Some Preliminary Data on Consumer-Directed Health Insurance. Jeff Lemieux Center for Policy and Research America s Health Insurance Plans

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1 Some Preliminary Data on Consumer-Directed Health Insurance Jeff Lemieux Center for Policy and Research America s Health Insurance Plans

2 U.S. Health Spending as a Percent of GDP 20% 16% 12% 8% 4% 0% PPS (and Economic Recovery) Managed Care (and Economic Recovery) CMS Jan 2005 (2003) extrapolated to 2009 using CBO etc. Consumerism, Chronic Care, Measurement, IT and PHRs, Pay for Quality?

3 Private Health Insurance and Out-of-Pocket Spending vs. GDP 16% Annual Growth Rate 14% 12% 10% 8% 6% 4% 2% 0% Managed Care Boom Private Insurance and Out-of- Pocket GDP (includes inflation)

4 Consumerism Theories Early 1990s: Tiered Premiums Managed Competition, Premium Support, Defined Contribution Late 1990s: Tiered Providers In-Network/Out-of-Network Early 2000s: Tiered Products (especially Rx) Mid-2000s: Accounts with High Deductibles Late 2000s: Hybrid Products? Widespread Use of Accounts, some with High Deductibles; Tiered Premiums, Providers, Products; Networks; Managed Chronic Care; DM v2.0; PHRs and Self-Care.

5 People Covered by an HSA Plan March 2005 Individual Market Small-Group Market Large-Group Market 162,000 Other Group 1 88,000 Other 2 77,000 Total Total Covered Lives 556, ,000 1,031,000 [1] AHIP defines small group as businesses with 50 or fewer employees and large group as businesses with more than 50 employees. Companies that were able to provide numbers of lives covered by group policies, but whose definitions did not match up with AHIP defined categories for small and large group were placed into a category called other group. [2] The other category was necessary to accommodate companies that were able to provide information on the number of HSA/HDHP policies sold and the lives they covered, but were not able to provide a breakdown by market.

6 Growth of HSA/HDHP Participation from September 2004 to March 2005 Number of Lives Covered 1,000, , , , ,000 Other Other Group Large Group Small Group Individual 438,000 1,031,000 0 Sept March 2005

7 Number of AHIP Member Companies Reporting Enrollment in an HSA/HDHP Number of Companies Sept March 2005

8 Age Distribution of People Covered by an HSA/HDHP Product Individual Market Small-Group Market Large-Group Market Percent of Covered Lives 30% 25% 20% 15% 10% 5% 0% Age Groups Data as of March 2005

9 Percentage of HSA/HDHP Policies Purchased by Previously Uninsured 3 Previously uninsured, 37% Individual Market Replacing prior coverage, 63% [3] Companies responding to this question reported HSA/HDHP enrollment of 204,374 lives in the individual market, with 75,618 previously uninsured. Data as of March 2005

10 Percent of New HSA/HDHP Policies Purchased by Small Employers 4 New coverage, 27% Small-Group Market Previously offered coverage, 73% [4] Companies responding to this question reported HSA/HDHP enrollment in 3,675 new small-groups (which previously offered no health insurance coverage), covering 37,868 lives. Data as of March 2005

11 Average Annual Premiums for HSA/HDHP Products, by Age Group Individual Market Best-Selling Product $6,000 $5,518 Avg Annual Premium $5,000 $4,000 $3,000 $2,000 $1,000 $919 Single Policy Family Policy $1,872 $1,204 $2,772 $1,894 $3,550 $3,306 $ Age Groups Data as of March 2005

12 Average Annual Premiums HSA/HDHP Plans, Employer Market Small and Large-Group Best-Selling Products $7,500 Small Group $7,471 $6,839 Avg Annual Premium $6,000 $4,500 $3,000 $1,500 Large Group $3,607 $2,792 $0 Single Policy Family Policy Data as of March 2005

13 Average Annual Deductible Best-Selling HSA/HDHP Product Avg Annual Deductible $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 Individual Market Small-Group Market Large-Group Market $2,790 $1,850 $1,607 $5,230 $4,007 $3,000 $0 Single Policies Family Policies Data as of March 2005

14 Annual Premiums Individual Market Average vs. HSA (Individual) $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 < Individual Market- Single HSA- Single Individual Market- Family HSA- Family Sources: AHIP HSA Census (March 2005) and Individual Market Survey (2004, forthcoming).

15 $15,000 $13,500 $12,000 $10,500 $9,000 $7,500 $6,000 $4,500 $3,000 $1,500 $0 Individual Health Insurance -- Average Premiums by State KY MT CO MN NE ND MO AZ CA OR MI PA ID IA NM MS VA AL OH KS NC WI NJ MA NY MD AR CT NH WV SC SD NV TN IL GA TX FL LA OK IN WY Single Family Source: 2004 AHIP Individual Insurance Survey (forthcoming).

16 McKinsey Study (June 2005) Five Full-Replacement CDC Plans (mostly HRAs) Increased and persistent price sensitivity More consumer engagement in managing care More interest in wellness, prevention Consumers need more information on prices Nobody likes benefits cuts, or, possibly, not having choices

17 Larger Political Trend: More Collaboration, Less Confrontation Value, Consumerism, Public-Private Partnerships IT and PHRs, Tech Evaluation and Surveillance Measurement, Outcomes, Effectiveness and Pay for Quality Medicaid LTC Partnerships, Cash and Counseling, Managed Care for Disabled Medicare Chronic Care, DM, P4P Legal and Regulatory Reforms and Streamlining Still some Thirty Years War Holdouts...

18

19 Assimilate Private Health Care Into Government Realm

20 Need Strategy on Health to Keep Government Small

21 Evaluate Old Warriors Claims Cautiously Inaccurate or Misleading Sky is Falling Claims Example: Bankruptcy Junk Science Unwarranted Utopianism Example: Accounts will Transform Health System By Themselves Benefit Innovation Imperative Learning from Consumers and Providers Allow, Experiment, Improve Price Incentives Work in U.S.

22 Consider HSAs as a Vehicle for Health Insurance Subsidy Tax Credits Losing Momentum? Low-Income, Unemployed Individual, Low-Wage Small Firm Tax Reform Based on Untaxed Savings Accounts? HSAs for all Low-Income? All Unemployed? Use For Payment of Premium, Regardless of Plan Health Expenses only if HDHP Some Roll-Over? Additional Subsidies via Various Programs

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