What Are the Provisions in the New Law for Containing Costs and How Effective Will They Be?

Examines 2010 healthcare reform provisions for cost containment and quality improvement, including insurance exchanges, excise tax on high-cost plans, delivery system and payment reforms, Medicare payment cuts, and prevention and wellness programs

Louisiana's Proposed Section 1115 Medicaid Demonstration Project: Estimating the Numbers of Uninsured and Projected Medicaid Costs

Analyzes the composition and medical costs of the uninsured in Louisiana after Hurricane Katrina, based on a detailed analysis of who the uninsured are in Louisiana, their current medical spending, and what their spending might be under Medicaid

Policy Options to Improve the Performance of Low Income Subsidy Programs for Medicare Beneficiaries

Outlines options for establishing a unified annual Medicare deductible, uniform coinsurance, and limits on out-of-pocket spending and providing better protection to low-income beneficiaries and beneficiaries with the greatest health care needs

Changes to the Tax Exclusion of Employer-Sponsored Health Insurance Premiums: A Potential Source of Financing for Health Reform

Examines eight options for limiting the tax exclusion of employer-sponsored health insurance premiums. Compares, by income level, estimated effects of various caps and indices on tax revenues and after-tax incomes in the first year and over ten years

Limiting the Tax Exclusion of Employer-Sponsored Health Insurance Premiums: Revenue Potential and Distributional Consequences

Serious efforts to forge a budget agreement in 2013 will increase the likelihood that lawmakers will seek changes to tax provisions in order to raise revenue. The exclusion of employer-sponsored health insurance premiums and medical benefits from taxable income could be a target, since this exclusion reduced federal tax revenues by $268 billion in 2011 alone -- by far the largest federal tax expenditure. Moreover, the exclusion disproportionately subsidizes those with higher incomes. Yet proposals to change the tax exclusion of employer-sponsored insurance have provoked intense debate. This brief provides estimates of the revenue potential and distributional consequences of a new policy option. The policy analyzed here would impose a cap, or dollar limit, on the aggregate cost of employer-sponsored health coverage excluded from income and payroll taxes. The cap would be set at the 75th percentile of the sum of premiums and other medical benefits, and would be indexed, or allowed to grow over time, by a five-year average of the rate of GDP growth. The goal in choosing the level and indexing for the cap was to select a policy that would make a significant contribution to debt reduction, but would be distributionally equitable. This brief answers four critical questions related to the 75th percentile cap on the exclusion of premium and medical benefits:What are the estimated new tax revenues related to this policy in 2014 and 2014 -- 2023?How many people would pay higher taxes in each quintile of income?How much would taxes increase for those paying higher taxes?What are the characteristics of employers whose employees are likely to pay higher taxes?The evidence shows that the 75th percentile tax cap would produce$264.0 billion in new income and payroll tax revenues over the coming decade while still preserving 93 percent of the tax subsidies available under the current policy. Across all tax units, 15.7 percent would pay higher taxes under the 75th percentile cap on the exclusion of premium and medical benefits in 2014, with this share increasing to 20.0 percent by 2023. Although tax units across the entire income distribution would experience some tax increases, these increases are considerably smaller and less prevalent at lower income levels. The policy change would affect public-sector employees to a greater extent than private-sector employees. In addition, among private-sector employees, those in the financial services/real estate or professional services industries would be affected to a greater extent, while employees in other industries such as the retail industry, would be affected to a lesser extent. Establishments with a union presence have only a modestly higher share of employees with premiums above the 75th percentile premium, compared to the average across all establishments

Virtually Every State Experienced Deteriorating Access to Care for Adults Over the Past Decade

Presents state-by-state data on 2000-10 changes in the likelihood of non-elderly adults and a subgroup of uninsured adults having unmet medical needs due to cost, receiving a routine checkup, and having a dental visit

Variation in Insurance Coverage Across Congressional Districts: New Estimates From 2008

Examines trends in rates of private health insurance coverage, public coverage, and uninsurance by congressional district and poverty rate. Identifies districts that have the most to gain from health reforms designed to increase coverage

How Will Hospitals Be Affected by Health Care Reform?

Outlines healthcare reform provisions for Medicare and Medicaid payment changes, performance incentives, quality improvement pilot programs, graduate medical education, and requirements for nonprofits that will affect various types of hospitals

How Will Physicians Be Affected by Health Reform?

Outlines how healthcare reform provisions including coverage expansion, higher Medicare and Medicaid fees for primary care, and efforts to bend the cost curve such as payment reform and comparative effectiveness research may affect physicians financially

Do Medicare Advantage Plans Respond to Payment Changes? A Look at the Data from 2009 to 2014

Issue: Medicare Advantage (MA) enrollment has grown significantly since 2009, despite legislation that reduced what Medicare pays these plans to provide care to enrollees. MA payments, on average, now approach parity with costs in traditional Medicare.Goal: Examine changes in per enrollee costs between 2009 and 2014 to better understand how MA plans have continued to thrive even as payments decreased.Methods: Analysis of Medicare data on MA plan bids, net of rebates.Findings: While spending per beneficiary in traditional Medicare rose 5.0 percent between 2009 and 2014, MA payment benchmarks rose 1.5 percent and payment to plans decreased by 0.7 percent. Plans' expected per enrollee costs grew 2.6 percent. Plans where payment rates decreased generally had slower growth in their expected costs. HMOs, which saw their payments decline the most, had the slowest expected cost growth.Conclusions: In general, MA plans responded to lower payment by containing costs. By preserving most of the margin between Medicare payments and their bids in the form of rebates, they could continue to offer additional benefits to attract enrollees. The magnitude of this response varied by geographic area and plan type. Despite this slower growth in expected per enrollee costs, greater efficiencies by MA plans may still be achievable