More than 15% of Americans covered by employer insurance plans receive "surprise" medical bills, according to the Kaiser Family Foundation. Kaiser defined a "surprise" bill as an inadvertent out-of-network charge. Kaiser found that 18% of all emergency room visits and 16% of in-network hospital stays resulted in a surprise bill. To reach this conclusion, Kaiser analyzed actual data from large employer plans from 2017, and not opinion polls. The Kaiser study recognized that emergency room stays could result in surprise bills, because a patient often cannot select the emergency room or the treatment options. However, surprise bills also resulted from stays at in-network hospitals, said Kaiser. According to Kaiser, patients in different states faced a wide variation in the incidence of surprise bills, with patients in Texas, New York and Florida most likely to face a surprise bill. Kaiser is a non-profit organization focusing on national health issues, and serves as a non-partisan source of facts, analysis and journalism for policymakers, the media, the health policy community and the public.
Medicaid, an aid program under intense scrutiny now, is a joint federal and state program that provides health coverage to almost 70 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities, according to the federal Centers for Medicare and Medicaid Services. Medicaid now accounts for about 10 percent of all federal expenditures, according to an analysis by The Plain Facts.
Medicaid is the single largest source of health coverage in the United States. Medicaid was signed into law in 1965 at the same time as the Medicare program. All states, the District of Columbia, and the U.S. territories have Medicaid programs designed to provide health coverage for low-income people. About 12 percent of all Medicaid payments go to physicians, while about 11 percent is used for prescription drugs.
Although the Federal government establishes certain parameters for all states to follow, each state administers their Medicaid program differently, resulting in variations in Medicaid coverage across the country. Beginning in 2014, the Affordable Care Act provided states the authority to expand Medicaid eligibility to individuals under age 65 in families with incomes below 133 percent of the Federal Poverty Level.
Americans spend more than $3 trillion a year on healthcare, according to the federal Centers for Medicare & Medicaid Services. In 2015, Americans spent $3.2 trillion on healthcare, or $9,990 per person. This spending account for 17.8 percent of the country's gross domestic product, or the total value of goods and services produced by the country in a year. Medicare spending accounted for $646.2 billion in 2015, or 20 percent of the total healthcare expenditures. Medicaid spending comprised $545 billion, or 17 percent of the total spending. Private health insurance spending accounted for $1,072 billion, or 33 percent of the total healthcare expenditures. Also, Americans spent $325 billion on prescription drugs in 2015. In 2014, per capita personal health care spending ranged from a high of $11,064 in Alaska and a low of $5,982 in Utah. Per capita spending in Alaska was 38 percent higher than the national average ($8,045) while spending in Utah was about 26 percent lower than the national average.
A second federal agency has determined that millions will lose their health insurance under the proposed American Health Care Act (AHCA). The Office of the Actuary, of the Department of Health and Human Services, Center for Medicare and Medicaid Services, determined that, under the AHCA, 4 million Americans become uninsured in 2018 under the AHCA, mainly due to the impact of repealing the individual mandate requirement of the existing Affordable Care Act (ACA). The Office of the Actuary estimates that by 2026, 13 million Americans lose their insurance if the AHCA passes, as opposed to the coverage expected from leaving the ACA in place. This estimate differs from the 23 million Americans expected to lose their health insurance, as estimated by the Congressional Budget Office, and reported on The Plain Facts here.
The reduction in the number of Americans with health insurance results mostly from declines in eligibility for Medicaid, the impact of the repeal of the individual mandate, and the net reduction to subsidies available for the purchase of individual insurance. The Office of the Actuary also determined that, in the individual insurance market, average net premiums for health insurance will rise slightly under the AHCA, but that out of pocket costs for those purchasing individual health insurance policies will soar by 61 percent by 2026. Additionally, the Office of the Actuary estimates that 3 million Americans will lose employer-sponsored health insurance by 2026, if the AHCA becomes law.
The Office of the Actuary is an independent technical adviser to both Congress and the President, and its work does not represent an official position of the Department of Health & Human Services or the Administration.
The American Health Care Act, as formally passed by the House of Representatives, still causes up to 23 million Americans to lose health care coverage, according to the score released by the bipartisan Congressional Budget Office. The score of the actual bill passed by the House, H.R. 1628, differs little than the CBO's score for the earlier, failed attempt to replace the Affordable Care Act. The Plain Facts reported on the CBO's preliminary analysis here. According to the revised analysis, in 2018, 14 million more people will be uninsured under H.R. 1628 than under the current Affordable Care Act. The number of uninsured Americans relative to the number projected under current law increases to 19 million in 2020 and 23 million in 2026. Also according to the CBO, under the AHCA, premiums for individual health insurance policies will increase about 20 percent in 2018 and five percent in 2019. However, starting in 2020, premiums for individual polices may start to decline. The CBO also determined that the House bill should reduce the federal deficit by about $1 trillion over the years 2017 through 2026, primarily through reductions in Medicaid spending and from the replacement of the Affordable Care Act subsidies for nongroup health insurance with new tax credits for nongroup health insurance. The accompany chart summarizes the CBO's estimates of the effect on the federal budget. Further, the respected Tax Policy Center estimates that the tax savings generated by the AHCA fall to the richest households, while the bottom 80 percent of households receive almost no relief. In fact, the Tax Policy Center estimates that the top 1 percent of taxpayers with the highest earnings (annual income of over $772,000) get a tax cut of $37,000 per year. The top 0.1 percent of taxpayers by income receive an annual tax cut of over $200,000. These households have an annual income over $3.9 million.
Up to 24 million Americans will lose their insurance coverage under the American Health Care Act, according to the nonpartisan Congressional Budget Office. The CBO estimated that 14 million Americans will be uninsured in 2018 as a result of the AHCA. That number rises to 21 million in 2020 and 24 million by 2026. As to premiums, the CBO determined that, because of the AHCA, in the non-group market, "insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people." On average, premiums will increase through 2020 but begin to decrease thereafter.
More Americans believe the Democratic Party does a better job than the Republicans at the environment, health care, education and government spending. According to the respected Pew Research Center, almost 60 percent of Americans believe the Democrats better manage the environment. Additionally, the Democratic Party received better scores than the Republicans in health care, education, foreign policy, immigration and government spending.
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