How Many of Obamacare’s New Enrollees Were Uninsured Last Year? Why It Doesn’t Matter
Maggie Mahar on the Uninsured:
As I explain in an earlier post, Charles Gaba, the enrollment guru who has been tracking Obamacare sign-ups since October, now estimates that by April 15, some 17 million Americans will have purchased their own insurance policies either in the Obamacare Exchanges (8 million) or off-Exchange (9 million)
But how many of them were uninsured and how many were simply replacing policies that the Affordable Care Act (ACA) had forced insurers to cancel? This is the question conservatives ask. After all they argue, if most of these folks already had coverage, we have just wasted a great deal of time and money moving them from a policy they chose to one that President Obama prefers.
There are two answers to their question. The first is that while we don’t have an exact number as to how many of the new enrollees were uninsured,we do know (thanks to Obamcare), the percent of Americans who are “going naked” has declined.
Gaba offers a second, even better, answer: “It doesn’t really matter.”
I agree. As he explains:
“It doesn’t matter because every one of those new policies–whether on-exchange or off-exchange; whether it went to someone who didn’t have insurance before, someone who had their old policy cancelled or went to someone who voluntarily made the switch to a new one…which . . is a LOT of people, by the way…is still a fully ACA-compliant, full-coverage healthcare plan.”
Gaba points out; “’the primary point’ of his website (ACASignups.net) ‘is to track how many people are now enrolled in a ‘QHP certified” plan regardless of whether they had insurance before or not. Some moved from no plan at all to a QHP. Others moved from a ‘junk’ policy to a QHP (some have argued that there aren’t that many of these, but there were still a lot of them). Still others yet (myself included) have moved from a decent plan to a QHP. . . . The point is, they’re all ACA QHPs now.” [his emphasis]
This is critical to understanding the purpose of health care reform. From the beginning the goal of the Patient Protection and Affordable Care Act (PPACA) was not simply to insure the uninsured, but to protect the under-insured by making certain that everyone has comprehensive coverage. Whether a carrier is peddling policies in a state marketplace or off-exchange all plans now must comply with the ACA’s rules by:
- covering the ten essential benefits
- offering free preventive care, and
- capping how much a patient can be asked to pay out-of-pocket.
Additionally, carriers can no longer discriminate against customers suffering from pre-existing conditions by charging them exorbitant premiums and they cannot set a limit on how much the insurer will pay out over the course of a year or a lifetime.
The second goal of the Patient Protection and Affordable Care Act is to make sure that the price of such high quality insurance is not beyond reach. Government subsidies help low-income and median-income families, but the only way to make sure that everyone else can afford policies meeting the ACA’s high standards is by asking all of us to share in the cost.
This is why the ACA mandates that everyone purchase insurance. When more people pay into the risk pool, the costs decline for everyone. It is only then that universal coverage becomes possible
Originally Appeared on HealthBeat: www.healthbeatblog/com
I’m still confused by all these numbers. Is it 11m? Or maybe 17m? Or possibly just a half million?
Gallup just did a big poll on this topic. The results show that the number of uninsured has fallen substantially since last fall. Gallup estimates that the rate fell from 17.1% to 15.6%. The Gallup link:
http://www.gallup.com/poll/168248/uninsured-rate-lowest-2008.aspx
But wait a second.. That % drop translates into only 3.5M people – half the WH#.
The WH has also said that the number of those covered by Medicaid rose by 3.1m. Take these two numbers together and the net Obamacare is circa 500k.
Also consider the Gallup graph. Where are we today on the critical issue of uninsured? Back to the levels of 2008….. Where’s the beef?
Krasting you can just take numbers extrapolated from a poll and then just subtract them from numbers developed using a different surveying/collecting methodology. Out of curiosity I’ll take a look at that poll but I suspect a lot rests on Gallup’s definition of “uninsured” as it relates to their polling language.
Also you seem to have missed the main point of this post which I would summarize as “underinsured” vs “uninsured” and why a hyper-focus on the latter misses the thrust of PPACA as designed.
10 secs with the poll shows that it is a survey of adults 18 and older and so excludes any children that might be in those households So that in itself would make nugatory your simple multiplication of 1.5 points times the American population to get your “3.5M”. In fact the absense of children might as much as double that number. And since it is lower income families with children that make up almost all the previouls Medicaid elibible pool and due to the way they define FPL (in loarge part by family composition) still do, a very large percentage of the 3.1 million now covered by Medicaid (in an unsourced number) ARE children and so CANNOT be subtracted from a 3.5M number that is itself flawed. Making your “circa 500k” a GIGO number on both sides of the proposed equation.
(Children included on one side and excluded on the other)
Just more “goofy math” from the ACA opposition. If the ACA was so bad, they would not have to resort to such tactics. All they would have to do is tell the truth. You only have to cook the books if the truth gets in the way of the agenda.
Webb: This from the AP re the Gallup poll:
“The decline of 1.5 percentage points would translate roughly to more than 3.5 million people gaining coverage.”
A Link to AP story:
http://www.thenorthwestern.com/viewart/20140407/OSH0101/304070156/Survey-US-Health-insurance-gains-pick-up-under-President-Barack-Obama-s-health-care-law
And yes, Gallup only includes adults:
“Gallup is counting just adults, while the administration figures include children as well.”
But if a significant difference between the two numbers is the adult/non-adult issue, then explain to me why these results could not have been created by passing a law that Ins. cos. had to carry kids from 18 to 26. That would have been a simple solution vs ACA.
This may add to the confusion. This is a PPACA Signup Graph as created by Charles Gaba.
His Comments:
The key numbers:
The net result, according to RAND? An overall drop in the adult uninsured rate from 20.5% to 15.8%, or around 9.3M people nationally.
Assuming the RAND study is accurate (and most people from both sides of the aisle seem to think it’s a pretty solid source), we may finally have an answer to the question “How many of them were UNINSURED???” Answer? Around 36%…of the first 3.9 million enrolled! That’s right: Their study doesn’t even include the 3.2 million more people who enrolled in individual QHPs via the exchanges after the survey concluded! ACASignups.net
Bkrasting–
Please see Bruce Webb’s reply to you (right after your first comment.)
He is right– the point of my post is that being Underinsured can be just as bad as being uninsured–especially
if you are diagnosed with cancer, and your policy doesn’t cover chemo.
Pre-Obamacare, the most popular policy in New Jersey’s individual market did not cover Chemo.
Some policies covered surgery–but not rehab after surgery.
Many policies paid for hospital care Only after you had paid down a $10,000 or $15,000 deductible
Most people didn’t know what their policies didn’t cover–until they found out, the hard way.
Let me suggest that you re-read the post, and focus on the part that explains that “Patient protection” means that patient have real insurance– not Swiss cheese policies filled with holes.
Bruce Webb–
You write: “Also you seem to have missed the main point of this post which I would summarize as “underinsured” vs “uninsured” and why a hyper-focus on the latter misses the thrust of PPACA as designed.”
Thank you for an extremely lucid summary of what the post is about.
Jerry–
Yes, exactly.
The fact that Obamacare’s opponents have to twist themselves into
pretzels (and lie) to try to prove that reform is a disaster tells us something.
If they were right, they could simply cite facts and figures from respected sources.
run75411–
Thank you!
Gaba remains the best source on enrollment numbers.
The Rand survey focuses on people who have signed up for insurance outside the Exchanges.
It turns out that even more of them were uninsured.
But all of them are buying “Obamacare plans”–Today, any plan sold to an individual or family whether in the Exchange or outside the Exchange has to comply with all of the Obamacare requirements.
This means that no one winds up “under-insured.”
Pre-Obamacare being ‘under-insured” was as big a problem as
being uninsured.
At least if you were UNinsured you knew you had no protection. If you
were Under-insured, you probably didn’t–until you were in a accident or became sick, and found yourself falling through one of the holes in your Swiss Cheese policy.
Or until your insurer wrote you a letter and said: You 10-year-old, who has cancer, has now exhausted the benefits that we pay out over the course of a individual’s lifetime. We are sorry, but we can no longer
reimburse for her care.”
“Webb: This from the AP re the Gallup poll:
“The decline of 1.5 percentage points would translate roughly to more than 3.5 million people gaining coverage.”
Krasting that the crappy math is not actually YOURS but simply a matter of YOU uncritically citing crappy math doesn’t reflect well on you.
If we wanted to dig we would notice that 1.5% of either the population over 18 or the total population doesn’t readily yield 3.5 million. It would seem to overstate the former while understating the latter. So at a minimum it would have been helpful to reveal how AP came to that number before uncritically accepting it as an offset to a Medicaid enrollment increase itself vaguely cited.
That is we have four or more populations:
Adults over 18 newly enrolled in Medicaid
Children newly enrolled in Medicaid
Adults over 18 who report they are no longer uninsured
Children now covered by those no longer uninsured adults.
Then a 1.5% number tied to the third group.
And a 3.5 million number computed who knows how (at least as presented by you)
And a 3 million number derived from somewhere else that purports to report groups 1 and 2.
Which somehow gives rise to your “net Obamacare is circa 500k”. Which is bad math to start with and ignores that some fraction of those 3 million cited Medicaid enrollees are ALSO so enrolled because of the expansion provisions of PPACA.
Now it is not impossible to adjust and correct for all these variables. As Run noted Charles Gaba aka dKos User Brainwrap has done an admirable job. But lets just say he exercised a little more diligence than “3.5 mil – 3 mil = .5 mil = ObamaFail”
Which was my takeaway from your comment.
And I didn’t notice this:
Webb: This from the AP re the Gallup poll:
““The decline of 1.5 percentage points would translate roughly to more than 3.5 million people gaining coverage.”
how on earth do you get from “roughly” and “more than” to a hard number of 3.5 suitable to have 3 subtracted? You ignore both the STATED fuzziness AND the upside bias.
Webb- Like I said, I’m confused by all the numbers being tossed out.
For example, we have a Rand report out that says Ocare has covered only 1.4m of previously uninsured:
http://www.forbes.com/sites/theapothecary/2014/04/09/rand-comes-clean-obamacares-exchanges-enrolled-only-1-4-million-previously-uninsured-individuals/
You have to admit that there are too many numbers being bandied about.
FYI – I had an insurance plan. I got a cheaper one thanks to Ocare. So that is a good result for me, and I’m happy. But saving me a few bucks is not a positive reflection OCare.
Mahar – The average deductible for a Bronze plan is $5081. That number can run as high as $12k in some states.
So who is really paying for the chemo and post-op care?
The info on deductibles:
http://www.cbsnews.com/news/obamacare-deductibles-deliver-hefty-sticker-shock/
And by the way, re-read your first para – it was you who started off with the numbers on enrollment, not me……
Bruce K:
What are the premiums on the Bronze Plans you are citing?
Healthcare.Gov: A family of 4 making $46,960 (CBS salary cited) in Texas is eligible for a $238/month credit. The premium monthly would be ~$94 per month. The maximum out of pocket is $12,700 per family and $5,000 for an individual. “Blue Advantage Bronze HMO 005” Where could you get insurance for $94/month? You could never get a premium that low previously. The copay for the doctor visit is 20% after deductible. The doctor visit cost is the negotiated rate.
If they choose a silver plan. Same family of 4 and same tax credit. The premium would be $232 per month with a deductible of $4500 for the family or $1500 per individual. The difference is in what is paid for doctor visits. $30 copay for a visit, etc.
Families pretty much have to decide what works for them and in either case above the cited premiums are far lower than whatever could be had before. Without insurance, the family of 4 would be subject to Emergency Room “Chargemaster” rates which are far greater than the negotiated rates resulting from having insurance. There are features in these plans to which the deductible does not apply.
In addition to this, there are many Preventative measures such as shots, care for women, etc. which are covered in these plans regardless of which one you choose that are at no cost to you. All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. I am not going to list all of them here; but, you can read on them here: https://www.healthcare.gov/what-are-my-preventive-care-benefits/ For adults, one of the preventative coverages would be; immunizations such as for Flu, or pneumonia; for women one of the preventative coverages would be Well-woman visits or Folic Acid supplements for women who may become pregnant; and for children some preventative coverages are Measles, Mumps, Rubella inoculations or Vision screening or lead screening.
There is much included in these plans that are covered with no copay that are not being divulged by the news media as it does not sell. The Republicans, Tea-baggers and the I hate everything crowd are not going to discuss this with you either. You are coming pretty late to this game Bruce Keating and I have been writing on Angry Bear on this topic forever and featuring Maggie Mahar here also . I am thinking you are gaming us.
Run – You say I’m late to this game – I say you’re early to it.
Wait 3 years. There are significant parts of Ocare that have been deferred. And hold your breath on those cheap rates.
Face it Ocare supporters, the only ‘solution’ for heath care in the USA is a single payer system. ACA delivers a bastardized system. The social and economic consequence of which will be broad and deep.
Watch this one over time. This is a Whack-A-Mole problem. You think the mole is whacked – but two more are about to pop up.
Bruce K:
What am I waiting for in this prediction of yours? And what parts have been deferred which will have such a huge impact on costs? Lay out your supposed moles so Maggie, Bruce W, or I can address them. I do not want to wait three years.
You cited deductibles as an issue, I answered your observations. Now you moved on to this next whack a mole on higher rates in three years. Within the PPACA is something called the MLR which controls how much can be charged in premiums as broken out between administrative and actual medical costs. 80% for individual polices and 85% for group policies must go to actual costs. The highest which can be charged is 150% (smoking) or 300% (older of the insured) of the lowest cost individual, the youngest and healthiest.
The PPACA delivers an almost exact duplicate of the Heritage/Republican plan for PPACA which incorporates insurance companies who by the way are not what has caused healthcare to inflate in cost over the last 20 years. You are for private industry and for private investment of retirement funds still, aren’t you?
Bruce-I think you and BK are talking about adults age 18-65, not all adults over 18. You may have meant that, if so my apologies.
Run-Thanks for the links to Gaba and Rand numbers. I think we can all agree these are just educated guesses. The Rand survey has such a crazy margin of error that the numbers could be anywhere from 5.8 to 21 million. I guess the insurance carriers will release real numbers sometime soon?
Maggie- I have two issues with your post. One, I can’t ever recall in the run-up to the PPACA vote that the President, members of the administration or members of Congress touted the ACA as a remedy for the under insured. That argument seems to have sprouted post 10.1.13. Maybe you can correct me in that regard. In addition the under insured argument would seem to directly conflict with the “you can keep your policy” assertions along with the extension of legitimacy of non-ACA compliant policies until 2016. Secondly, the numbers do matter. Assuming that 17 million is the number and only, say, 3 million
were previously uninsured (we’re talking individual market here) that’s not a very large addition to the risk pool, especially given the significant potential for adverse selection. Are you familiar with Pauly and Herring’s paper from 2007? (Health Affairs May 2007) There are some interesting comments regarding the individual market’s risk pooling.
Bkrasting,
“…the only ‘solution’ for heath care in the USA is a single payer system.”
I agree with your statement. However I would change “only” with “best”.
Little John–
Clearly, you haven’t been following the debate on health care reform over the years. In the early 1990s, when the Clinton’s proposed reform,
everyone was clear that we needed it to help the Under-insured as well as teh Unsinured.
People have been talking about “Swiss Cheese Policies” and “junk insurance” long before 2007.
I wrote about the problem in my book, Money-Driven Medicine, when I began in 2003 and published in the spring of 2006.
As I, and others have explained, many times, when Obama said “If you like your policy you can keep it” he was speaking directly to the “majority of you”(majority of Americans) who work for a large company that offers health benefits. Those policies meet ACA standards: they
are comprehensive; insurers cannot limit how much they pay out in a year or over a lifetime, etc. etc. Employees like these policies because employers pay 70% to 80% of the premiums.
At the time that Obama made this statement (during his first run for the White House) Politifact ranked it “True.” Nothing about Obama’s healthcare plan would force companies to cancel these comprehensive policies. He was explaining that Obamacare was designed for people who didn’t have comprehensive benefits at work.
Some liberals wanted a “single payer” plan –which would mean that we would abolish employer based insurance and put everyone into
a single payer plan run by the government.
Obama was reassuring his audience that, if you have good insurance at work that you like, you can keep it.
Obama kept repeating this message, and conservatives began ripping that one line out of context– as if Obama was telling everyone in the country that they could keep whatever plan they now have, even if it was junk.
Of course he could never guarantee that. For one thing, insurers constantly cancel these junk plans and replace them with new junk plans (with higher premiums.)
On the Pauly/ Herring paper. It was written in 2007–before Congress
decided that under reform, we would have to provide subsidies for low-income people. (Pauly and Herrring are arguing that low-income people cannot afford insurance that would cover their risk.)
Bkrasting–
Are you aware that no country in Western Europe has a single payer system?
Yet they all have much less expensive healthcare than we do–with better outcomes.
They have what you call “bastardized systems”–much like Obamacare–using a combination of private sector insurers and
government. The private sector insurers are Regulated –just as they are under Obamacare.
Single Payer would do nothing to address the root of our health care problem: We Overpay for everything (doctors who make 4 times as much as doctors in France–even after adjusting for differences in teh cost of med school education and cost of living) hospitals with waterfalls, marble lobbies, and resort-like amenities; drugs and devices that are wildly over-priced (In Europe, governments regulate doctors’ fees, hospital fees, and drug and device prices). We also
over-treat, doing far more unnecessary surgeries than in other countries.About half of all heart surgeries do patients no good–and we know which ones they are. . .
That is the real problem with U.S. health care.
BKrasting–
On deductibles–you’re’ wrong again. (CBS is not a very reliable source).
Here is the truth Fully 50% of the lowest-cost bronze plans, along with 75% of mid-tier silver plans, kick in with your first visit to a physician.” http://www.healthbeatblog.com/2014/03/why-is-it-that-so-many-reporters-seem-to-know-so-little-about-obamacare-part-1/#sthash.b7dnZPfP.dpuf
In other words, you do not have to pay down the deductible before your insurer begins covering treatments.
Secondly, Bronze plans are out-liers. The most popular plans are Silver plans. Only 19% of Exchange shoppers picked Bronze plans
62% picked Silver plans.
The average deductible for a Silver plan is $2,905– 40% less than the Bronze plan deductible you cite. And in most cases, you don’t have to pay down the deductible before the insurance kicks in.
Moreover, you can find Silver plans with a 0 deductible.
Overall, when you compare deductibles in the Exchanges to deductibles in the individual market Pre-Obamacare you will find that, on average, deductibles in the Exchanges are lower AND the coverage is much better.
Many of those “junk policies” in the individual market pre-Obamacare
carried high deductibles.
Also see Run 75441 above on premiums.
Jerry Critter–
Consider this: If single-payer is the “best solution” then why is it that
France, Germany, Denmark, Norway, Japan, and Singapore –the nations with the best outcomes, longest life-spans and highest patient satisfaction don’t have single-payer systems?
They all have systems that regulate insurers, prices and the supply of medical services and products. In that way, they avoid over-treatment,
over-paying and curb waste.
Sure Maggie there are tons of works floating around out there pre-ACA that talk about the under insured. That’s great. But my point is that the chief promoters of the ACA, the administration and their allies in Congress didn’t exactly go out of their way to talk about the under insured. As a matter of fact they didn’t mention it at all.
As I’ve pointed out to run on numerous occasions we’re not talking about what a candidate proposes. We are talking about a sitting President, after the passage of his most important legislative accomplishment, telling citizens the exact opposite of what really happened. Some people liked their plan, but they couldn’t keep it…at least until the political pressure became too great and the President made another exception. And, you can talk about context all you want but it’s all right there in black and white…at the White House web-site no less. Maybe you should reread the President’s comments after the SCOTUS legitimized the individual mandate. There was no qualification about employer coverage, etc.
When I first heard the analogy of current ACA cheerleaders with the neocon cheerleaders of the Iraq War I was amused. Now I am starting to worry.
Little John:
And what did run tell you on numerous occasions? No Obama did NOT tell them the opposite, yes in 2010 the Secretary of Health came out and said many “individuals” would be transitioning, and there was qualification of employer insurance. The site showing both of these comments was cited in one of Maggie’s posts earlier in black and white. You just do not want to hear it Little John.
Good point, Maggie Mahar. What countries do have single payer?
Jerry–
Canada and the UK both have single-payer.
When Margaret Thatcher was running the UK she slashed funding for their single-payer system.
That was a long time ago, but it’ UK’s system is still recovering.
*They have to ration some hearlhcare by age. If you’re over a certain age, you won’t get certain surgeries. And outcomes are not as good as in the best systems in Western Europe)
Don’t get me wrong–the UK system is still fairer than ours–and less expensive. But it’s not as good as the best.
The same is true in Canada–though the system–and patient satisfaction is higher than in the U.K. But it varies from one province to another.
One reason I don’t endorse single-payer is because of what happened in the UK when Thatcher came in.
If we had single-payer and Jed Bush were elected president, (and a slew of conservative Republicans rode his coattails into Congress) , what would happen to: free contraception; end of life care (as you may recall he fought hard to keep a woman in a permanent coma alive for a log time); subsidies for low-income people; scholarships for
nurses and doctors coming from low-income families. federal funding for Medicaid expansion . . . etc. etc.
I wouldn’t want Jed Bush’s (or another conservative Republican’s) health care system to be the only game in town.
Looking forward, I think that we, like many countries in Western Europe, will wind up with a combination of non-profit private sector insurers and government insurers (Medicare, Medicaid, the VA)
The best non-profit insurers (Kasier, Geisinger, Group Health Cooperative in Seattle–and many others, particularly in the Northwest and Upper Middle West are much better than Medicare. Better coverage; evidence-based medicine (the insurer takes medical evidence into account when deciding what to cover); etc.
Medicare’s Board of Directors is Congress, and Congress is greatly influenced by lobbyists representing hospitals, nursing homes physician specialty groups, drug makers and device makers who make huge campaign contributions.
Thus Congress is not willing to let Medicare cut reimbursements–even when it is being gouged.
Kaiser Permanente, on the other hand, is not beholden to lobbyists–and does not want to be gouged. It also uses medical evidence to decide what drugs it should and shouldn’t pay for.
.
Maggie,
My sister has had Groip Health in Seattle for years and loves it.
I think one of the biggest improvements we could make in US healthcare is to require health insurance companies to be non-profit.
Jerry–
We don’t need to “require” that health insurance companies be non-profit.
For profit insurers are already backing away from Obamacare because they know that the new regulations will make it very difficult for them to
make the profits that Wall Street Expects.
Please see http://www.healthbeatblog.com/2013/05/who-will-sell-insurance-in-the-exchanges-non-profit-insurers-for-consumers-this-is-great-news-part-1/
In the future, I think we will have what countries in Western Europe have– a combination of non-profit insurers and govt’ insurance (Medicare ,Medicaid, the VA)
Jerry–
What your sister has told you about Group Heath
Cooperative in Seattle is an example of how these v. good
non–profit insures will spread, word-of -mouth.
“Non-profit” is not a magic word. Close to half of private insurers are set up as nominally “non-profit” or what is close “mutual insurance” including the bulk of Blue Cross/Blue Shield. This doesn’t stop them from predatory behavior, it just diverts the gains to the executives and perhaps the providers and not stockholders per se.
For example a comparison of salaries of top execs of non-profit Blue Cross operations vs that of a flat out for profit Big Insurance company like Aetna might not show the differences you might expect a priori.
Like any other such private organization, and certainly not excluding churches and cultural operations, it is common for the Officers and the Board of Directors to conclude “By God, We are WORTH It!” and award themselves high salaries.
(See the upheaval in the Catholic Church as the new Pope dismissed the German ‘Bishop of Bling’ and U.S. Archbishops are apolgizing for building lavish retirement houses or new pastoral residences for themeselves, and indeed in Atlanta actually selling the just completed $6.5 million residence).
To repeat there is no magic in the words “non-profit” any more than there is in the words “charitable” or “religious” to insure that the leadership whether ‘Pastor’ ‘Chairman of the Board’ or ‘Executive Director’ doesn’t aspire to be in at least the top 5%. Because ‘worth it’.
Bruce–
I am aware of the wide range of non-profits. I’ve written about them.
This is why, when I refer to non-profits I almost always say “like Kaiser
Permanente, Groups Health Cooperative, or Geisinger.”
Many Blue Cross/Blue Shields have converted to ‘for-profit”and most of those that are still called “non-profit” are not patient-centered. (Much of Blue Cross/ Blue Shield has been corrupt for decades.) There are exceptions: the Blue Cross/Blue Shield HMO in Massachusetts gets very high scores for quality and consumer satisfaction.
Some of the very best are “integrated systems” that both insure their customers and provide medical care.
If you look at Consumer Reports ratings of insurers– using NCQA (Natioinal Committee for Quality Assurance)
quality standards– you will find that non-profits score at the top of the lists. 70 percent of the top plans that provide insurance for employers and individuals are non-profits. 80 percent of the top
Medicare HMOs are not for profit. 76 percent of the top 25 Medicaid HMOs are not for profit.
One reason quality is higher is because these non-profits use “staff- and group-model health plans” that provide an infrastructure such as patient registries and electronic medical records that supports better performance on qualify measures such as how well they manage diabetes. .
Consumer Reports’ analysis found that five out of 10 of the top performers in NCQA’s rankings of private plans are integrated health systems, which provide insurance while also employing the doctors, and in some cases owning the hospitals, that care for their customers. Within these tight networks, care is better co-ordinated, and doctors are expected to practice “evidence-based medicine.”
In 2012 the five integrated health systems that rise to the top of NCQA’s health plan rankings were: Capital Health Plan in Florida, Group Health Cooperative of South Central Wisconsin, and Kaiser Foundation Health Plans in Colorado, Northern California and Southern California.
In 2013-2014 these were the top Medicare plans:
1. Kaiser Foundation Health Plan of Southern California – HMO (CA)
2. Kaiser Foundation Health Plan of Northern California – HMO (CA)
3. Kaiser Foundation Health Plan of the Northwest – HMO (OR, WA)
4. Kaiser Foundation Health Plan of Colorado – HMO (CO)
5. Kaiser Foundation Health Plan – Hawaii – HMO (HI)
6. Capital Health Plan – HMO (FL)
7. Geisinger Health Plan – HMO (PA)
8. Kaiser Foundation Health Plan of the Mid-Atlantic States – HMO
(DC, MD, VA)
9. Capital District Physicians’ Health Plan – HMO (NY)
10. Security Health Plan of Wisconsin – HMO (WI)
11. Kaiser Foundation Health Plan of Ohio – HMO (OH)
12. Group Health Cooperative – HMO (WA) *
12. Priority Health – HMO (MI)
13. Health New England – HMO (MA)
14. Group Health Plan (Cost) – HMO (MN, WI)
15. Fallon Community Health Plan – HMO (MA)
Here are the top Medicaid plans for 2013-2014:
1. Fallon Community Health Plan – HMO (MA)
2. Kaiser Foundation Health Plan – Hawaii – HMO (HI)
3. Network Health – HMO (MA)
4. Neighborhood Health Plan of Rhode Island – HMO (RI)
5. Priority Health – HMO (MI)
6. Neighborhood Health Plan – HMO (MA)
7. Boston Medical Center HealthNet Plan – HMO (MA)
8. UnitedHealthcare Community Plan – HMO (RI)
9. Capital District Physicians’ Health Plan – HMO (NY)
10. Blue Cross Complete of Michigan – HMO (MI)
11. Medica – HMO (MN)
12. Security Health Plan of Wisconsin – HMO (WI)
13. HealthPlus of Michigan – HMO (MI)
14. Midwest Health Plan – HMO (MI)
15. UPMC For You – HMO (PA) http://www.ncqa.org/Directories/HealthPlans/HealthInsurancePlanRankings/MedicaidandMedicareHealthPlanRankings201314.aspx
The rankings reveal that Kaiser performs the best of any of the major private insurers, with 75 percent of its private plans in the top 25 percent of rankings. Plans not affiliated with a major national brand come next, with 53 percent in the top quarter. (Folks in the NorthEast don’t realize how important Kaiser is Established in 1945, Kaiser is the largest nonprofit health insurance plan in the U.S. with over 8.7 million members. Its network includes over 13,500 doctors and 35 medical centers. ” Both patient satisfaction and physician satisfaction is very high.
The big brand names did not fare as well. For example, Coventry, which Aetna has purchased, has two-thirds of its plans in the bottom quarter, Both in 2012 and in 2012 Aetna, Humana, and UnitedHealthCare all have more private plans in the bottom 100 than in the top 100. : http://www.healthbeatblog.com/2013/05/who-will-sell-insurance-in-the-exchanges-non-profit-insurers-for-consumers-this-is-great-news-part-1/#sthash.DeBYYWbz.dpuf
Finally, executive salaries are not that important because they represent such a tiny slice of the company’s total budget. For example, Aetna recently paid its CEO 1.4% of net income. Of course these salaries are excessive–as are CEO salaries at non-profit hospitals–and single-payer advocates often point to the high salaries of insurers’ CEO’s to suggest that is where your premium dollars are going. But the truth is, if you cut CEO salaries at all insures to $100,000 a year, and this would have virtually no effect on premiums.