December Research Roundup: What We’re Reading

We at CHIR are excited to ring in the New Year with new health insurance research! In December we reviewed studies on health care spending, marketplace subsidies for employer plans, public opinions on a COVID-19 vaccination, and the structure of health plan networks. 

Baumgartner, J, et al. Removing the Firewall Between Employer Insurance and the ACA Marketplaces: Who Could Benefit?. The Commonwealth Fund, December 15, 2020

This report estimates the potential effects of a proposed strategy to improve health plan affordability by allowing more people to enroll in subsidized health plans through the ACA marketplaces, removing the current “firewall” between employer plans and marketplace subsidies.

What it Finds

  • Researchers examined the potential effects of allowing nonelderly people with employer coverage to buy marketplace plans under two  premium subsidy schedules: 1) Under the current 2021 marketplace premium tax credit schedule, and 2) Under a schedule with enhanced premium subsidies extended to all income levels, linked to a gold-level benchmark plan that covers a larger percentage of average costs than the current silver-level benchmark plan. They found: 
    • 6 percent to 13 percent of people in nonelderly households with employer-based coverage could pay lower premiums through a marketplace plan.
    • Those who would benefit the most under the subsidy options would be low or middle-income families making between 0 percent and 399 percent of the Federal Poverty Level.
    • Larger numbers of Black, Latino, and American Indian or Alaska Native individuals with employer-based coverage could have reduced premiums compared to white and Asian Americans.
    • Consumers in southern states would benefit more than consumers in other regions of the country, as employee plan premiums in this region often account for a larger percentage of household income than the national average.

Why it Matters 

The costs of employer-sponsored insurance have been steadily rising, leading many employers to shift more financial liability to employees. Many low- and middle-income individuals work in jobs that do not offer generous health benefits, and their expected contributions to premium can eat into family budgets. The ACA limits access to Marketplace subsidies to those for whom their employer coverage is deemed “unaffordable,” but the definition of “unaffordable” requires people to spend, at a minimum, 9.83 percent of their household income on premiums. This research suggests that enabling more people to obtain Marketplace subsidies could reduce premiums for many individuals, particularly for people of color. 

Martin, A, et al. National Health Care Spending in 2019: Steady Growth for The Fourth Consecutive Year. Health Affairs, December 16, 2020

In this report, Health Affairs researchers summarize annual health care spending from 2019. 

What it Finds

  • Health care spending in the United States increased by 4.6 percent in 2019, similar to the rate of growth in 2018, 4.7 percent. Overall, spending costs reached $3.8 trillion in 2019.
    • Health care spending growth has remained stable since 2016, with costs increasing at an average annual rate of 4.5%.
    • The 4.6% rate of growth in 2019 is associated with a faster growth rate in Medicare spending, a slower growth rate in private health insurance spending, and a stable rate of growth in Medicaid spending.
  • 2019 saw faster growth in spending for personal health care, including hospital care, physician and clinical services, and retail purchases of prescription drugs (which accounted for 61% of total national health expenditures), and a decline in the net costs of health insurance, which were lower due to the suspension of the health insurance tax in 2019.
    • Spending for personal health care accounted for 84% of all health care spending in 2019, reflecting a 5.2% increase in the rate of growth, compared to a 4.1% increase seen in 2018.

Why it Matters

The COVID-19 pandemic has affected health care spending and the overall U.S. economy in 2020. Although the full scope of its impact has not yet been determined, this report provides a useful look at the state of health spending in pre-pandemic times.

Hamel, L, et al.  COVID-19 Vaccine Monitor: December 2020. KFF, December 15, 2020

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations through surveys and focus groups.

What it Finds

  • If a COVID-19 vaccine was deemed safe by scientists and free to all those who wanted it, 71% of all participants reported that they would “definitely” (41%) or “probably” (30%) get vaccinated while 27% of all participants said they would “probably” (12%) or “definitely” (15%) not.
  • The number of all those willing to get vaccinated has increased from 63% to 71% since a previous survey conducted in September 2020. This increase is observed among Black, white, and Hispanic adults. In addition, willingness to get vaccinated has increased for both Democrats (from 77% to 86%) and Republicans (from 47% to 56%), but has remained consistent among independents (67%).
  • The main factors contributing to vaccine hesitancy include concerns about possible side effects (59%), lack of trust in the government to ensure the vaccines’ safety and effectiveness (55%), concerns that the vaccine is too new (53%), and concerns over the role of politics in the development process (51%).
    • Black adults who are vaccine hesitant are more likely than white adults to be concerned about side effects (71% vs. 56%) or the newness of the vaccine (71% vs. 48%). 
    • Overall, vaccine hesitancy is highest among Republicans (42%), adults aged 30-49 (36%), and rural residents (35%). 
  • 71% of the public believes a vaccine will be widely available for anyone who wants it by the summer of 2021. 
  • 85% of participants reported that they trust their personal doctor or health care provider “at least a fair amount” for reliable vaccine information. Trust in governmental sources varies based on partisan affiliation, with Democrats tending to express higher levels of trust than Republicans.

Why it Matters

As COVID-19 vaccines become more widely available, these study findings will be useful for clinicians, insurers, and public health officials aiming to connect with patients and consumers, particularly those who remain hesitant about receiving the vaccine. Understanding the breadth of perspectives among this group can aid communication and outreach efforts. 

Graves, J. et al. Breadth and Exclusivity of Hospital and Physician Networks in US Insurance Markets. JAMA Network, December 17, 2020

This study uses 2019 plan directory data to examine variations in the breadth of health care networks and the degree to which they overlap across physician specialties and insurance markets throughout the United States. Specifically, researchers sought to quantify network breadth and exclusivity among primary care physician, cardiology, and general acute care hospital networks for (small and large-group) employer-based, marketplace, Medicare Advantage, and Medicaid Managed Care plans.

What it Finds

  • Areas with high levels of insurer, physician, and hospital market concentration had broader and less exclusive networks, while the narrowest and most exclusive networks were found in areas with the least market concentration.
    • Networks were narrowest and most exclusive in California, and broadest and least exclusive in Nebraska.
  • Networks were broadest in employer-sponsored large-group plans, and narrowest in marketplace and Medicaid Managed Care plans. However, despite being narrower, Medicaid networks were more connected with other networks in their area.
  • The breadth and exclusivity of networks were not always linked; researchers found that in several states, the broadest networks had a lower degree of overlap with other networks in the same area.

Why it Matters 

These findings suggest that plan network structures– and the level of market competition in a given area– can greatly influence the availability of care for enrollees. Because narrower, less heavily concentrated networks were found to have more overlap with other networks in the same area, while broader networks were linked with increased market concentration, enrollees in some networks may be able to switch to a lower-cost, narrow plan without losing in-network access to their providers. Policymakers and insurers seeking to make coverage more accessible for consumers and to improve health care quality across plan networks may use these findings to inform further research and decision making on the makeup of plan networks. 


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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.