Health Policy Updates: December 10 2017

Health care spending continues to increase – the rate of increase in 2016 was 4.3%, down from 5.8% in 2015 but still greater than inflation. Health care now takes up 17.9% of the US economy. The out-of-pocket costs borne by patients, though, are up more sharply.

“A shift toward insurance plans that transfer more of the burden of health care costs onto patients helped fuel the rise in out-of-pocket costs. In 2016, 29 percent of people who receive insurance through employers were enrolled in high-deductible plans, up from 20 percent in 2014. The size of the deductibles also increased over this time period, a 12 percent increase in 2016 for individual plans, compared with a 7 percent increase in 2014.”


This was a great infographic in the NYTimes, showing the full picture of premium increases in the ACA markets. Which levels of plans are experiencing price increases, and where they are and are not.

There is a common conception that the uninsured avoid primary care because of their inability to pay, and then end up using more higher-cost forms of health care down the road, particularly emergency rooms. This recent piece in Health Affairs explains why this only partially true – while the uninsured use more ER relative to their amount of primary care compared to the insured, they actually don’t use the ER more often than the insured do.

“It has therefore been surprising to many to encounter evidence that insurance coverage increases ED use instead of decreasing it. Two facts may help explain this unexpected finding. First, there is a common misperception that the uninsured use the ED more than the insured. In fact, insured and uninsured adults use the ED at very similar rates and in very similar circumstances—and the uninsured use the ED substantially less than the Medicaid population. Second, while the uninsured do not use the ED more than the insured, they do use other types of care much less than the insured.”

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