Privately insured people face poorer access and higher costs than government plans: JAMA report



Brief description of the dive:

  • Private insured people are more likely to report worse access to health care, higher medical costs, and lower satisfaction than those on government insurance programs such as Medicare, according to a new study published in JAMA. Tuesday.
  • The study, led by scientists at the San Francisco Veterans Affairs Medical Center and the University of California, San Francisco, comes amid a renewed push by Democrats to enact a public health insurance option – a key aspect of President Joe Biden’s health care program that conservatives vehemently oppose. …
  • As lawmakers look for ways to lower costs and improve coverage, policies to increase the number of people covered by Medicare or better protect those covered by private insurance from increased personal spending, high deductions, and unexpected billing may be associated with with improved service quality and satisfaction, ”the researchers said.

Dive Insight:

The study authors noted few recent studies. and the difference in individual experiences related to access to health care, cost, and satisfaction between public and private health insurance in the five main forms of insurance in the United States, although in general, government programs such as Medicare and military insurance are cheaper and more comprehensive.

The researchers used state telephone survey data from 2016 to 2018 of nearly 150,000 people in 17 states and Washington, D.C., which reflects the experiences of more than 61 million adults, to compare private (individually purchased and employer sponsored) and public insurance. (Medicare, Medicaid, and military insurance through the Department of Veterans Affairs).

Compared to people on Medicare, people with employer-sponsored insurance are less likely to have a personal doctor and are more likely to report unstable coverage, difficulty getting medical care, or getting required prescriptions due to cost. They were also less satisfied with their care.

Comparing people with individually purchased insurance with those using Medicare had similar results, the researchers said.

Comparison of privately insured persons with Medicaid recipients has yielded more mixed results. People with employer-sponsored insurance were less likely to find it difficult to see a doctor because of cost or didn’t take medicine because of cost than their Medicaid counterparts. The results were the same when comparing people with individually purchased insurance, except that there was no difference between them and people on Medicaid in reporting that they did not take medication because of cost.

There was no difference in satisfaction with coverage between people who received insurance in the workplace and those who received Medicaid.

However, people with private insurance – sponsored by an employer or purchased individually – were more likely to report medical debt than those covered by any form of private insurance.

Rebecca Pifer / Healthcare Dive, data provided by study authors

The researchers found similar patterns when comparing private insurance and military insurance.

The results show that, in general, people with private insurance have a worse experience than those with public insurance, the researchers said.

However, results may not be related to the source of coverage, but rather to the quality of the benefits offered by each plan. Historically, Medicare recipients have faced relatively low out-of-pocket costs and higher levels of satisfaction.

“This suggests that our results may not be so much a function of the source of insurance coverage (in this case, a public insurance company and a private insurance company), but rather the completeness of the benefit scheme,” the researchers write.

Nonetheless, Democrats have focused on expanding access to public insurance as a key route to dramatically lowering the country’s uninsured rate. The adoption of the Affordable Care Act in 2020 saw a steady decline in the number of uninsured Americans, but that number began to rise again in 2017 under the Trump administration. There are currently about 30 million uninsured in USA

During his campaign, President Biden presented a health plan he said he would insure more than 97% of Americans through measures such as lowering the eligibility age for Medicare to 60 and introducing a new government option similar to Medicare.

About two thirds of the population said they support the public option as medical costs continue to skyrocket.

On Wednesday, Democrats Frank Pallone, chairman of the House Energy and Commerce Committee, and Patti Murray, chairman of the Senate Committee on Health, Education, Labor and Pensions, sent out a request for public feedback to help them draft a public choice bill. resurgence of major pre-pandemic political efforts from my side.

However, the hospitals and health insurance lobbies are fiercely opposed to this idea and will fight for it. Hospitals oppose the government option because it will reduce the number of people in commercial plans who reimburse providers at a higher rate than Medicare; while payers oppose public choice because it directly threatens massive private health sector.

And it is unlikely that any public election law will be promoted in the Senate, where Democrats have a tiny majority and any defectors can effectively undermine efforts.


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