The uninsured rate has fallen among all racial and ethnic groups under the Affordable Care Act with steeper declines among people of color compared to Whites, according to a new analysis by the Kaiser Family Foundation. The findings for Hispanics were especially striking. Between 2013 and 2015, the uninsured rate for Hispanics fell from 26 percent to 17 percent – a sharper decline than for any other group. Nationally, the total number of nonelderly uninsured fell from 41.1 million to 28.5 million, reducing the overall uninsured rate from 15 percent to a historic low of 10 percent over the period.

Despite such gains, however, non-elderly Hispanics, Blacks and American Indian and Alaska Natives still remained more likely than Whites to be uninsured as of 2015. American Indians and Alaska Natives and Hispanics were at the highest risk of being uninsured (see figure).

The analysis of Current Population Survey data also shows that eligibility for coverage among the remaining uninsured varies by race and ethnicity. Overall, more than 4 in 10 remaining nonelderly uninsured people are eligible for help to gain coverage through the ACA. Key findings include:

• Sixty-seven percent of nonelderly uninsured American Indians and Alaska Natives are eligible for such help.
• Nearly half (47%) of nonelderly uninsured Blacks are eligible for coverage, but they are twice as likely as uninsured Whites (20% vs. 10%) to not qualify for help because their state did not expand Medicaid.
• The shares eligible for coverage are lower for Asians (34%) and Hispanics (33%) because they include more noncitizens that do not qualify based on immigration status.

Coverage is more available under the ACA, but more gains are possible by reaching the uninsured who are eligible but not enrolled. Overall, people of color account for over half (55%) of the total nonelderly uninsured who are eligible for Medicaid but not yet enrolled, and 42 percent of those eligible for ACA tax credits to help buy private insurance.

This post now available at the Health Affairs Blog by Jack Hoadley of Georgetown University’s Health Policy Institute, and Tricia Neuman and Juliette Cubanski, both of the Kaiser Family Foundation, updates a two-year-old analysis of Sovaldi (sofosbuvir), an oral drug  approved by the FDA for the treatment of chronic hepatitis C, and the potential impact of the new specialty drug on Medicare spending and Part D premiums.For that 2014 piece, the authors used the best available data to estimate the number of people on Medicare who might seek treatment and the impact on Medicare spending. Here they revisit the earlier analysis using new data released by the Centers for Medicare and Medicaid Services, and consider both the ongoing impact of hepatitis C drugs for Part D and the broader implications for Medicare of new high-priced drugs entering the market.

Following two major Supreme Court rulings on same-sex marriage, a new Kaiser Family Foundation data note finds that in 2016, 84 percent of employees who worked at firms offering spousal health benefits also had access to same-sex spousal benefits. Eight percent did not have access, while another 8 percent worked at firms who reported they had not encountered this benefits issue.

The data note draws from responses to the Kaiser/Health Research & Educational Trust (Kaiser/HRET) 2016 Annual Employer Health Benefits Survey. Small employers are less likely to offer same-sex spousal coverage, while larger firms, which employ the majority of U.S. workers, are more likely to offer this benefit. Ninety-four percent of workers at large firms (200 or more employees) with access to opposite-sex spousal health benefits also had access to same-sex spousal benefits, compared to 59 percent of workers at small firms.

Across all employers who offer spousal coverage, less than half (43%) say they offer coverage to same-sex spouses. About as many (41%) say they have not encountered this issue, while a smaller share (16%) say they do not offer same-sex spousal coverage.

How Premiums Are Changing in 2018 is now available.

Health insurance premiums on the Affordable Care Act’s marketplaces (also called exchanges) are expected to increase faster in 2017 than in previous years due to a combination of factors, including substantial losses experienced by many insurers in this market and the phasing out of the ACA’s reinsurance program. We analyzed 2017 premiums and insurer participation made available through Healthcare.gov on October 24, 2017, as well as data collected from states that run their own exchange websites.

Changes in the Second-Lowest Silver Premium

The second-lowest silver plan is one of the most popular plan choices on the marketplace and is also the benchmark that is used to determine the amount of financial assistance individuals and families receive. The table below shows these premiums for a major city in each state with available data. (We have been reporting premiums in these cities since the launch of the ACA’s exchanges in 2014; similar analyses for 2015 and 2016 are also available.)

Across these major cities in 2016, the second-lowest silver premium for a 40-year-old non-smoker ranged from $186 per month in Albuquerque, NM to $719 in Anchorage, AK, before accounting for the tax credit that most enrollees in this market receive. In 2017, the second-lowest silver premium for a 40-year-old non-smoker living in these cities will range from $229 in Louisville, KY and Cleveland, OH to $904 in Anchorage, AK, before accounting for the tax credit.

Of these major cities, the places with the largest increases in the unsubsidized second-lowest silver plan were Phoenix, AZ (up 145% from $207 to $507 per month for a 40-year-old non-smoker), Birmingham, AL (up 71% from $288 to $492) and Oklahoma City, OK (up 67% from $295 to $493). Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Indianapolis, IN (down -4% from $298 to $286 for a 40-year-old non-smoker), Cleveland, OH (down -2% from $234 to $229), Boston, MA (down -1% from $250 to $247), and Providence, RI (down -1% from $263 to $261) and increase just 1% in Little Rock, AR (from $310 to $314).

Most enrollees in the marketplaces receive a tax credit to lower their premium. In most parts of the country in 2016, a 40-year-old adult making $30,000 per year would pay about $208 per month for the second-lowest-silver plan. If this person is willing to switch to whatever the new second lowest-cost silver plan is in 2017, they will pay a similar amount (the after-tax credit payment for a similar person in 2017 is $207 per month or a change of 0%). In some parts of the country (for example, in Albuquerque, NM), premiums for a 40-year-old are so low in 2016 that an enrollee making $30,000 may not have qualified for a subsidy. In these places, an increase in the benchmark silver premium may make them newly-eligible for financial assistance.

Changes in Insurer Participation

As a result of losses in this market, some insurers like UnitedHealth and Aetna have announced their withdrawal from the ACA marketplaces or the individual market in some states. In 2016, the number of insurers participating in each state (grouped by parent company) ranged from 1 in Wyoming to 16 in Texas. In states that use Healthcare.gov, the average number of insurers participating in the marketplace will be 3.9 in 2017 (down from 5.4 companies per state in 2016, 5.9 in 2015 and 4.5 in 2014). Marketplace insurer participation in states using Healthcare.gov in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin.

This Visualizing Health Policy infographic provides a snapshot of Medicare and end-of-life care. Of 2.6 million total deaths in the United States in 2014, 2.1 million were Medicare beneficiaries. Although Medicare spent significantly more on care for people at the end of life who died in 2014 ($34,529 per person) than for other beneficiaries that year ($9,121 per person), the share of total Medicare spending for people at the end of life decreased from 18.6% to 13.5% between 2000 and 2014. Medicare spending for people at the end of life also decreased with age. Hospice use among Medicare beneficiaries at the end of life increased between 2000 and 2014 to nearly half (46%) of all beneficiaries. Medicare spending on hospice also increased during that period, from $2.3 billion to $10.4 billion. Surveys show that more than 7 in 10 people aged 65 years and older have not discussed end-of-life care with a physician, and that 4 in 10 have not documented their end-of-life care wishes. Before Jan. 1, 2016, Medicare did not reimburse physicians for patient visits to discuss end-of-life care, and as of 2016, 68% of physicians report that they have not received training for such discussions.

Visualizing Health Policy is a monthly infographic series produced in partnership with the Journal of the American Medical Association (JAMA). The full-size infographic is freely available on JAMA’s website and is published in the print edition of the journal.

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This Visualizing Health Policy infographic provides a snapshot of Medicare and end-of-life care. Of 2.6 million total deaths in the United States in 2014, 2.1 million were Medicare beneficiaries. Although Medicare spent significantly more on care for people at the end of life who died in 2014 ($34,529 per person) than for other beneficiaries that year ($9,121 per person), the share of total Medicare spending for people at the end of life decreased from 18.6% to 13.5% between 2000 and 2014. Medicare spending for people at the end of life also decreased with age. Hospice use among Medicare beneficiaries at the end of life increased between 2000 and 2014 to nearly half (46%) of all beneficiaries. Medicare spending on hospice also increased during that period, from $2.3 billion to $10.4 billion. Surveys show that more than 7 in 10 people aged 65 years and older have not discussed end-of-life care with a physician, and that 4 in 10 have not documented their end-of-life care wishes. Before Jan. 1, 2016, Medicare did not reimburse physicians for patient visits to discuss end-of-life care, and as of 2016, 68% of physicians report that they have not received training for such discussions.

Visualizing Health Policy is a monthly infographic series produced in partnership with the Journal of the American Medical Association (JAMA). The full-size infographic is freely available on JAMA’s website and is published in the print edition of the journal.

A new Kaiser Family Foundation report finds that donor governments provided US$1.3 billion in bilateral funding for family planning programs in low- and middle-income countries in 2015, essentially matching 2014 levels in real terms (after accounting for exchange rate fluctuations and inflation). In current U.S. dollars, however, 2015 funding was 6 percent below the 2014 level, largely due to the appreciation of the U.S. dollar.

When measured in their currency of origin, the report finds five donors actually increased funding, while three donors decreased, and two donors remained flat.

The U.S. was the largest donor, providing US$638 million, or nearly half of all bilateral funding for family planning programs in 2015. The U.K. (US$270 million) was the second largest bilateral donor, followed by the Netherlands (US$166 million), France (US$69 million), and Sweden (US$66 million).

Among the ten donor countries profiled in the analysis, eight made commitments at the London Summit on Family Planning in 2012; seven of the eight are on track towards fulfillment of these commitments.

This analysis is being released at the same time as Family Planning 2020’s (FP2020) annual report on progress toward goals agreed upon at the 2012 London Summit on Family Planning.