
This Week in Managed Care: December 14, 2018
This week, the top managed care news included a report that found uninsured rates were on the rise in 2017; an analysis of rising health insurance costs for families; predictions for cardiology trends in 2019.
Uninsured rates were on the rise in 2017, health insurance costs rose for families, and enrollment on the exchanges is off for the coming year.
Welcome to This Week in Managed Care, I’m Laura Joszt.
Uninsured Rate Increases
The share of Americans without health coverage rose last year for the first time since 2014,
The number of uninsured people rose by 700,000 in 2017, representing the first increase since the Affordable Care Act took full effect. The large increases came in states that did not expand Medicaid, and occurred among African Americans and those living just above the poverty line.
After trying to repeal the ACA, the Trump administration made several changes:
- It used the 2017 tax law to repeal the individual mandate
- It allowed several types of short-term plans that do not require essential health benefits
- It allowed association health plans for employer groups
Financial Burden of Insurance
The Commonwealth Fund
As premiums have climbed, so have employee contributions. After rising an average of 4.6% each year for 5 years, premium costs for family coverage rose 6.8% in 2017.
Said lead author Sara Collins, “The cost of employer health insurance premiums and deductibles continues to outpace growth in workers’ wages. This is concerning, because it may put both coverage and healthcare out of reach for people who need it most—people with low incomes and those with health problems.”
ACA Enrollment
Meanwhile,
Sign-ups appear down by about 12% heading into the final week of enrollment, and experts listed several reasons, including:
- The end of the individual mandate
- New enrollment options off the exchange
- Virginia’s addition of Medicaid expansion
- Fewer insurers exited the market, so more consumers will be auto-enrolled. These sign-ups won’t be reported until after enrollment ends.
Cardiology Predictions for 2019
The American College of Cardiology has
Among the trends expected are:
- More use of direct oral anticoagulants.
- Increased interest in the use of artificial intelligence
- Greater use of wearable technology and integration of patient-collected data into care
- More focus on the cost-effectiveness of PCSK9 inhibitors, in light of new cholesterol recommendations and steps by drug makers to cut prices
However, in an interview with The American Journal of Managed Care®, Richard Kovacs, MD, FACC, said so far, he’s not hearing many results from an agreement with Sanofi and Express Scripts to make it easier to prescribe the PCSK9 inhibitor Praluent. “Regardless of the PBM, the prior authorization process is still taking time. I think that our own prescribers have tried to adapt to the system, but it’s still taking about the same amount of time.”
December EBO
Finally, the
In an essay,
For all of us at the Managed Markets News Network, I’m Laura Joszt, Thanks for joining us.
Newsletter
Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.