low-income, privately insured people with chronic conditions particularly hard: Between 2001 and 2003, the proportion of such people who spent more than 5 percent of their income on out-of-pocket health care costs grew from 28 percent to 42 percent. (Center for Studying Health System Change, September 2004)
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