Health affairs
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Many families rely on employer-sponsored health insurance for their children. However, the rise in the cost of such insurance has outpaced growth in family income, potentially making public insurance (Medicaid or the Children's Health Insurance Plan) an attractive alternative for affordable dependent coverage. Using data for 2008-13 from the Medical Expenditure Panel Survey, we quantified the coverage rates for children from low- or moderate-income households in which a parent was offered employer-sponsored insurance. ⋯ This trend was most pronounced for families with incomes of 100-199 percent of the federal poverty level, for whom the share of children with public insurance increased from 22.8 percent to 29.9 percent. Among families with incomes of 200-299 percent of poverty, uninsurance rates for children increased from 6.0 percent to 9.2 percent. These findings suggest a movement away from employer-sponsored insurance and toward public insurance for children in low-income families, and growth in uninsurance among children in moderate-income families.
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Price transparency initiatives encourage patients to save money by choosing physicians with a relatively low price per office visit. Given that the price of such visits represents a small fraction of total spending, the extent of the savings from choosing such physicians has not been clear. Using a national sample of commercial claims data, we compared the care received by patients of high- and low-price primary care physicians. ⋯ Total spending per year among patients cared for by low-price physicians was $690 less than spending among patients cared for by high-price physicians. There were no consistent differences in patients' use of services between high- and low-price physicians. Despite modest differences in physicians' office visit prices, patients of low-price physicians had substantively lower overall spending, compared to patients of high-price physicians.
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It is generally believed that most hospitals lose money on Medicaid admissions. The data suggest otherwise. Medicaid admissions are often profitable for hospitals because of payments from both the Medicaid program and the Medicare program, including payments for uncompensated care and from the Medicare disproportionate-share hospital program. ⋯ In contrast, adding a single charity care day in the same year will decrease overall Medicare payments by about $20 on average. The Centers for Medicare and Medicaid Services recently announced a proposal to shift some Medicare payments from supporting hospitals' costs for Medicaid patients to directly supporting their costs for uncompensated care. If that proposal is adopted, hospitals' profits on Medicaid patients would decrease, but their losses on care for the uninsured would be reduced.