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SUMMARIES OF
Commonwealth REPORTS
Dec 2003 - Apr 2004
NEARLY TWICE OFFICIAL ESTIMATE ARE UNINSURED AT ANY TIME
Some patients
Eighty-five million Americans had no health insurance at some point between 1996 and 1999--more than double the number uninsured at any one point or in any one year during this period. That's also nearly double the 43.6 million Americans recently estimated by the Census Bureau to have been without coverage in 2002.
According to "Battery-Powered Health Insurance? Stability in Coverage of the Uninsured," nearly two of five (38%) Americans under age 65, and more than two-thirds (68%) of those with low incomes, lacked health coverage at some point within the study timeframe.
Minorities were at high risk for experiencing gaps in coverage and having an extensive time without insurance. Half (50%) of African Americans and three of five (61%) Hispanics were uninsured during the 1996-99 period. Among those with low incomes, Hispanics stood out for high rates uninsured and for the number of months uninsured. Young adults were also at high risk, with over half uninsured during this time.
CLICK HERE for Issue Brief (Acrobat)
CLICK HERE for Health Affairs Article
HEALTH COSTS ROSE 9.3% IN 2003
Health care costs rose to $1.6 trillion in 2002, or $5,440 per person. Health spending increased 9.3 percent in 2002, "advancing much faster than the rest of the U.S. economy for the second consecutive year,". The increase was more than twice the rate of growth of nation's gross domestic product. "These persistent health care spending increases point to the need for a long-term solution to reform the U.S. health care system," Karen Davis said. "The dramatic increase in insurance premiums-which rose even faster than other health spending-is especially disturbing, and bears watching. Shifting more costs to patients is not a viable solution to the problem of spiraling health care spending."
What might help control these increases? Noting that recent studies show little if any relationship between cost and quality, Davis suggests that the answer is to move towards a high-performance health care system one that rewards hospitals, physicians, and health systems that provide both high-quality and efficient health care.
CLICK HERE for the Article in Health Affairs
FEHBP APPROACH WOULD NOT WORK WELL FOR THE OLDER, SICKER POPULATIONS SERVED BY MEDICARE
The Federal Employee Health Benefits Program (FEHBP) provides health coverage for 8.5 million federal employees, retirees, and their families, as well as supplemental coverage for retirees on Medicare. Considered to be a well-run program, FEHBP has been proposed by some politicians and analysts as a model to replace the current Medicare program, to cover small businesses and the uninsured, or, in some cases, to cover the entire nation. although it would be an improvement over the high premiums and limited benefits faced by small businesses and uninsured adults, the FEHBP approach would not work well for the older, sicker populations served by Medicare.
Not only is the FEHBP model likely to lead to discrimination against ill or disabled beneficiaries, but Medicare's large-group purchasing clout would be diminished, program administrative costs would rise, and, as a result, costs to government and beneficiaries alike would grow, the Fund report says. Medicare, moreover, has experienced slower expenditure growth over time than FEHBP. While FEHBP insures retirees, this coverage is largely supplemental to Medicare and thus does not bear the full risk of health services for an elderly, less healthy population.
CLICK HERE for Summary
CLICK HERE for full Report (Acrobat)
NEARLY ONE IN TEN SENIORS HAS NO DRUG COVERAGE
Nearly one of 10 adults under 65 has health insurance but no drug coverage, and that many face high out-of-pocket costs and burdensome medical bills. The study also found that lacking drug benefits is often a sign of other holes in basic coverage.
CLICK HERE for Study (Acrobat)
TWO THIRDS OF INTERNISTS IN PRIVATE PRACTICE ASSIST UNINSURED PATIENTS FINANCIALLY
Two-thirds of primary care internists in private practice help their uninsured patients by reducing or waiving fees for office visits. The study found, however, that internists are concerned about their ability to continue supplying high-quality care to the uninsured: less than half (49%) of internists said they are able to provide the quality of care they would like to their uninsured patients, while nearly all (91%) said they were able to do so for their insured patients.
As reported in "Care for the Uninsured in General Internists' Private Offices," charity care alone cannot adequately address the needs of rising numbers of uninsured Americans. Less than one-quarter of internists said they can often get medications for their uninsured patients at reduced cost, and fewer than one of 10 can often get reduced-cost lab tests or diagnostic procedures.
CLICK HERE for Press Release
CLICK HERE for Full Report
SCAM INSURERS
At a hearing held today by Sen. Charles Grassley (R-Iowa), Georgetown University researcher Mila Kofman testified about possible solutions to the growing problem of unauthorized or bogus health insurance. Kofman and her colleagues authored a recent Commonwealth Fund brief on the subject, cited in a new General Accounting Office study, that called for several steps to prevent the proliferation of phony health plans. Among the recommendations:
Fund state and federal consumer education campaigns to alert the public and small businesses about insurance scams. Institute mandatory training for insurance agents to identify these plans. Give the Department of Labor greater authority to shut down unauthorized plans and seize assets to pay medical claims and protect victims. Strengthen state and federal criminal penalties against perpetrators of health insurance scams. Expand access to health insurance coverage to reduce the need for affordable insurance that allows phony plans to thrive.
CLICK HERE for her testimony (Acrobat)
CLICK HERE for her report (Acrobat)
WHEN PATIENTS AND PHYSICIANS DIFFER RACIALLY
When patients and physicians were the same race, office visits lasted longer and patients rated their visits as more satisfying and participatory than when patients and physicians were different races.
CLICK HERE for Press Release
EFFECT OF RESTRICTING CARE FROM RECENT IMMIGRANTS
The effect of 1996 regulations that restricted funding for coverage of recent immigrants, many of whom lack health insurance. While as of 1999 the law had not greatly worsened the crisis, it had shifted costs from the federal government to cash-strapped states.
CLICK HERE for Press Release
IMPORTANCE OF RELATIONSHIP AND TRUST IN PATIENT CARE
Patient-physician interactions contribute to disparities in the quality of care between minority and white patients.
CLICK HERE for Press Release
HEALTH REFORM A KEY ISSUE IN THIS ELECTION YEAR
Rising health care costs and growing instability in insurance coverage have made health reform a key issue in this election year, according to the new Commonwealth Fund Biennial Health Insurance Survey released today. Findings from the survey, along with business, labor, and consumer perspectives, are being discussed at a policy briefing and webcast from Washington, D.C.
Nearly six of 10 Americans say presidential and congressional candidates' views on health reform will be a "very important" factor in their vote this November, the survey finds. What's more, majorities across the political spectrum support policies that would provide coverage to uninsured adults.
CLICK HERE for Press Release
CLICK HERE for Survey Results
COMMONWEALTH FUND QUARTERLY
Includes the following articles:
CLICK HERE for the Quarterly
- While big employers are still much more likely than small ones to offer health coverage, workers in large firms, together with their dependents, comprise a significant and growing share of the working uninsured.
- Report laying out the strategies of the 2004 presidential candidates and compares estimates of the number of uninsured who would be covered under each plan as well as the plans' projected costs.
- Nearly two of five Americans under age 65, and two-thirds of those with low incomes, had no health insurance at some point over a four-year period, according to a recent Health Affairs article.
- At a December 5 Alliance for Health Reform briefing, Fund president Karen Davis noted that near-poor Medicare beneficiaries will still face daunting out-of-pocket costs and will continue to pay a large share of their income for prescription drugs.
- Converting Medicare to an FEHBP-like model would diminish the program's large-group purchasing clout, create higher administrative costs, and discriminate against ill or disabled beneficiaries.
- Report examines how well the U.S. health system works from the perspective of patients, confirming what several other recent studies have shown that the U.S. performs worse than its peer nations on several dimensions of quality.
PREMIUM INCREASES FOR SMALL FIRMS OUTPACE THE 13.2 PERCENT INCREASE FOR LARGE FIRMS
Small businesses that provide health insurance for their employees experience more frequent premium increases and steeper jumps in deductibles over time than large firms. In their issue brief, "Risky Business: When Mom and Pop Buy Health Insurance for Their Employees", Gabel and Pickreign find that premiums for small firms (3 to 199 employees) increased 15.5 percent, outpacing the 13.2 percent increase for large firms (200 or more employees). Workers in small firms pay more of their premium costs and have higher deductibles as well. They also pay more for family coverage but less for single coverage than workers in large firms.
CLICK HERE for Issue Brief
CLICK HERE for Press Release
AHPs MAY BE HIGHLY UNSTABLE
With health costs and insurance premiums rising, many policymakers think association health plans (AHPs) may expand access to affordable insurance coverage. But a new Fund study warns that self-insured AHPs, or Multiple Employer Welfare Arrangements (MEWAs), often have less stringent licensing requirements than those imposed on traditional insurers. As a result, they could leave enrollees with unpaid medical bills if plans become insolvent.
CLICK HERE for the Commonwealth Issue Brief
CLICK HERE for the Press Release
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