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How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries

January 1, 2018

The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. This report examines gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates.

Medicare Beneficiaries' High Out-of-Pocket Costs: Cost Burdens by Income and Health Status

May 12, 2017

Issue: Fifty-six million people—17 percent of the U.S. population—rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs.Goal: To inform discussion of possible changes to Medicare, this issue brief looks at beneficiaries' out-of-pocket costs by income and health status.Methods: Spending estimates based on the Medicare Current Beneficiary Survey.Findings and Conclusion: More than one-fourth of all Medicare beneficiaries—15 million people—spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services. Beneficiaries with incomes below 200 percent of the poverty level (just under $24,000 for a single person) and those with multiple chronic conditions or functional limitations are at significant financial risk. Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs. Financial burdens and access gaps highlight the need to approach reform with caution. Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries.

The Affordable Care Act and the U.S. Economy: A Five-Year Perspective

February 2, 2016

Despite fears that the Affordable Care Act's health coverage expansions and market reforms would cost jobs or accelerate health care inflation, the U.S. economy has grown steadily, if slowly, since the law's passage in 2010. The level of overall economic output and employment is currently well above the peaks prior to the 2008–09 recession. Jobs have increased by more than 13 million since 2010—5 million more than at the pre-recession peak. All of the net gain has been in full-time, private-sector jobs. Furthermore, the marked slowdown in health care cost growth that started during the recession has continued, although recent indicators show this trend may be waning. In reviewing evidence over the past five years, this report concludes that the ACA has had no net negative economic impact and, in fact, has likely helped to stimulate growth by contributing to the slower rise in health care costs.

State Trends in the Cost of Employer Health Insurance Coverage, 2003-2013

January 8, 2015

From 2010 to 2013—the years following the implementation of the Affordable Care Act—there has been a marked slowdown in premium growth in 31 states and the District of Columbia. Yet, the costs employees and their families pay out-of-pocket for deductibles and their share of premiums continued to rise, consuming a greater share of incomes across the country. In all but a handful of states, average deductibles more than doubled over the past decade for employees working in large and small firms. Workers are paying more but getting less protective benefits. Costs are particularly high, compared with median income, in Southern and South Central states, where incomes are below the national average. Based on recent forecasts that predict an uptick in private insurance growth rates starting in 2015, securing slow cost growth for workers, families, and employers will likely require action to address rising costs of medical care services.

National Trends in the Cost of Employer Health Insurance Coverage, 2003-2013

December 9, 2014

Looking at trends in private employer-based health insurance from 2003 to 2013, this issue brief finds that premiums for family coverage increased 73 percent over the past decade—faster than median family income. Employees' contributions to their premiums climbed by 93 percent over that time frame. At the same time, deductibles more than doubled in both large and small firms. Workers are thus paying more but getting less protective benefits. However, the study also finds that while premiums continued to rise through 2013, the rate of growth slowed between 2010 and 2013, following implementation of the Affordable Care Act. While families experienced slower growth in premium contributions and deductibles over this period, sluggish growth in median family income means families are paying more in premiums and deductibles as a share of their income than ever before.

Access to Primary and Preventive Health Care Across States Prior to the Coverage Expansions of the Affordable Care Act

July 17, 2014

One goal of health insurance is ensuring people have timely access to primary and preventive care. This issue brief finds wide differences in primary and preventive care access among adults under age 65—across states and within states by income—before the Affordable Care Act's major insurance expansions took effect. When comparing experiences of adults with insurance, the analysis finds that state and income differences narrow markedly. When insured, middle- and lower-income adults across states are far more likely to have a regular source of care, receive preventive care, and be able to afford care when needed. The findings highlight the potential of expanding health insurance to reduce the steep geographic and income divide in primary and preventive care that existed across the country before 2014. Success will depend on the participation of all states. This brief offers baseline data for states and the nation to track and assess change.

Aiming Higher: Results from a State Scorecard on Health System Performance, 2014

April 30, 2014

The Commonwealth Fund's Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period, which includes the Great Recession and precedes the major coverage expansions of the Affordable Care Act. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others. In a few areas that were the focus of national and state attention—childhood immunizations, hospital readmissions, safe prescribing, and cancer deaths— there were widespread gains. But more often than not, states exhibited little or no improvement. Access to care deteriorated for adults, while costs increased. Persistent disparities in performance across and within states and evidence of poor care coordination highlight the importance of insurance expansions, health care delivery reforms, and payment changes in promoting a more equitable, highquality health system.

America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions

March 25, 2014

The Affordable Care Act insurance reforms seek to expand coverage and to improve the affordability of care and premiums. Before the implementation of the major reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these "underinsured" people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. Nationally, more than half of people with low incomes and 20 percent of those with middle incomes were either underinsured or uninsured in 2012. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.

State Trends in Premiums and Deductibles, 2003-2011: Eroding Protection and Rising Costs Underscore Need for Action

December 1, 2012

Rapidly rising health insurance premiums and higher cost-sharing continue to strain the budgets of U.S. working families and employers. Analysis of state trends in private employer-based health insurance from 2003 to 2011 reveals that premiums for family coverage increased 62 percent across states -- rising far faster than income for middle- and low-income families. At the same time, deductibles more than doubled in large and small firms. Workers are thus paying more but getting less-protective benefits. If trends continue at their historical rate, the average premium for family coverage will reach nearly $25,000 by 2020. The Affordable Care Act's reforms should begin to moderate costs while improving coverage. But with private insurance costs projected to increase faster than incomes over the next decade, further efforts are needed. If annual premium growth slowed by one percentage point, by 2020 employers and families would save $2,029 annually for family coverage.View the related infographic.

Rising to the Challenge: Results From a Scorecard on Local Health Performance, 2012

March 14, 2012

Provides comparative data with respect to healthcare access, prevention and treatment, costs and avoidable hospital use, and outcomes in three hundred-plus localities. Examines disparities in access and quality by geography, income, and poverty rate.

State Trends in Premiums and Deductibles, 2003-2010: The Need for Action to Address Rising Costs

November 16, 2011

Examines the rise in employer-based insurance premiums and deductibles and as a percentage of median household income. Projects average family coverage premiums in 2020 if federal health reform is not implemented and historical rates of increase continue.

Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2011

October 18, 2011

Assesses the U.S. healthcare system's average performance in 2007-09 as measured by forty-two indicators of health outcomes, quality, access, efficiency, and equity compared with the 2006 and 2008 scorecards and with domestic and international benchmarks.