Other federal initiatives

“For the first time, U.S. health regulators have judged a type of smokeless tobacco to be less harmful than cigarettes, a decision that could open the door to other less risky options for smokers.

The milestone announcement on Tuesday makes Swedish Match tobacco pouches the first so-called reduced-risk tobacco product ever sanctioned by the Food and Drug Administration.

[..] FDA acting commissioner Ned Sharpless said the agency based its decision on long-term, population-level data showing lower levels of lung cancer, emphysema and other smoking-related disease with the use of snus.

Sharpless added that the agency will closely monitor Swedish Match’s marketing efforts to ensure they target adult tobacco users.

“Anyone who does not currently use tobacco products, especially youth, should refrain from doing so,” he said in a statement

The U.S. smoking rate has fallen to an all-time low of 14% of adults, or roughly 34 million Americans. But smoking remains the leading cause of preventable disease and death in the U.S., responsible for some 480,000 deaths annually.”

US endorses tobacco pouches as less risky than cigarettes (2019.10.22)

“The rule permits employers to make defined contributions to their employees’ health insurance costs, while freeing them of the responsibility of purchasing a group health plan. It potentially gives employees more choice and transportability in their benefits.

[..] HRAs [health reinsurance arrangements] can boost coverage if the prospect of making a defined contribution without contracting for a group plan motivates small employers who currently do not offer health insurance. For the individual market, an increase in enrollees transferring out of the employer segment is a potential game changer, dwarfing current sources of growth. This growth can improve the risk pool, reduce premiums, and increase insurer participation, thereby creating more choice for consumers. Even employers that offer group coverage may gain leverage in their negotiations with carriers and providers once the HRA possibility is on the table.

[..] The biggest headwind right now is that individual plans are currently more expensive and less generous than group coverage in most parts of the country, with higher premiums, more cost sharing, and narrower provider networks. And there is the danger of making the individual market less healthy if employers find ways to use the rule to offload their least healthy workers.

[..] The HRA rule deserves attention because it permits experimentation with an alternative to employer insurance. As such, it represents a bridge to a very different system. It remains to be seen who will cross it and when.

The HRA rule could be a game changer for health insurance – STAT (2019.10.22)

“Health care spending is often expressed using aggregate spending from the National Health Expenditure Accounts (NHEA) as a share of GDP. We sought a more granular perspective that accounted for nearly all health expenditures in the NHEA but did so by income group, because our goal was to construct ratios of average spending in each income group to the group’s average household income. The out-of-pocket spending component of such an analysis can be readily obtained from household data, but a more complex analysis is needed to allocate federal and state spending on public health insurance programs and adjust spending burdens to reflect tax preferences. [The team used the Medical Expenditure Panel Survey–Household Component (MEPS-HC) for the incidence of out-of-pocket spending on health care and out-of-pocket premiums, as well as the distribution of sources of health insurance, the MEPS–Insurance Component (MEPS-IC) for employer premiums, NHEA for public spending totals by program and for private spending benchmarks supplemented with state-specific Medicaid data, and information compiled by the Congressional Budget Office (CBO) on income by source and taxes paid by type across the household income distribution.]

[..] By 2016 average spending had increased from 17.6 percent to 21.4 percent of household income. During this period, the incidence of the spending had shifted considerably, becoming nearly proportional. Despite the overall increase in spending as a share of income, the average burden in the bottom 20 percent of the income distribution dropped from 26.8 percent to 22.6 percent. In part, this reflected a 3.8-percentage-point decline in private burden and a 0.8-percentage-point decline in Medicare burden. In contrast, the average burden in the top 1 percent increased by 7.6 percentage points, from 13.8 percent to 21.4 percent. The amounts spent on Medicare and Medicaid were the primary drivers, increasing as shares of income by 3.0 percentage points and 2.3 percentage points, respectively (data not shown). Cumulatively over the period 2005–16, average income and average health care spending rose by 7.2 percent and 30.4 percent, respectively. The growth in health care spending varied depending on whether it was in the private-sector (13.9 percent), Medicare (46.9 percent), or Medicaid (53.3 percent).

Exhibit 2

[..] Much of the incidence shift was attributable to the fact that average private-sector spending, the most regressive component of health care spending, grew in real terms by only 13.9 percent over the study period, compared to 46.9 percent and 53.3 percent growth in average spending for Medicare and Medicaid, respectively. The slower growth in private spending reflected the fact that throughout the study period, rapid private insurance premium increases were offset by an erosion in private coverage (until the introduction of Marketplace coverage in 2014). Simultaneously, increases in public coverage were driven by aging, disability, and (by the end our study period) the ACA. These increases in public coverage not only increased federal spending on these programs but also helped reduce private out-of-pocket spending by the uninsured, both of which increased the progressivity of health care financing.

[..] The ACA may also have played an important role in helping prevent a return to prerecession regressivity in at least two key ways. First, increases in Medicaid coverage and the introduction of subsidized Marketplace plans may have helped protect low-income adults by reducing out-of-pocket spending. Second, this expansion in coverage was financed primarily through federal tax revenues, which are progressive. The expansion in Medicaid had an enhanced federal matching rate of 100 percent for newly eligible enrollees for the years covered by our study, and the federal government primarily financed the Marketplace subsidies. Taken together, these changes slowed any tendency to return to the more regressive financing that was the norm before the ACA.”

Changes In The Equity Of US Health Care Financing In The Period 2005–16 (2019.10.16)