National Health Expenditure Projections, 2013–23: Faster Growth Expected With Expanded Coverage And Improving Economy
Abstract
In 2013 health spending growth is expected to have remained slow, at 3.6 percent, as a result of the sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements. The combined effects of the Affordable Care Act’s coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth this year and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015–23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990–2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013–23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023.
Why Do Doctors Commit Suicide?
By PRANAY SINHA
NEW HAVEN — TWO weeks ago, two medical residents, in their second month of residency training in different programs, jumped to their deaths in separate incidents in New York City. I did not know them, and cannot presume to speak for them or their circumstances. But I imagine that they had celebrated their medical school graduation this spring just as my friends and I did. I imagine they began their residencies with the same enthusiasm for healing as we did. And I imagine that they experienced fatigue, emotional exhaustion and crippling self-doubt at the beginning of those residencies — I know I did.
The statistics on physician suicide are frightening: Physicians are more than twice as likely to kill themselves as nonphysicians (and female physicians three times more likely than their male counterparts). Some400 doctors commit suicide every year. Young physicians at the beginning of their training are particularly vulnerable: In a recent study, 9.4 percent of fourth-year medical students and interns — as first-year residents are called — reported having suicidal thoughts in the previous two weeks.
Hospitals and residency programs recognize the toll residency takes on the mental stability and physical health of new doctors. In 2003, work hours were capped at 80 hours a week for all residency training programs. Residents are provided confidential counseling services to help cope with stress. My residency program offers writing workshops and monthly reflection rounds. We have a wellness committee that organizes social events such as bonfires on the beach and visits from therapy dogs.
But despite these efforts, people still fall through the cracks. While acute stress, social isolation, pre-existing mental illness and substance abuse may be obvious factors to consider, we must also ask if there are aspects of medical culture that might push troubled residents beyond their reserves of emotional resilience.
There is a strange machismo that pervades medicine. Doctors, especially fledgling doctors like me, feel pressure to project intellectual, emotional and physical prowess beyond what we truly possess. In his famous essay “Aequanimitas,” Sir William Osler, who founded the first American residency program at Johns Hopkins Hospital in 1889, stressed the importance of equanimity in a physician.
‘Obamacare’ Challengers Lose Again
On Thursday morning, as almost everyone predicted it would, the federal appeals court in Washington, D.C., voted to toss out a three-judge panel’s ruling upholding the latest attempt to kill “Obamacare.” The full 11-member court is scheduled to rehear the case on Dec. 17.
The claim this time was that subsidies for the health exchanges that are at the heart of the law are available only to those exchanges “established by the State.” In other words, not available in the three dozen states where the federal government has set up an exchange because the state refused to. This would result in the denial of coverage to an estimated 4.7 million Americans.
To succeed, the claim required that those four words be considered in a hermetically sealed tube, independent from the rest of the 900-page law, whose core purpose was to ensure affordable health-care to lower-income Americans.
To succeed, the claim required that those four words be considered in a hermetically sealed tube, independent from the rest of the 900-page law, whose core purpose was to ensure affordable health-care to lower-income Americans.
Luckily for the challengers, two of the three panel judges in the case,Halbig v. Burwell, were sympathetic to that way of reading the law. The third was less impressed, calling it a “not-so-veiled attempt to gut” the Affordable Care Act.
Hackers Breach Security of HealthCare.gov
By ROBERT PEAR and NICOLE PERLROTH
WASHINGTON — Hackers breached security at the website of the government’s health insurance marketplace, HealthCare.gov, but did not steal any personal information on consumers, Obama administration officials said Thursday.
The administration informed Congress of the violation, which it described as “an intrusion on a test server” supporting the website.
“Our review indicates that the server did not contain consumer personal information, data was not transmitted outside the agency and the website was not specifically targeted,” said Aaron Albright, a spokesman at the Centers for Medicare and Medicaid Services, which runs the website. “We have taken measures to further strengthen security.”
Mr. Albright said the hacking was made possible by several security weaknesses. The test server should not have been connected to the Internet, he said, and it came from the manufacturer with a default password that had not been changed.
In addition, he said, the server was not subject to regular security scans as it should have been.
The security of HealthCare.gov, which serves residents of 36 states, has been a major concern for some members of Congress, particularly Republicans.
Congressional investigators found that administration officials, eager to begin enrollment on Oct. 1, activated the website even though its security had not been fully tested and did not meet federal standards. This created a potentially “high risk” for the exchange, according to a memorandum prepared by security experts at the Medicare agency.
Since then, administration officials have repeatedly reassured consumers that the problems were fixed.
New York State Gives Health Insurers Average Rate Rise of 5.7%
Health insurance companies in New York State will receive average rate increases of 5.7 percent next year, less than half the increases they had requested for individual and family plans, Benjamin M. Lawsky, the state’s financial services superintendent, said on Thursday.
The insurance companies had proposed increases averaging 12.5 percent, with some companies seeking as much as 28 percent more for some plans.
The average increase that the state decided to award is below the state’s 8 percent overall increase in health care costs.
Mr. Lawsky said the state had tried to balance its interest in making insurance affordable and not putting too much stress on insurance companies. “We don’t want to see a spike in the rate, but we also don’t want to see companies withdrawing, and that’s the yin and yang,” he said.
But the insurance industry said on Thursday that on the contrary, the new rates were “irresponsible” and “do not reflect actuarial reality.”
Paul Macielak, president of the New York Health Plan Association, an industry trade group, said the rates would be destabilizing for companies and consumers, and could lead some companies to reduce the types of plans they offered or to withdraw from some regions or from the market entirely.
The increase also applies to New York State of Health, an exchange set up under the Affordable Care Act last year to provide subsidized health insurance for state residents who might not otherwise be able to afford it. Mr. Lawsky said he wanted to maintain the momentum that had given New York one of the more successful state exchanges. It has enrolled nearly one million New Yorkers in individual coverage, including about 370,000 in private plans.
Mark Scherzer, a health care lawyer who represents policyholders, said using California’s 4.2 percent increase in the rates of that state’s exchange as a barometer, the result for New York seemed reasonable.
Mr. Scherzer said he was disappointed that in most of New York, none of the insurance companies’ plans allowed patients to use physicians who were not in their network.
Nation's healthcare changes may rein in costs in long run, report says
National healthcare spending will continue to rise in coming years, but at a slower rate than in the previous two decades, according to a government analysis of the nation’s $3-trillion healthcare tab.
The report released Wednesday suggests that changes underway in medical care and insurance coverage may help rein in America’s notoriously high-cost system, even as millions of Americans gain insurance through the federal healthcare law.
But the slowing still may not make healthcare affordable, as medical spending is projected to outpace economic growth over the next decade, the report says.
“Analysis of historic trends tells us that healthcare spending tracks with economic growth, so as the economy is anticipated to improve over the next decade, health spending growth is projected to grow faster,” said the report’s lead author, Andrea Sisko, an economist at the Department of Health and Human Services.
The agency each year analyzes how the country spends money on healthcare. Although the projections are vague, they provide something of an annual report card on the nation’s complex system.
This year’s analysis is mixed.
After years of very slow growth, stemming largely from the recession, healthcare spending is expected to pick up to an average annual rate of 5.7% over the next decade, or 1.1 percentage points higher than overall economic growth.
The spending growth is driven by the recovering economy and by the expansion in insurance coverage that began this year under the Affordable Care Act, according to analysts. The health law allows Americans in most states to get guaranteed coverage through a commercial health plan or through Medicaid. (Some states whose political leaders oppose the law have not expanded their Medicaid programs to cover all their poorest residents, an option under the law.)
The acceleration in spending will push the country’s total healthcare tab to more than $5 trillion in 2023, or about 19.3% of the economy. That is up from 17.6% this year, already far more than that of any other industrialized nation.
How People Feel About Their Employer-Sponsored Health Plans
We’re still waiting to get really good information about how people who have bought health plans on the new state marketplaces are liking them. There’s some early polling evidence that people are happy to have coverage — but also some accounts that people are frustrated by small doctor networks andstruggling to afford medical care even after getting insurance.
We know more about the people who already had health insurance through their employers. And the evidence suggests that many people with that more common type of coverage also feel the financial strain of paying for medical care. That information is going to be helpful when we start evaluating early results from the new Affordable Care Act plans. People’s experience with those plans may turn out to be different in some major way that suggests a policy triumph or failure — or it may just reflect the experience we all have with health insurance these days.
There are new results from the Urban Institute’s Health Reform Monitoring Survey, which asked people with employer-based coverage how they liked what they had. A large majority said they were satisfied with the range of services that were covered and the quality of the care they could get. But just over half said they were satisfied when they were asked about their premiums, deductibles and financial protection against big bills.
For people earning between 138 percent and 400 percent of the federal poverty limit, or between $33,000 to $95,000 — the income range of people who are most likely to buy insurance on the public marketplaces — more than 23 percent of workers with employer coverage reported having problems paying their medical bills in the last year. For workers even lower on the income spectrum — who are now eligible for Medicaid coverage in the states that have expanded their programs — more than 32 percent with employer coverage had struggled to pay their medical bills. But about 9 percent of higher earners also had trouble with health care costs.
Sharon Long, a senior fellow at Urban, said that the results suggested that consumers might not be prepared for what happened when they combined a high-deductible insurance plan with big medical bills.
“What we’ve heard anecdotally from people with health plans is more people are signing up for high-deductible health plans and then being surprised that they have to pay the deductible,” she said. That’s a concern on the new health insurance marketplaces, too. Early evidence suggests that people tended to opt for cheaper plans, many of which came with high deductibles — meaning that the newly insured may face some of the same financial strain if they become seriously ill.
The survey results are consistent with trends in the employer-based market. Deductibles and co-payments have been rising, as a growing number of employers embrace the idea that giving workers more of a financial stake in their medical care will help reduce overuse. “It’s been going up over the past few years,” said Gary Claxton, a director of theHealth Care Marketplace Project at the Kaiser Family Foundation, which runs a comprehensive annual survey of the employer insurance market. And no one likes paying high insurance premiums or out-of-pocket costs.
Over all, Ms. Long said, the rising costs of health care are likely to remain a concern for consumers, wherever they get their insurance. “I expect what we’ll see over time, unless we are able to get costs under control, is that all the cost questions are going to be an issue,” she said.
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