Sarah Miller

Health Care in the United States

Where are we coming from and

where are we going?

Business Economics

Three (Recent) Eras of Health Care

Pre-ACA

• Combination of government provided, employer sponsored, and uninsured
• Minimal non-group coverage
• Gaps by income
• Erosion of coverage as costs increased

Source: 2011 CPS ASEC, Non-Elderly Only

Employer-Sponsored Health Insurance

Uninsured

Medicaid/Public

Non-group

Affordable Care Act

• Increase health insurance coverage
• Reduce health care costs
• Improve quality

Coverage Expansions

1.Young adults allowed to stay on their parents’ private insurance until age 26 (effective September 2010)

2.Eligibility for Medicaid extended to everyone with incomes below 138% of the Federal Poverty Level (effective Jan 2014*)

3.New tax credits for private insurance for families between 100 and 400% of the Federal Poverty Level (effective Jan 2014)

4. Individual mandate to purchase health insurance (now repealed)

5. Guaranteed issue

Medicaid Expansion

Source: KFF

• High profile supreme court case challenging constitutionality of the ACA
• Because of this ruling, states could opt not to expand Medicaid without risking losing additional funding.

• The goal: make it easier to shop for health insurance if you don't have coverage through an employer
• Consumers shop for standardized plans.
• Low-income consumers are subsidies (premiums capped at % of income)

Health Insurance Marketplaces

Individual mandate repealed

More states adopt Medicaid expansions

Subsidies to buy health insurance coverage are more generous

Medicare negotiates on prescription drug prices

Changes under Trump and Biden

Trends in Coverage

• Highest insurance coverage rate in years
• 22M gain coverage
• Still many left uninsured!

Trends in Cost

• As percent of GDP
• Source: KFF

Trends in Hospital Consolidation

• Source: NICHM

Integration on payer side

• Aetna: Insurer
• CVS caremark: PBM
• CVS Specialty: Specialty pharmacy
• CVS minute clinic: Provider

Discussion