Last week resulted in the release of a range of health care statistics as well as some Administration actions that could greatly impact the ACA. First the numbers.
National Health Interview Survey, part of the Centers for Disease Control and Prevention (CDC) released new data on the decline in the percentage of uninsured in the U.S. The nation’s uninsured rate dipped slightly to 8.8 percent between January and September 2016, down from 9.1 percent the year before. Continuing an ongoing trend, it’s the lowest level on record. The figures refer to people of all ages. For the adult population from 18 to 64 (Medicare begins at 65) the uninsured rate was 12.4 percent. That compares favorably to 2013 when 20.4 percent of this population lacked health insurance. For children through age 17 the uninsured rate was 5 percent. With the uninsured rate at 12.4 percent for the 18 to 64 population other interesting statistics included:
- The uninsured rate in Medicaid expansion states is 9.3 percent. That’s down from 18.4 percent in 2013, a 45 percent decline in less than three years, and a slight dip from the 9.8 percent rate measured in 2015.
- The uninsured rate in non-Medicaid expansion states is 17.5 percent. That’s down from 22.7 percent in 2013, a 23 percent decline. It’s also the same rate that the survey found in 2015, suggesting that improvement has flatlined in the 19 states that have rejected the ACA’s Medicaid expansion.
The Office of the Actuary (OACT), a part of CMS released figures that indicated that in 2016, total health spending is projected to have reached nearly $3.4 trillion, a 4.8-percent increase from 2015. The report by OACT found that by 2025, federal, state and local governments are projected to finance 47 percent of national health spending, a slight increase from 46 percent in 2015. Growth is expected to average 5.6 percent annually over 2016-2025. National health spending growth is projected to outpace projected growth in Gross Domestic Product (GDP) by 1.2 percentage points. As a result, the report also projects the health share of GDP to rise from 17.8 percent in 2015 to 19.9 percent by 2025.
Total spending in health care is different from medical inflation. Medical price inflation (which is equated with medical prices) is expected to increase more rapidly after historically low growth in 2015 of 0.8 percent to nearly 3 percent by 2025. This faster projected growth in prices is influenced by an acceleration in both economy-wide prices and medical specific prices and is projected to be partially offset by slowing growth in the use and intensity of medical goods and services. Whether directly related to the ACA, medical inflation has been at historic lows since its adoption.
CMS on Wednesday submitted a proposed rule change that will create changes in the ACA exchanges. One change would shorten the open enrollment to November 1 through December 15, significantly shorter than the end of January deadline. It would also make changes to the pre-enrollment verification requirements that insurance companies can request. A third change is to allow insurance companies to collect premiums for prior unpaid coverage, before enrolling a patient in the next year’s plan with the same issuer. A fourth change would allow the insurance industry to make adjustments in determining the level of coverage. A fifth change would give states more authority on current limitations on insurers in the review of qualified health plans. CMS proposes to defer to the states’ reviews in states with the authority and means to assess issuer network adequacy. Finally, HHS will revise the proposed timeline for certification and rate review process for plan year 2018.
While CMS was issuing regulations that could affect premiums and enrollment through the health insurance exchanges, the IRS on February 14, announced it would require tax filers to fill out the line on their tax form that requires filers to indicate they did have insurance in 2016. This is the enforcement mechanism for the individual mandate which in turn it a key provision in the ACA. “Silent” returns that do not have the information will not be rejected as had been the original practice.