This report provides an early look at state efforts to prepare for health reform, examining the experiences to date in five states (Connecticut, Michigan, Massachusetts, North Carolina and Washington).

The report finds that the state political environment and expected leadership transitions create uncertainties and are already factoring into state strategies on health reform implementation. State leaders dealing with an aging workforce, hiring constraints, and the toll from the recession also see a need for additional staff and outside contractors to help with designing insurance exchanges, handling expanded enrollment for Medicaid and state exchanges and updating eligibility systems in the timeframe required under the reform law.

The report was released at a Sept. 30, 2010 briefing on state Medicaid programs, the recession and health reform. It was authored by researchers at the Kaiser Family Foundation and the Center for State and Local Government Excellence.

Report (.pdf)

This annual 50-state survey finds that number of states experienced rapid growth in their Medicaid enrollment and spending last year and expect additional growth, though at a slower pace, in fiscal year 2011.

In the survey of Medicaid officials, states reported an average increase in Medicaid spending of 8.8 percent across all states in fiscal year 2010, the highest rate of growth in eight years and well above their original projections of 6.3 percent growth. Medicaid directors attributed the unexpected jump to higher-than-expected increases in eligible families due to the recession, which pushed the national unemployment rate above 10 percent and even higher rates in some states.

For fiscal year 2011 (which runs through June 2011), states budgeted for an average 7.4 percent increased in spending above fiscal year 2010 – a slightly slower rate of growth consistent with their expectations that enrollment growth will slow to 6.1 percent, according to the 10th annual survey and of state Medicaid directors.

The American Recovery and Reinvestment Act of 2009 (ARRA) provided a temporary boost in the federal government’s share of Medicaid costs, providing an estimated $87 billion to states starting in October 2008. ARRA’s increased federal Medicaid support was originally scheduled to end in December 2010, but in August, Congress enacted additional relief for states through June 2011 at a reduced level, providing $16 billion over six months.

The report was released at a Sept. 30, 2010 briefing on state Medicaid programs, the recession and health reform. It was authored by researchers at the Kaiser Family Foundation and Health Management Associates.

Executive Summary (pdf)Full Report (.pdf)

Mid-Year Update Report for FY 2011

About One In Four Covered Workers Now Face Annual Deductibles Of $1,000 Or More, Including Nearly Half Of Those Employed By Small Businesses

WASHINGTON, D.C. —  Workers on average are paying nearly $4,000 this year toward the cost of family health coverage – an increase of 14 percent, or $482, above what they paid last year, according to the benchmark 2010 Employer Health Benefits Survey released today by the Kaiser Family Foundation and the Health Research & Educational Trust (HRET).

The jump occurred even though the total premiums for family coverage, including what employers themselves contribute, rose a modest 3 percent to $13,770 on average in 2010, the survey found.  In contrast, the amount employers contribute for family coverage did not increase.

Preferred Provider Organizations (PPOs) continue to dominate the employer market, enrolling 58 percent of covered workers.  Average PPO family premiums topped $14,000 annually in 2010.

Since 2005, workers’ contributions to premiums have gone up 47 percent, while overall premiums rose 27 percent, wages increased 18 percent, and inflation rose 12 percent.

Many employers are also raising the annual deductibles workers must pay before their health plans begin to share most health care costs.  A total of 27 percent of covered workers now face annual deductibles of at least $1,000, up from 22 percent in 2009, the survey finds.  Among small firms (3-199 workers), 46 percent face such deductibles.

The annual Kaiser/HRET survey provides a detailed picture of private health insurance coverage and costs. The full report and summary of findings from the annual survey of small and large employers will be available today online. Selected findings will also be published today as a Web First article in the journal Health Affairs.

“With the economy struggling, businesses have been shifting more of the costs of health insurance to workers through premiums, deductibles and other cost-sharing,” Kaiser President and CEO Drew Altman, Ph.D., said. “This may be helping to stem the rapid rise in premiums that we saw in the early 2000s, but it also means employer coverage is less comprehensive.  From a consumer perspective, the cost of health insurance just keeps going up faster than wages.”

“High out-of-pocket expenses and premiums affect health care decisions for patients.  If premiums and costs continue to be shifted to consumers, households will face difficult choices, like forgoing needed care, or reexamining how they can best care for their families,” said Maulik Joshi, Dr.P.H., president of HRET and senior vice president for research at the American Hospital Association.

The nation’s recession contributed to the shift in burden to workers.  In response to the economic downturn, 30 percent of employers say they reduced the scope of health benefits or increased cost sharing, and 23 percent report increasing the amount employees pay for coverage, the survey finds.

Among other plan types, only consumer-driven plans (which are high-deductible plans that also include a tax-preferred savings options such as a Health Savings Account or Health Reimbursement Arrangement) saw growth in their market share.  Such plans now enroll 13 percent of covered workers, up from 8 percent last year.

“Consumer-driven plans have clearly established a foothold in the employer market, tripling their market share from 4 percent in 2006 to 13 percent today,” said study lead author Gary Claxton, a Kaiser vice president and director of the Healthcare Marketplace Project.

Surprisingly, the survey saw the percentage of firms offering health benefits in 2010 increase sharply to 69 percent, up from 60 percent in 2009, largely because of an increase in the offer rate among firms with 3 to 9 workers.  Because most workers are employed by large firms, the shift among the smallest firms did not have a major effect on either the percentage of workers offered health benefits or the percentage of workers covered at their job.

The reason for the large increase in offer rate is unclear.  Because of the poor economic climate in 2010, it is unlikely that many firms began offering coverage this year.  A possible explanation is that non-offering firms were more likely to fail during the past year, with the attrition of non-offering firms leading to a higher offer rate among surviving firms.

Other findings from the survey include:

• Single coverage.  The survey also tracks the premiums for worker-only health benefits, which increased 5 percent in 2010 to reach $5,049 annually.  Workers on average are paying $899 annually for single coverage, up from $779 in 2009.   Forty-seven percent of covered workers are in single coverage plans.

• Physician office visits.  Among covered workers with a copayment for in-network physician office visits, the average copayment increased a small but statistically significant amount from 2009 to 2010 — from $20 to $22 for primary care and from $28 to $31 for specialty care.

• Mental health benefits.  In response to the 2008 Mental Health Parity and Addiction Equity Act, 31 percent of firms with more than 50 workers made changes to the mental health benefits they offer.  Most of this group eliminated limits on coverage to comply with the law, though a small share (5 percent of those making changes) dropped mental health coverage altogether.

• Wellness benefits.  About three-fourths (74 percent) of employers offering health benefits offer at least one of the following wellness programs: weight loss program, gym membership discounts or on-site exercise facilities, smoking cessation program, personal health coaching, classes in nutrition or healthy living, web-based resources for healthy living, or a wellness newsletter.

• Health risk assessments.  Among firms offering coverage, 11 percent give their employees the option of completing a health risk assessment to help employees identify potential health risks.  Within this group, 22 percent — or a relatively small two percent of all employers — offer financial incentives such as lowering the worker’s share of premiums or offering merchandise, gift cards, travel, or cash to their workers.  Large firms are more likely than small firms both to offer assessments and to offer financial incentives.

Now in its 12th year, the survey is a joint project of the Kaiser Family Foundation and the Health Research & Educational Trust.  The survey was conducted between January and May of 2010 and included 3,143 randomly selected, non-federal public and private firms with three or more employees (2,046 of which responded to the full survey and 1,097 of which responded to a single question about offering coverage).  A research team at Kaiser and HRET conducted and analyzed the survey, led by Kaiser’s Gary Claxton and including researchers at the National Opinion Research Center (NORC) at the University of Chicago (working on the project under contract to HRET).  For more information on the survey methodology, please visit the Survey Design and Methods Section at http://ehbs.kff.org.

Six months since the enactment of the Patient Protection and Affordable Care Act and a month and a half before the midterm congressional elections, Kaiser’s September Health Tracking Poll finds the public remains divided on the new law. Public confusion over the new health law has risen to its highest point since April.

The tug of war for public opinion on health reform continues this month, with approval and disapproval staying in the same relatively narrow band each has occupied since passage even as favorable views regain a small upper hand, 49 percent favorable vs. 40 percent unfavorable. Opinion is more closely divided among this fall’s likely voters (46 percent vs. 45 percent), and opponents of the law continue to hold their views more emphatically than supporters. Overall, 26 percent of Americans believe the law should be repealed.

Six weeks from the contentious midterm elections, confusion over the new health law has risen to its highest point since April, with 53 percent of Americans saying they are confused about health reform, up 8 percentage points from August. Misperceptions about the law also persist: for example, three in ten seniors believe the law will permit government panels to make decisions about end-of-life care for Medicare recipients (often referred to as “death panels”).

When it comes to voter turnout and vote choice, the September tracking survey suggests that, at least at this point, health reform is not playing a major role or providing a decisive advantage to one party’s position over the other.

Meanwhile, while the views of independents have consistently appeared to be hovering midway between the majority support expressed by Democrats and the majority opposition expressed by Republicans — a balance waiting to tilt the public’s views decisively in favor or opposed once and for all — an analysis of the September tracking data reveals that in fact most independents look much like their partisan brethren in having embraced or rejected the new law. Roughly a third of independents say they lean toward the Democrats, and in this group health reform receives majority support. The opposite holds true for those independents who say they lean toward the Republicans, leaving only a relatively small sliver in the middle.

Findings (.pdf)

Chartpack (.pdf)

Toplines (.pdf)

Data Note: Health Reform and the Tea Party Movement

This survey is the third in a series by the Foundation that aims to illuminate the American public’s views and knowledge of U.S. efforts to improve health for people in developing countries.

The survey examines perceptions about foreign aid in general and assistance for health specifically, including the public’s priorities for international health assistance, perceptions of progress in improving health abroad, sources of news and information on global health issues, and the relationship between positive and negative news coverage and attitudes.

The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation. It was conducted August 3 through August 16 among a nationally representative random sample of 1,213 adults ages 18 and older. The margin of sampling for the overall survey is plus or minus 3 percentage points.News Release

Survey (.pdf)

This policy brief examines the low-income subsidy program that provides premiums and cost-sharing assistance under Part D plans, documenting trends in both beneficiary and plan participation over time. With fewer plans available to low-income enrollees without having to pay a premium, and annual changes in those plans, the brief discusses challenges facing low-income Part D enrollees and strategies that could be used to increase the effectiveness of the subsidy program.

It was prepared for the Foundation by Laura Summer and Jack Hoadley of Georgetown University and Elizabeth Hargrave of NORC at the University of Chicago.

Policy Brief (.pdf)

Health Reform Roundtables: Charting A Course Forward is a series of discussions among federal officials, state officials and outside experts that provides an opportunity to share insights and explore key issues related to implementing a significant expansion of the Medicaid program as part of the new health reform law that will require most U.S. citizens and legal residents to obtain health coverage. States will be largely responsible for implementing the Medicaid expansion, which will provide coverage for lower income Americans through one of the largest enrollment efforts in the program’s history, and for establishing new health insurance Exchanges and coordinating Medicaid and Exchange coverage.

The roundtables are convened periodically by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured at the Foundation’s Washington, D.C. offices. Briefs highlighting key issues raised in each discussion will be posted here as they become available.

Ensuring Access to Care in Medicaid Under Health Reform

Medicaid Policy Options for Meeting the Needs of Adults with Mental Illness under the Affordable Care Act

Coordinating Coverage and Care in Medicaid and Health Insurance Exchanges

Expanding Coverage to Adults Through Medicaid Under Health Reform

Key Issues to Consider for Outreach and Enrollment Efforts under Health Reform

The Kaiser Commission on Medicaid and the Uninsured convened a roundtable discussion on June 23, 2010 with a group of federal and state officials and experts to discuss key issues related to reaching, enrolling and delivering care to adults in Medicaid under health reform. The discussion focused in particular on non-disabled adults without dependent children (often referred to as “childless adults”) who have historically been ineligible for the program. When the new coverage goes into effect in 2014, states will face one of the largest enrollment efforts in the Medicaid program’s history. Roundtable participants agreed that it was important for states to begin preparing and making necessary upgrades to their systems now, and also that federal guidance and support is key for helping them move forward.

Issue Brief (.pdf)

The Kaiser Family Foundation has issued a collection of analyses related to the Part D Medicare stand-alone drug plan options available to seniors for calendar year 2010.

Each of these spotlights focuses on a key aspect of the drug plans that will be available to Medicare beneficiaries in 2010 and examine relevant trends since the Medicare drug benefit took effect in 2006. They were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation.

Medicare Prescription Drug Plans In 2010 and Key Changes Over Five Years

Premiums

Benefit Design and Cost Sharing

A Comparison of PDPs Offering Basic and Enhanced Benefits

Part D Plan Availability in 2010 and Key Changes Since 2006

Coverage of Top Brand-Name and Specialty Drugs

Prices for Brand-Name Drugs in the Coverage Gap

The Medicare Part D Low-Income Subsidy Program: Experience to Date and Policy Issues for Consideration

>> Previous Medicare Part D Data Spotlights Available

This brief summarizes key findings from the full collection of 2010 Part D Data Spotlights examining key trends in the private stand-alone drug plans available to Medicare beneficiaries.

The spotlight is one in a series analyzing key aspects of the Medicare Part D drug plans that will be available to beneficiaries in 2010. The analysis was conducted jointed by Jack Hoadley and Laura Summer of Georgetown University, Elizabeth Hargrave of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation.

Data Spotlight (.pdf)