Private Insurance: Bad Ideas
Bad Ideas discusses Health Savings Accounts (HSAs), Association Health Plans, and other “solutions” to the health crisis that would actually make matters worse, not better.
From Families USA
The Perils of Health Insurance Sold Across State Lines explains the hidden dangers in legislation—being pushed at the state and the federal level—that lets out-of-state insurers evade state regulation. (July 2011)
CoverTN, Tennessee's Barebones Health Plan: A Case Study uses Tennessee's barebones health plan as an example to examine how limited-benefit plans fail to meet the health coverage needs of consumers. (May 2009)
Limited-Benefit Plans: Expanding Coverage or Holding Your State Back? examines the negative effects of limited-benefit insurance plans (also known as "barebones" or "mandate-lite" plans) based on how these plans have fared in some states. This brief also discusses how advocates can respond to limited-benefit proposals in their states. (October 2008)
Six Reasons to Be Wary of High-Deductible HSA Plans (December 2006)
Stop Bad Ideas—How HSAs Can Drain Your Wallet and Harm Your Health presents three examples that illustrate what can happen to employees working for a hypothetical company that purchases a high-deductible health plan. (December 2006)
Stop Bad Ideas—HSAs: Missing the Target examines the effects that HSAs will have on those without health insurance and on the health care system overall. (November 2006)
H.R. 2355, The Health Care Choice Act: The Wrong Prescription for America's Health Care Needs discusses how this legislation, sponsored by Rep. Shadegg and favored by the Administration, would undermine state laws designed to protect health care consumers. (August 2006)
Summary of S. 1955: The Health Insurance Marketplace Modernization Act outlines the legislation that introduces Small Business Health Plans (SBHPs) and exempts private insurers from many state laws and regulations governing health insurance. (March 23, 2006)
President Bush's Fiscal Year 2007 Budget: Analysis of Key Health Care Provisions Includes discussion and commentary on Health Savings Accounts (HSAs), Medicaid, and Medicare. (February 22, 2006)
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Stop Bad Ideas—AHPs: Bad Medicine for Small Employers Association Health Plans (AHPs) are a major part of the President's package of health care proposals aimed at reducing the growing number of uninsured Americans. This fact sheet finds that AHPs are not a solution for the number of uninsured, are not an effective way to control costs, and provide fertile ground for fraud and abuse. (December 2005)
Stop Bad Ideas—HSAs: Missing the Target This fact sheet examines the effects that health savings accounts (HSAs) will have on the uninsured and on the health care system overall. It finds that HSAs won't reduce the number of uninsured, are not an effective way to control costs, are inequitable, and are a radical threat to our current health insurance system. (December 2005)
Stop Bad Ideas—Too Little, Too Late: Why a $1,000 Tax Credit Won’t Help the Uninsured Every year since 2001, President Bush has proposed a $1,000 tax credit to help uninsured people purchase health insurance in the individual market. This fact sheet finds that his tax credit is justified by questionable studies, is tied to the flawed individual market, and wouldn't make insurance affordable. (December 2005)
What Consumers Need to Know about Buying Health Coverage from Associations (July 2005)
What Consumers Need to Know about Health Savings Accounts (July 2005)
HSAs: Why High-Deductible Plans Are Not the Solution This fact sheet examines the effects that health savings accounts (HSAs) will have on those without health insurance and on the health care system overall. (January 2005)
The Illusion of Group Health Insurance: Discretionary Associations Discretionary associations enable insurance carriers to market individual health insurance policies under the guise of group insurance to consumers seeking low-cost insurance that appears to offer group protections. This Issue Brief identifies problems in the discretionary association marketplace and suggests a number of regulatory and legislative solutions. (March 2004)
What's Wrong with Tax-Free Savings Accounts for Health Care? Tax-free personal savings accounts for health care have become the latest cure-all for the problems facing our health care system. This Issue Brief uses a hypothetical company to examine how such accounts undermine the pooling of risk--the basis for insurance. (November 2003)
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From Other Organizations
Health Savings Accounts and High-Deductible Health Insurance Plans: Implications for Those with High Medical Costs, Low Incomes, and the Uninsured examines the potential for HSAs and HDHPs to reduce health care spending and decrease the number of uninsured. The study finds that the tax structure and incentives built into HSAs make them most attractive to high-income and healthy people who are already advantaged by the current system and that they tend to shift more of the health financing burden onto those needing significant amounts of care. As such, it is not clear that cost containment or reductions in the uninsured will follow. (The Urban Institute, February 2009)
Consumer-Driven Health Care: Promise and Performance analyzes the evolution of consumer-driven health care in terms of its original vision, subsequent implementation, and the transformations it has gone through as it moves into its second decade. Growth of high-deductible health plans and individually purchased insurance has been slower than anticipated. (Health Affairs, January 2009) SUBSCRIPTION REQUIRED
Health Savings Accounts: Participation Grew, and Many HSA-Eligible Plan Enrollees Did Not Open HSAs while Individuals Who Did Had Higher Incomes found that the number of individuals participating in HSA-eligible, high-deductible health plans and HSAs has risen significantly since 2004. Adjusted gross income for HSA enrollees in 2005 was about $139,000, compared to $57,000 for other taxpayers. However, many HSA-eligible plan enrollees did not open an HSA, citing their inability to afford one or a belief that they did not need one. (GAO, May 2008)
Findings from the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey presents information about the growth of account-based and high-deductible health plans and their impact on the behavior and attitudes of consumers. It provides statistics on the numbers of adults enrolled in consumer-driven health plans, their incomes, health status, and satisfaction rates, the rates at which they actually use their plans, and whether these plans have had an impact on the numbers of uninsured. (EBRI/ Commonwealth Fund, March 2008)
Behind the Slow Growth of Employer-Based Consumer-Driven Health Plans finds that employees who use a consumer driven health plan (CDHP) are less likely to be given a choice of plans. Also, employers pay approximately the same amount for employees’ CDHPs as they do for traditional plans, but employees in CDHPs are faced with much higher out-of-pocket costs than those in traditional plans. (The Center for Studying Health System Change, December 2006)
Enrollees in the Federal Employees Health Benefits Program (FEHBP) High-Deductible Health Plans (HDHP) were younger and earned higher federal salaries than other FEHBP enrollees, according to Federal Employees Health Benefits Program: First-Year Experience with High-Deductible Health Plans and Health Savings Accounts. For example, 43 percent of HDHP enrollees employed by the federal government earned salaries of $75,000 or more, compared to 23 percent of all those enrolled in FEHBP plans. (GAO, January 2006)
Association Health Plans: No State Regulation Means Loss of Protections for Consumers, Small Employers and Providers examines the impact of Association Health Plans (AHPs). The report states that AHPs will do little to cover the uninsured and will allow insurers to drop coverage for certain medical services. Released with patient groups such as the American Diabetes Association and the American Academy of Pediatrics. (Blue Cross Blue Shield Association, May 2005)
Rhetoric vs. Reality: Employer Views on Consumer-Driven Health Care This study, which looks at employer views on consumer-driven health plans in 12 metropolitan areas, finds that employers know more today than in the past about consumer-driven health care plans and that increased knowledge is raising questions about the effectiveness of such plans. In addition, employers are unsure that cost savings will result from consumer-driven care, have concerns about the ability of employees to access the information necessary to make decisions in a consumer-driven system, and are wary of the ability of tiered provider networks to provide sufficient access to quality health care services. (The Center for Studying Health System Change, July 2004)
Many health and tax policy analysts suspected that Health Savings Accounts (HSAs) would be used as tax shelters for high-incomes individuals. GAO Study Confirms Health Savings Accounts Primarily Benefit High-Income Individuals indicates that HSAs are disproportionately used by affluent individuals. The report also explains how HSAs and high-deductible plans reduce costs for healthy people while increasing out-of-pocket costs for less healthy people. (Center on Budget and Policy Priorities, September 2006)
Health Savings Accounts (HSAs) are accounts in which individuals who have high-deductible health insurance can save money to pay for out-of-pocket health expenses. The Bush Administration has touted HSAs as a solution to covering the uninsured. A Brief Overview of the Major Flaws With Health Savings Accounts explains why HSAs might not be such a good idea after all. (Center on Budget and Policy Priorities, April 2006)
Consumer-Directed Health Plans is a tutorial that explains the principles and different models of so-called consumer-directed health plans, including Health Savings Accounts (HSAs). The tutorial also discusses how such health plans are financed, as well as the impact they are likely to have on health care spending. (Kaiser Family Foundation, June 2006)
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Health savings accounts (HSAs) and high-deductible health plans (HDHPs) have been promoted by the Administration as part of the solution for the problems facing the U.S. health care system. Health Savings Accounts: Why They Won’t Cure What Ails U.S. Health Care presents expert testimony that encouraging Americans to join HSAs will only exacerbate the nation’s health care woes. Current evidence shows that HSAs suffer from low enrollment, low satisfaction, high out-of-pocket costs, and cost-related access problems. (The Commonwealth Fund, June 2006)
Americans enrolled in "consumer-directed" health plans—a relatively new type of health coverage that is purportedly designed to make people more cost-conscious—are less satisfied with their coverage than those with comprehensive health insurance, according to Early Experience with High-Deductive and Consumer-Driven Health Plans: Findings from the EBRI/Commonwealth Fund Consumerism in Health Care Survey. The survey also found that those enrolled in consumer-directed plans are more likely to pay high out-of-pocket costs and receive little or no information about their health care. (EBRI and the Commonwealth Fund, December 2005)
Do High-Deductible Health Plans Threaten Quality of Care? questions whether lowering costs by shifting cost-sharing burdens toward the consumer is worth the tradeoff of decreased care. Citing the RAND Health Insurance Experiment and recent research by Harris, the article expresses concern about consumers' abilities to differentiate between necessary and unnecessary care and the limited availability of information to help consumers "shop around." (The New England Journal of Medicine, September 22, 2005)
Health Savings Accounts—The Ownership Society in Health Care explains how HSAs fit into the Administration's larger goal of an ownership society. The author explains how the "choices" HSAs allow consumers to make will not lower health care costs and will encourage skipping necessary medical services. (The New England Journal of Medicine,September 22, 2005)
How High Is Too High? Implications of High-Deductible Health Plans finds that high-deductible health plans (HDHPs) are unlikely to have a substantial effect on either costs or coverage and can undermine the basic purposes of health insurance -- to reduce financial barriers to needed care and protect against financial hardship. The authors suggest legislative modifications to protect lower-wage adults and ensure access to early preventive and primary care. (The Commonwealth Fund, April 2005)
The Effect of Health Savings Accounts on Health Insurance Coverage concludes that HSAs are not likely to be an important contributor to expanding coverage among uninsured people because most of them do not face high enough marginal tax rates to benefit substantially from the tax deductibility of HSA contributions. Meanwhile, HSAs could potentially destabilize the small-group market. To the extent that they encourage well-compensated healthy workers to abandon job-based coverage, HSAs could undermine the entire structure of job-based coverage among small firms. (The Commonwealth Fund, April 2005)
Debate continues over Health Savings Accounts (HSAs), though many leading health care analysts and economists have warned that HSAs pose a high risk of causing "adverse selection." Adverse selection occurs when healthy people and less-healthy people separate into different insurance arrangements, which drives up the cost of insurance for less-healthy enrollees. Initial Data on Individual Market Enrollment Fail to Dispel Concerns about Health Savings Accounts considers data, which the authors conclude do not support the claims of HSA proponents. (Center on Budget and Policy Priorities, September 13, 2004)
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)
Limited-Benefit Policies: Public and Private-Sector Experiences A number of states have passed legislation allowing states to sell limited-benefit plans to small groups or to experiment with providing limit benefit plans through public programs. This issue brief examines the experiences of 11 states that have passed limited-benefit legislation and three states that have implemented limited-benefit public programs. (State Coverage Initiatives, July 2004)
The U.S. is experiencing an unprecedented influx of unauthorized insurers selling phony health insurance. Regulators believe this problem will only grow as premiums continue to increase at double-digit rates and people continue looking for affordable alternatives. Health Insurance Scams: How Government is Responding and What Further Steps Are Needed highlights state and federal strategies that have been successful at identifying and closing unauthorized health plans, as well as methods of preventing their proliferation. (The Commonwealth Fund, August 2003)
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