Healthcare (& Related Issues) News Roundup: 12 May 2017

As I mentioned in my previous post, I will be incorporating mapping into my everyday reading and writing practice. Mapping is an indispensable way to represent data and make it more easily comprehensible to a broader audience. Most people are not willing or interested in looking at tables of data, and visualizing geographic/spatial patterns often tells the story better and more concisely than words could. It’s just true in our increasingly visual world where brief, catchy headlines and header images are better drivers of “clicks” than quality content sans titles that “hook” readers outside of a niche audience.

The below map shows the number of people who received health insurance coverage through a marketplace created by the Affordable Care Act (colloquially called “Obamacare”). The data comes from the Kaiser Family Foundation’s estimates of U.S. Department Health and Human Services data. I downloaded the 115th Congressional Districts boundary shapefile from data[dot]gov. Processing the data was not nearly as arduous as I expected. I only had to add a GEOID to enable a table join with the shapefile’s attribute table. I then classified the data with 6 classes using Jenks Natural Breaks. The data is available in table form on Indivisible’s Rese ource Library, with Congressional representative names added.

Further notes on the map: The blank white areas were null values in the table- either due to lack of reported data or technical error. The white areas should not be interpreted as zeros.

ACA_MarketplaceEnroleesByCongressionalDist

Below are some recent news reports and briefs on health policy, healthcare access, and healthcare outcomes.

Health Insurance Company Monopolies Constrain Rural Residents’ Choice & Raise Costs

Kaiser Health News – 12 May 2017 – Rural Shoppers Face Slim Choices, Steep Premiums On Exchanges

  • This year, about a third of the country’s population live in areas where just one or two insurers sold policies on these ACA marketplaces, the analysis by researchers at the Urban Institute found. That included four states — Alaska, Alabama, North Carolina and Oklahoma — as well as rural areas of several others.In regions with just one insurer, monthly premiums were $451 or higher in half of the silver “benchmark” plans on which premium subsidies are based. In contrast, in areas where six or more insurers offered plans, monthly premiums were much lower for comparable coverage: Half were $270 or less. Premium growth from 2016 to 2017 also varied substantially based on how many insurers participated in a region: Median premium growth was 30 percent in areas with one insurer versus 5 percent in regions with six or more carriers.”

There is a geographic pattern among rating areas with 2 or fewer insurers and those with more competition among insurers. The rating areas with just 1-2 insurers were concentrated in the South, while the rating areas with 6 or more insurers were concentrated in the Northwest.

  • “The “rating areas” with just one or two insurers were concentrated in the South. Eighty-two percent of the rating areas with just one insurer were located in the South as were 59 percent of regions with two insurers. Regions with six or more insurers were concentrated in the Northeast, with 30 percent of the total, and the Midwest, with 41 percent.”
  • An Urban Institute report found that “... of the 498 rating regions in the United States, 146 had only one insurer selling nongroup coverage through its state marketplace in 2017; 125 had just two insurers. In contrast, 32 rating regions had five insurers selling marketplace nongroup coverage and 37 had six or more in the same year.” And in the vast majority of rating areas with just one insurer, the insurer was Blue Cross Blue Shield or an affiliate.

 

What percentage of children receive healthcare via Medicaid or CHIP coverage at the county level?

The Georgetown Health Policy – Center for Children and Families has an Open Street Map-based map showing the percentage of children covered by Medicaid and/or CHIP in the 2011-2015 period. The population data are based on the US Census Bureau American Community Survey 5-year estimates (2011-2015). Notice the clusters in the sunshine belt and the Pacific Northwest.

CHIP
Screencap from the website – I highly recommend the interactive map!

 

MEDICARE BENEFICIARIES’ FINANCIAL BURDEN

The Commonwealth Fund just published a new issue brief entitled, “Medicare Beneficiaries’ High Out-of-Pocket Costs: Cost Burdens by Income and Health Status” (Citation: C. Schoen, K. Davis, and A. Willink, Medicare Beneficiaries’ High Out-of-Pocket Costs: Cost Burdens by Income and Health Status, The Commonwealth Fund, May 2017). In this issue brief, the authors note that approximately 56 million people or 17 percent of the US population rely on Medicare to access healthcare. However, Medicare’s core benefits exclude key healthcare services including but not limited to dental, vision, hearing healthcare (audiological services), and long-term services. Moreover, Medicare does not have a ceiling on out-of-pocket costs for covered services, which places beneficiaries at financial risk.

Based on an analysis of the Medicare Current Beneficiary Survey, the authors found that over 25 percent of beneficiaries expended more than a fifth of their income on on premiums and medical care (inclusive of cost-sharing and uncovered services). This is relevant to my own research on the accessibility and affordability of audiological services in the US, as age is one of the strongest risk factors for hearing loss, yet these services are not covered under Medicare, nor are they covered under most private health insurance plans. When the average hearing aid cost $4,700 in 2013, equivalent to 11% of the median household income in that year, that is a real problem. This poses a particular financial burden on elderly and disabled Medicare beneficiaries, whose incomes are typically lower than the working-age population’s.

COUNTY-LEVEL DISPARITIES IN LIFE EXPECTANCY AT BIRTH (1980-2014)

The Journal of the American Medical Association (JAMA) Internal Medicine published a new paper entitled “Inequalities in Life Expectancy Among US Counties: 1980 to 2014: Temporary Trends & Key Drivers.”  (citation: Dwyer-Lindgren L, Amelia Bertozzi-Villa AB,  Stubbs RW, et al. 2017. Inequalities in Life Expectancy Among US Counties: 1980 to 2014: Temporary Trends & Key Drivers. JAMA Intern Med. Published online May 8, 2017. doi:10.1001/jamainternmed.2017.0918)

LifeExpectancyChange1980_2014
Image downloaded here. (Copyright JAMA 2017)

Significant findings included

  • Widening geographic disparities in life expectancy between 1980 and 2014. “Absolute geographic inequality in life expectancy at birth increased between 1980 and 2014, with the gap between the 1st and 99th percentile increasing by 2.4 (95%UI, 2.1-2.7) years.”
ChangesInLifeExpectancy1980_2014
Figure 2 in Lindgren et al (2017) (Copyright JAMA 2017)
  • Lowest life expectancy in West Virginia counties, South Dakota counties comprising Indian Reservations, eastern Kentucky, and southern Mississippi.
  • Counties with the highest life expectancy at birth were clustered in Colorado

 

And finally… the importance of messaging in health policy

The New York Times’ 12 May 2017 article entitled, “Why Some Can’t Wait for a Repeal of Obamacare,” highlights the gap between thinking as individual consumers and as members of a social collective whose well-being is linked. One target is the tax penalty levied on those who did not have health insurance at all or whose health insurance plans were not compliant with the Affordable Care Act. They perceived the ACA’s marketplace, tax penalties, and Medicaid expansion as “big government.” These perceptions are in contrast with the defenses of the Affordable Care Act, which emphasize the indiviudal and shared costliness of healthcare in the absence of coverage- with emphasis on pre-existing conditions which were used to deny people health insurance coverage before the Act.

The interviewees in the story chose non-ACA compliant high-deductible plans with catastrophic care coverage to lower their monthly costs, potentially incurring higher healthcare costs if they or any member of their household received a diagnosis for a chronic illness or develops a disability due to any number of the “catastrophic” events that are covered under their plans. They do not share common ground with those who were previously denied health insurance on the basis of a pre-existing condition prior to the Affordable Care Act. This is one of the areas to consider as we communicate research as “experts” in health policy, public health, and health geography.

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