Krutika Amin

i thought i had 4 things to say, but only have 3, ROFL. forgive me for mis-numbering 😅

3/3 Even if the health care situation is amenable to shopping, payments have moved to value-based models making fee-for-services rates irrelevant.
www.healthsystemtracker.org/brief/ongoin...

Few adults are aware of hospital price transparency requirements - Peterson-KFF Health System Tracker As of January 1 of this year, hospitals are required to post prices of common health services on their websites via consumer-friendly tools for patient use. Prior to implementation of this rule, hospi...

2/3 Few adults research the price of health care -- Few instances where price transparency is truly possible due to lack of providers in-network or in your area.
www.healthsystemtracker.org/brief/few-ad...

I did a talk on price transparency! hctransparencysummitportal.com/auditorium
Some @PetersonCHealth @KFF work I talked about:

1/4 Price transparency bipartisan legislation passed House last year, so Congressional action on price transparency is possible: www.healthsystemtracker.org/brief/policy...

Out-of-pocket spending on insulin among people with private insurance - Peterson-KFF Health System Tracker The Build Back Better Act, which has passed the House but stalled in the Senate, would cap insulin out-of-pocket costs for people with insurance. Several other recent legislative proposals would also ...

22% privately insured people and 30% uninsured people reported rationing insulin because of cost--to save money, among the reasons listed.
www.healthsystemtracker.org/brief/out-of...

Out-of-pocket spending on insulin among people with private insurance - Peterson-KFF Health System Tracker The Build Back Better Act, which has passed the House but stalled in the Senate, would cap insulin out-of-pocket costs for people with insurance. Several other recent legislative proposals would also ...

At least 1 in 5 privately insured people taking insulin spend more than $35 per month per insulin product.
This share is greater in the small group fully insured market than for Marketplace enrollees (who get income-based deductible and copay subsidies).
www.healthsystemtracker.org/brief/out-of...

Eli Lilly's nationwide insulin pricing settlement called off A settlement between Eli Lilly and purchasers of its insulin drugs that would have capped prices and provided $13.5 million to resolve claims that the company inflated the drugs' cost has fallen apart, after an unfavorable ruling from the judge overseeing the case.

Federal law capping insulin costs to $35 a month is still on Dems health policy agenda. Why?

> Reuters: Eli Lilly's nationwide insulin pricing settlement called off www.reuters.com/legal/litiga...

How does cost affect access to healthcare? - Peterson-KFF Health System Tracker Although most adults are in good health and have health insurance, more than 1 in 4 adults (28%) reported delaying or foregoing healthcare due to cost.

Link to PetersonCHealth KFF analysis:
www.healthsystemtracker.org/chart-collec...

"For too many Americans drugs are unaffordable... [and] having to ration life saving drugs." -
linakhanFTC w jonstewart: youtu.be/oaDTiWaYfcM?...

Fact check: Looking at #insulin, over 1 in 5 non-elderly adults (18-64 years) with private insurance rationed insulin due to cost.

I'm sure you saw, but in case--these VCI hub use and costs estimates. HHS didn't disclose the exact tag, but could back match a little based on the # of state exchanges and state Medicaid/CHIP programs. My read is that most of the cost (except the federal admin part) is variable on the # of pings.

New paper w/Ben Sommers & Rebecca Smith:

Looking at self-reported insurance in Census data, we document a big disconnect between (1) "actual" growth in Medicaid (in administrative data) during continuous coverage, (2) self-reported Medicaid coverage, and (3) self-reported uninsurance #healthpolicy

What resources are available for privately insured patients who get surprise balance bills? | KFF Most patients do not know about the new surprise billing protections and likely also do not know of resources available to seek recourse for incorrect medical bills. This brief provides resources to p...

The No Surprises Act prohibits many surprise balance bills, but not all. For more on:
-when privately insured people may still be getting surprise balance bills?
-what happens next?
-what federal resources are available?
See #kff brief: www.kff.org/health-costs...

At the time of @kff_org analysis, United Healthcare had 14% of the enrollment, and accounted for nearly a quarter of No Surprises Act federal disputes. healthsystemtracker.org/brief/indepe... #healthpolicy

Relatedly to today's NYT on MultiPlan and $UHG nytimes.com/2024/04/07/u... (from Chris Hamby),
Multiplan and United Healthcare are among top 3 entities getting claims disputed through the federal No Surprises Act process:
healthsystemtracker.org/brief/indepe... #KFF

🗨️What stood out to you in the 2025 NBPP final rule?

💰User fee decrease in 2025 NBPP has implications for SBMs & SBM-FPs: 1) potentially tougher for SBMs' charges. 2) at the same time, gives room to increase SBM fees. SBM functions tend to be more variable with enrollment and plan participation while @healthcaregov has greater economies of scale.

Mixed premium impact changes in 2025 NBPP:
🖌️Dental routine adult care, in states that do add, would have upward impact, but possibly mixed if lowers other long-run costs
💵Risk adjustment changes: since budget neutral, depends. Some plans will win others will lose by definition

🔽Negative premium impact policies in 2025 NBPP:
User fee for @healthcaregov Marketplace plans set at the lowest level ever at 1.5% for FFM and 1.2% for SBM-FPs, down from 2024 (2.2% and 1.8) and initial levels (3.5% and 3.0%). This has a direct➖downward premium impact

🔺Positive premium impact policies in 2025 NBPP:
Network adequacy minimum for state Marketplaces (including SBMs and SBM-FPs) plans set to the federal marketplace level starting in 2026. Likely already the case for many states, puts ➕pressure in states not at min federal level.

🧵HHS finalized the 2025 annual regulation (NBPP or Payment Notice) for ACA Marketplaces and individual/small group market. Quick takes on premium impact, and other implications.
Rule: www.cms.gov/files/docume... #healthpolicy

Health Insurer Financial Performance in 2021 | KFF Using health insurer financial data for 2021, we find that Medicare Advantage insurers reported gross margins that were at least twice as high as those reported by insurers in the individual/non-group...

How do gross margins vary by health insurance market? See #KFF analysis.
*Note: Positive margins do not necessarily translate into profitability since they do not account for administrative expenses or tax liabilities
www.kff.org/medicare/iss...

Graph showing cumulative ٪ change in health sector employment by setting Feb 2020 to Feb 2024. All selected settings have rebounded and surpassed prepandemuc baseline, except elderly care facilities (~ down 1%) and skilled nursing facilities (down ~ 8٪)

Have seen versions of this graph in other spots (maybe from KFF too). Prolonged and persistent implosion of workforce in long‐term care facilities post-pandemic is scary.

Latest health sector job numbers in charts:
-Employment in hospitals and clinics now back to pre-COVID projections
-Home- and nursing care jobs have seen higher average wage increases
www.healthsystemtracker.org/chart-collec... #KFF #polisky #healthpolicy

During the Trump Administration, short-term limited duration (STLD) health insurance plans were de-regulated and allowed to go on for longer (364 days, up to 3 years renewal). President Biden campaigned on reigning in these so called “junk” plans.

Biden Admin is concerned a lay consumer, searching the web for health insurance likely can't tell whether a health insurance plan will cover their pre-existing conditions or other major health events. See for example this ad--

Biden Admin has finalized rule limiting short-term limited duration (STLD) plans to 4 months instead of up to 3-years.

#KFF estimate: 1.2M were buying non-ACA-compliant plans (like grandfathered and short-term plans) in mid-2022, down from 5.7M in mid-2015.
www.kff.org/affordable-c... #healthpolicy

KFF State Health Facts link: www.kff.org/state-catego...

Of the net new #ACA Marketplace sign ups without APTCs (about 140,000), some could be ICHRA enrollees. Hard to put an exact figure on it though.

See stats in updated KFF State Health Facts
@jaredortaliza.bsky.social @mattmcgough.bsky.social @cynthiaccox.bsky.social #healthpolicy

CMS released 2024 ACA Marketplace plan selections public use files. Total sign ups* tallied 21.4Million. From last year, sign ups with premium help increased by 4.9M and by about 140,000 without APTC.

*Thru end of open enrollment for
@healthcaregov.bsky.social & SBMs
www.kff.org/affordable-c...

6/6 Nevada is one of the states experimenting with public option plans to address health care costs.
Compare premiums, enrollment, and other data points for NV vs national avg or other states with *KFF State Health Facts*: www.kff.org/affordable-c...