California

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Employer Health Benefits in California in 2011

January 24, 2012 in HC Statistics, Health Insurance, Managed Care | No comments

Each year, the California Health Care Foundation (CHCF) examines trends in employer health benefits in the state of California.  Last year, I reported on the 2010 CHCF report and now I will examine the 2011 report.

Between 2010 and 2011, some things have remained the same.  Healthcare premiums are far outpacing inflation over the medium run and California premiums remain higher than average. Workers at small California firms have to cover a large share of premiums and receive less generous insurance coverage (i.e., deductibles more than $1000).

High-wage firms (66% vs. 42%), firms with few part-time workers (70% vs. 41%) and firms with at least some unionized staff (84% vs. 61%) are more likely to offer health insurance to their workers.

Growth in California health insurance premiums (9.1%) in 2011 fell below the growth rate of the U.S. overall (9.5%). In 2010, the opposite was true. California health insurance premiums rose by 7.5%, but overall U.S. premium growth rose by only 3.0%.

The stereotype that California is the land of managed care holds true. Whereas the national proportion of covered workers enrolled in an HMO declined from 20% to 17% between 2009 and 2011, in California the proportion of covered workers enrolled in an HMO held steady at 54%. Also, although the U.S. overall has seen significant growth in high-deductible health plans (HDHPs) so that 17% of covered workers are enrolled in these plans, in California, only 6% of workers have enrolled in this plan type.

Is the ACA working? The answer is probably no. “Just 32% of small California firms not currently offering health benefits were aware of the small firm tax credit that is part of the Affordable Care Act.”

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The Number of Uninsured Growing in California

January 11, 2012 in HC Statistics | 1 comment

Although Health Reform has passed, many of its mandates–such as Health Insurance Exchanges–have not yet been implemented.  As the cost of health care has been growing over time, the number of uninsured has also been growing.

The California Health Care Foundation examines the uninsured in California in more detail.  Although Texas has the highest share of individuals uninsured (27.3%), California has the largest number of uninsured individuals in the country (6.9 million) and one of the largest share of (21%).  One of the reasons for this decline is a decrease in the share of firms offering insurance.  The share of non-elderly Californians who obtain their insurance through their job has  declined from 65% in 1987 to 53% in 2010. Part of this decrease has been offset by a rise in the share of Californians covered by Medicaid.

Some other highlights from the CHCF report include:

  • Employees in businesses of all sizes are more likely to be uninsured in California than in the United States.
  • Nearly one-third of the uninsured in California and the nation have family incomes of $50,000 or more.
  • Fifty-three percent of California’s uninsured children are in families where the head of household worked full-time during calendar year 2010, down from 61% in 2008.
  • About 60% of the uninsured population are Latino.

Below are two charts displaying the insurance source for Californians in 2010 and 2000.

For more facts and figures, see the CHCF Snapshot, California’s Uninsured, Dec 2011.

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California Health Care Almanac

December 23, 2011 in HC Statistics, Quality | No comments

The California Health Care Foundation (CHCF)’s Health Care Almanac provides some unique insights on trends in health care quality in California and for the United States as a whole.  Many of the national figures for the Almanac come from the CDC (BRFSS and Vital Stats) and AHRQ’s National Healthcare Quality Report.  California quality figures come from the California Department of Public Health, the Office of Statewide Health Planning and Development and the California Health Interview Survey.

Although not discussed in this post, another portion of the Health Care Almanac looks at quality by site of service.  Much of this data comes from Hospital Compare, CMS OASIS data, AHRQ’s National Healthcare Quality Report, and the Dartmouth Atlas.

Today I highlight 3 topics related to clinical quality:

  • Cesarean Deliveries
  • Infant Mortality
  • Cancer Incidence.

More detail is below.

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Does California really love Managed Care?

November 28, 2011 in Current Events, Health Insurance, Managed Care, Medicaid, Medicare, Medicare Advantage | 1 comment

In short, yes. California is the land of managed care. Kaiser-Permanente–the managed care poster child–owns one third of the market.  Love for managed care is not just in the private market; in 2010, over half of all Medi-Cal and more than one-third of Medicare beneficiaries were enrolled in managed care plans.  Further, California managed care plans even have their own regulator.  Whereas the California Department of Insurance (CDI) regulates non HMOs, the California Department of Managed Health Care (DMHC) regulates HMOs.

A recent report by the California Health Care Foundation investigates managed care in California and provides a high quality overview of the California health insurance market.  Some of their findings include:

  • Five insurance carriers (Kaiser, Anthem Blue Cross, Health Net, Blue Shield, United Healthcare) accounted for three-fourths of the $105 billion health insurance revenues in California in 2010. Revenue growth has been slower for managed care plans in recent years, however.
  • The six largest managed care plans together lost more than 400,000 commercial enrollees. On the other hand, Medi-Cal and Medicare managed care enrollment grew.
  • Anthem Blue Cross and Blue Shield experienced enrollment decline in 2010, which reversed a previous growth trend.
  • Large majorities of HMO and PPO members rated their plan highly in terms of getting appointments quickly, finding a doctor, and getting the care they need. HMO enrollees more often rated their care highly than those enrolled in PPOs, while PPO participants were more likely to favorably cite their ability to get an appointment quickly.

Source: Katherine Wilson, “California Health Plans and Insurers” California Health Care Foundation, November 2011.

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Health Exchanges

October 17, 2011 in Health Insurance, Health Reform | No comments

The California Healthcare Foundation (CHCF) notes that States face a number of challenges when determining how to design their Health Exchanges mandated by health reform.  Today, I briefly highlight some of the requirements State Exchanges must fulfill.
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Health Reform in California: Expanding Care to Ex-Cons?

September 15, 2011 in Health Reform, Medicaid | No comments

One of the goals of health reform was to expand coverage to poor childless adults who previously did not qualify for Medicaid.  One unintended (or perhaps intended) consequence of this expansion is that a large number of individuals formerly convicted of crimes will be eligible for the this coverage.

Policymakers face a number of questions.  First, do these ex-offenders “deserve” coverage?  Many in the public may wonder why middle class individuals should be uninsured when the government is providing health care for ex-offenders.  On the other hand, those who served time have already paid their debt to society.  Should the be punished again by being disqualified for entitlement programs for which they are eligible?

Regardless of whether you think ex-offenders should be eligible for this Medicaid expansion, they without a doubt do have a number of medical problems which require treatment. NPR describes some of the challenges these individuals face.

According to Dr. George Pearson, “…a 45-year-old ex-convict will often have the ailments of someone 10 years older. Ex-convicts have higher rates of almost all chronic conditions, like high blood pressure, diabetes and asthma. It’s from living a hard life, to be sure, he says, but it’s also because they have common medical problems that go untreated.

‘So the hypertension becomes heart failure, the diabetes becomes diabetic neuropathy, amputation, blindness,’ Pearson says.”

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How to stop health premium increases?

June 6, 2011 in Health Insurance, Regulation | 1 comment

California think they have found the answer.

“The bill in question is AB 52, introduced by Assemblyman Mike Feuer (D-Los Angeles). It would prevent health insurance premium increases from going into effect without the prior approval of the commissioner of insurance or the director of the Department of Managed Health Care, who share jurisdiction over health insurers.

The bill would give insurance regulators the same prior-approval authority they were given over auto and homeowner policies by Proposition 103 in 1988. Under current law, California health insurance regulators can’t reject a rate increase even if they think it’s unreasonable — they can only try to jawbone the insurance company or shame it with a public objection.”

Small business support this measure.  That is likely because small business care more about cost control than the quality of health care.

If the state forces insurance companies to cut premiums, however, something has to give.  Likely there will be more rationing, physician and hospital payments will be cut, and the quality of care will decrease.  Although there is much waste in healthcare, cutting spending with such a blunt tool as AB52 will decrease the quality of health care.  At this point, however, reducing (or simply holding constant) health plan premiums may be a more important goal than improving quality.

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State Health Reform in California

May 9, 2011 in Medicaid | No comments

Health Reform made a number of changes for State’s health care policies. But states themselves have also been enacting legislation to alter health care payment policies and regulations. The CHCF describes some examples of legislative changes in California:

  • Safety Net Care Pool (SNCP) – covers uncompensated costs in public hospitals and finances other state health care programs.  This Section 1115 Waiver designated California public hospitals (including University of California hospitals) continue to able to draw down funding from the SNCP for uncompensated care through their own expenditures.
  • Low Income Health Program (LIHP) provides Medi-Cal Coverage to uninsured adults under 200% of the federal poverty line.  This initiative is basically an early-stage implementation Medicaid expansions required by Health Reform.
  • Delivery System Incentive Reform Payments (DSIRP) support infrastructure development and redesign in public hospitals.  Examples of initiatives covered by DSIRP include telemedicine and improved interpretation services.

 

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How will Health Reform Affect California?

September 17, 2010 in Health Reform | No comments

This policy brief provides the answer.  One interesting finding is how the Affordable Care Act’s (ACA) individual mandate may put a bind on poor, legal immigrants.

“Legal immigrants with less than five years of legal permanent residency will face the same requirement as native born U.S. citizens to have health insurance coverage.  However, legal immigrants are subject to a “five-year bar” that makes them ineligible for federal health insurance programs like Medicaid.”

I have also replicated two charts from the paper.  The first shows how children’s eligibility for public health insurance programs will change with ACA.   The second calculates the maximum financial exposure for families after purchasing individual policies through the health insurance exchange.

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California Task Force on Affordable Care’s Top 10 Recommendations

May 17, 2010 in Public Policy, Supply of Medical Services | 2 comments

How can we improve health care?  The California Task Force on Affordable Care gives its top 10 recommendations in this report.  The report’s slogan is “ten ways Californians can save over $300 billion.”  These recommendations include:

  1. Implement bundled payments
  2. Hold hospitals accountable for progress in reducing utilization in targeted areas such as imaging
  3. Directly act to reduce hospital readmissions and hospital acquired infections
  4. Develop best practice guidelines that protect providers who use appropriate medical judgments in  targeted high-cost areas
  5. Common standards for billing, eligibility, and contracting
  6. Merge California’s two health insurance regulators, the Department of Insurance and the Department of Managed Healthcare.
  7. Create a sole-source insurance exchange for individuals and small businesses
  8. Increase support for shared decision making
  9. Impose a tax on high calorie, sweetened beverages.
  10. Make walking, biking, and the use of public transit viable, affordable, safe, and attractive

I will divide these ideas into the Good, the Mixed and the Bad.

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