Good News!

Ten million Americans now are covered by HSA-qualified health plans, according to a survey released today by America's Health Insurance Plans (AHIP).

This is an increase from eight million last year and six million in 2008. These are people enrolled in high-deductible health insurance plans that qualify them to open tax-free Health Savings Accounts (HSA/HDHP).

Clearly the solid growth shows the popularity of the HSA/HDHPs and their continuing appeal, even during a health reform debate that has gone in completely the opposite direction.

Some highlights of the AHIP survey:

  • Monthly premiums for individuals aged 30 to 54 averaged $2,465 a year ($205 a month) and $5,335 for a family ($445 a month).

  • Fifty-two percent of all individual market enrollees — including dependents covered under family plans — were aged 40 or older.

  • Overall, preferred provider organizations (PPOs) were the most popular insurance type, with 88 percent of enrollees. They generally have access to negotiated discount arrangements with health care professionals, even when paying bills from their HSA accounts.

  • More than 90 percent of responding companies reported offering access to HSA account information, health education information, physician-specific information, and personal health records as consumer decision support tools for their members.

  • The fastest growing market for HSA/HDHP products was large-group coverage, which rose by one-third, followed by small-group coverage, which grew by 22 percent.

  • HSA/HDHPs accounted for 11 percent of all new health insurance purchases in January 2010.

The charts tell the story of success:

Click here to enlarge.

Click here to enlarge.

HSA guru Roy Ramthun says the survey is the largest of its kind but may still not include some self-funded companies that use non-carrier-based payment administrators who may not be AHIP members.

The survey does not answer the question regarding how many HSA "accounts" exist, only how many have qualifying insurance. Or how many people are enrolled in HSA-sister plans, Health Reimbursement Arrangements. This number would bring the totals of those enrolled in consumer-directed plans much, much higher. More to come on that …

What's going to happen to HSAs under ObamaCare? Roy has a white paper explaining. While they don't take a direct hit in ObamaCare, I personally am very worried that the kind of health insurance we will be required to have will be so comprehensive that HSA-qualifying policies wouldn't satisfy the individual mandate.

This is a battle well worth fighting.

States with the highest percentage of HSA/HDHP enrollees were: Vermont (13.8 percent); Minnesota (9.2 percent); Colorado (9.2 percent); Arkansas (8.2 percent); Indiana (8.1 percent); and Ohio (8.0 percent).

States with the highest levels of HSA/HDHP enrollment were: California (1,018,000); Ohio (651,000); Florida (639,000); Texas (637,000); Illinois (575,000); and Minnesota (361,000).

As a refresher, AHIP explains: "Health savings account plans give consumers incentives to manage their own health care costs by coupling a tax-favored savings account used to pay medical expenses with a high-deductible health plan (HDHP) that meets certain requirements for deductibles and out-of-pocket expense limits.

"Most HDHPs cover preventive care services (e.g., routine medical exams, immunizations, well-baby visits) without requiring enrollees to first meet the deductible. The funds in the HSA are deposited tax free, interest is tax free, and the account is owned by the individual and may be rolled over from year to year."


Making it right: A reader wrote last week that she was dismayed about the title of our last newsletter, "More Bad News," saying conservatives have had far too much bad news and don't want to hear any more.

And she was exactly right.

The title should have said "More bad news for ObamaCare" because it chronicled more of the inevitable parade of adverse consequences of legislation that is unworkable and unaffordable. Hopefully today's headline makes up for it. We do listen.


Off to Europe: We will skip an issue of Health Policy Matters next week as I will be in Europe for speeches and meetings. I will be in London speaking at a forum sponsored by the Stockholm Network and then in Paris presenting at a conference sponsored by the European Union of Private Hospitals. (Yes, that's right.) They are interested to learn more about our health overhaul law. I will report back when I return.


Grace-Marie Turner on Claims that Health Care is a Right

This week's clip comes from Grace-Marie's hour-long appearance on the Health Beat of America radio show on Tuesday, during which she used free-market principles to address a caller's claim that health care coverage is a right.
Listen now (may take a moment to load) >>

The full interview is available here (right click to save).


ObamaCare Takes More Blows

Grace-Marie Turner, Galen Institute
National Review Online: Critical Condition, 05/17/10

The bad news for ObamaCare just keeps coming, Turner writes. Jobs are in jeopardy as employers examine the risks of ObamaCare. The CBO says the law will cost $115 billion more than it estimated before the law passed. And states are alarmed as they analyze the cost to their taxpayers and more have joined a lawsuit challenging the health care law. People are seeing through the sugarcoating to the core of the legislation and its damaging impact on our health sector and economy. But in the meantime, American business and the health sector have no choice but to press on and comply with the new law, restructuring around the volumes of yet-to-be-written regulations telling them how the law will work and how they must be subservient to Washington's growing power.
Read More »


A Regrettable Reform

David Gratzer, M.D., Manhattan Institute
The New Atlantis, Spring 2010

ObamaCare is an improvised mix of expensive deals, vague compromises, and competing objectives, Gratzer writes. The package is so confusing that supporters find it hard to explain and so sprawling in its ambitions that it is open to attack on multiple fronts. Gratzer focuses on three of the worst policies in the law that might be able to attract sufficient bipartisan support for a pullback: 1) Health insurance exchanges meant to spur competition that will instead strangle it with heavy regulations; 2) A new technocratic co
mmittee to "guide" health care spending; and 3) A tax on medical devices that will drive up cost inflation and impede innovation. Even if the Republican "repeal and reform" agenda bears no fruit, a handful of moderate reforms could attract support from both parties to undo these policies. Moving forward, it is critical that all health care legislation reflect the principles of choice, competition, and personal responsibility — principles concordant with the way the other five-sixths of the U.S. economy is organized.
Read More »

No, You Can't Keep Your Health Plan

Scott Gottlieb, American Enterprise Institute
The Wall Street Journal, 05/18/10

Defensive business arrangements designed to blunt ObamaCare's economic impacts will mean less patient choice, Gottlieb writes. Health plans and hospitals are restructuring to exert more control over doctors by buying up medical clinics and doctor practices. Where they can't own providers outright, they'll maintain smaller networks of physicians that they will contract with so they can manage doctors more closely. That means even fewer choices for beneficiaries. By next year, more than 60% of physicians will be salaried employees. Consolidated practices and salaried doctors will leave fewer options for patients and longer waiting times for routine appointments.
Read More »


Cash for Doctors

Tony Mecia
The Weekly Standard, 05/24/10

As ObamaCare ramps up, doctors and health providers will continue devising creative alternatives for patients who demand choices as the government tightens its grip, Mecia writes. Such market-driven approaches to health care seem poised to thrive in the years ahead. One business model that some doctors have been exploring is a "concierge" or "boutique" practice. One of the largest is MDVIP, a Boca Raton firm that has 365 member doctors and 125,000 patients. MDVIP doctors accept and process insurance, but for an additional $1,500 a year, they give an exhaustive 90- to 120-minute physical exam and run tests that insurance doesn't often cover, such as screening for mental or sleep disorders. They also help the patient develop a wellness plan and stick to it. MDVIP has continued growing in the last two years, despite the economic slowdown.
Read More »


Insurers Blame Rate Increase Cap for Losses Topping $150 Million

Robert Weisman
The Boston Globe, 05/18/10

Four major Massachusetts health insurers posted first-quarter losses totaling more than $150 million, with three of them blaming the bulk of the losses on the state's decision to cap rate increases for individuals and small businesses, The Boston Globe reports. For example, Blue Cross Blue Shield of Massachusetts, the state's largest health insurance carrier, reported a $65.2 million net loss for the three months ending March 31. Its operating loss was even steeper, $95.5 million. Tufts Health Plan reported a net loss of $51.9 million and an operating loss of $59 million for the quarter. For the same period last year, Tufts had a $13.1 million net loss and a $16.5 million operating loss. Health insurers in March proposed rate increases averaging 8 to 32% for the small-group market for policies that came up for renewal in the April to June period. Because of the insurance division denial, they are obliged to continue using rates from a year ago. The companies are challenging the decision in administrative hearings and through a lawsuit.
Read More »

Texas Doctors Opting Out of Medicare at Alarming Rate

Todd Ackerman
Houston Chronicle, 05/17/10

Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable, the Houston Chronicle reports. Two years after a survey found nearly half of Texas doctors weren't taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. The opt-outs follow years of declining Medicare reimbursement that culminated in a looming 21% cut in 2010. Congress has voted three times to postpone the cut, which was originally to take effect Jan. 1. It is now set to take effect June 1.
Read More »


Engaging Consumers in Health Care
Center for Advancing Health Briefing
Thursday, May 20, 2010
8:30am – 10:30am
Washington, DC

The Federal Government or Free Market: Which Can Offer the Most Compassionate and Effective Health-Care Plan for America?
Benjamin Rush Society Debate
Thursday, May 20, 2010
6:00pm – 7:00pm
Stanford, CA

The New Health Reform Law and Young Adults
Alliance for Health Reform Briefing
Monday, May 24, 2010
12:15pm – 2:00pm
Washington, DC

U.S. Health Reform: What Have They Done and What Will Change?
Stockholm Network Event
Monday, May 24, 2010
London, England
Grace-Marie Turner will provide an overview of the health overhaul legislation that has been enacted and that will make sweeping changes to one-sixth of the economy.

The Impact of U.S. Policy Restrictions on Women's Reproductive Health at Home and Abroad
Ipas Event
Tuesday, May 25, 2010
12:00pm – 2:00pm
Washington, DC

Regional Extension Centers: Service Offerings and Sustainability
eHealth Initiative Webinar
Wednesday, May 26, 2010
3:00pm – 4:30pm Eastern

Ready for Data Breaches Under the HITECH Act?
Institute for Health Technology Transformation Webinar
Thursday, May 27, 2010
1:00pm – 2:00pm Eastern

1st European Congress of Private Hospitals
European Union of Private Hospitals Conference
May 27-28, 2010
Paris, France
Grace-Marie Turner will give the lecture opening the Congress on Thursday, May 27, on "Evolution of the Health System in the United-States: Towards a Convergence with Europe?"

National Health Care Reform: How It Will Affect Our Economy, Our Families, Our Communities
Washington Policy Center Conference
Friday, June 4, 2010
7:30am – 1:30pm
Seattle, WA