Studying the Studies: Effect of the PPACA on Employer-Sponsored Insurance

The Government Accountability Office (GAO) reviewed recent studies on the likely effects of the Patient Protection and Affordable Care Act (PPACA), and found that the results varied widely depending on the assumptions and methodology used. These studies using publicly available data and statistical modeling predicted small effects on coverage ranging from a 2.5 percent decrease to a 2.7 percent increase. When surveys or other analytical methods were used, the results were highly variable. Likely explanations of the differences include the wording of the questions, the answers that respondents could choose, the nature and size of the sample or data, and the assumptions used.

Methodology

GAO reviewed studies published between 2009 and March 2012 that examined the rates of employer-sponsored health insurance coverage nationwide and examined the possible effects of PPACA. Five studies were based exclusively on the statistical modeling; often, they used similar data or techniques. Nineteen were reports of employers' surveys, and three used other methods. GAO considered the assumptions used, sample size, source data, and the variances in the questions each study examined. Each study examined at least one of the key provisions of PPACA, i.e., the individual mandate, the establishment of the health insurance exchanges, market reforms, and the Medicaid expansion.

Results of survey

GAO found much more variation in the results among the surveys than the statistical modeling. Sixteen of the 19 surveys estimated the likelihood that employers would drop coverage for all employees. Of these, 11 found that less than 10 percent of the respondents were likely to drop coverage, and the other five predicted between 11 percent and 20 percent were likely to do so. "Likely," for these purposes, meant anything from "seriously considering" to "very likely." All but three of the surveys included only employers that currently offered insurance, so there was no measurement of the employers who might begin or resume offering coverage. However, among the three that asked about the likelihood of employers adding a health insurance benefit, estimates ranged from 1 percent to 28 percent. When respondents were asked whether their decisions would be affected by the decisions of others, such as competitors, 78 percent said they would. In another survey, 25 percent would be influenced by a major "bellwether" employer's elimination of health insurance coverage.

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Source: CCH® NetNews Health Care Reform Update

Understanding Possible Health Care Reform Outcomes

Health Reform Bracketology is a fun and instructive exercise that illustrates potential future scenarios in American health care. Based on a series of assumptions, each scenario paints a picture of what the future could be and then presents the implications in simple and easy-to-understand terms. The scenarios are developed by professional staff at Leavitt Partners, in consultation with the Leavitt Partners' FuturePanel, a diverse, 14-member group of health care thought leaders. In addition, surveys are circulated among health-industry thought leaders to gauge their perspective on potential outcomes through LP Health Watch. These groups are not unanimous in their opinion, demonstrating the diversity of thought surrounding the future of health reform. Scenarios depict alternative futures ---- not necessarily desired futures ---- and help senior executives navigate the significant uncertainty that currently exists in American health care.

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The Health Enhancement Research Organization (HERO), American Cancer Society, American Cancer Network, American Diabetes Association and American College of Occupational and Environmental Medicine have collaborated to produce the first joint consensus document designed to provide guidance on the use of outcomes-based incentives in employer-sponsored wellness programs.

This publication incorporates research, practical application, policy perspectives and a set of basic considerations to help organizations that are considering or implementing this approach in their program development and planning. "Guidance for a Reasonably Designed, Employer-Sponsored Wellness Program Using Outcomes-Based Incentives" has been published by the Journal of Occupational and Environmental Medicine.

Resources:

• Guidance for a Reasonably Designed, Employer Sponsored Wellness Program Using Outcomes-Based Incentives Paper
• What employers need to know: 10 steps for developing outcomes-based incentives for wellness programs
• Webinar: Building Consensus on the Appropriate Use of Health Outcomes-Based Incentives in a Wellness Program with HERO President and CEO Jerry Noyce

2011 State Obesity Map Now Available

What: 2011 CDC map detailing adult obesity prevalence for all U.S. states based on Behavioral Risk Factor Surveillance System (BRFSS) data

Where: Click here for the CDC overweight and obesity adult obesity facts.

Background: In 2011, rates of adult obesity remained high, with state estimates ranging from 20.7 percent in Colorado to 34.9 percent in Mississippi. No state had a prevalence of adult obesity less than 20 percent, and 12 states (Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia) had a prevalence of 30 percent or more. The South had the highest prevalence of adult obesity (29.5 percent), followed by the Midwest (29 percent), the Northeast (25.3 percent), and the West (24.3 percent).

In 2011, several updates occurred with BRFSS that impacted estimates of state-level adult obesity prevalence. First, there was an overall change in the BRFSS methodology, including the incorporation of cell-phone only households, and a new weighting process. These changes in methodology were made to ensure that the sample better represents the population in each state. Second, to generate more accurate estimates of obesity prevalence, small changes were made to the criteria used to determine which respondents are included in the data analysis.

Because of these changes in methodology, estimates of obesity prevalence from 2011 forward cannot be compared to estimates from previous years. Data collected in 2011 will provide a new baseline for obesity prevalence data collected in subsequent years.

BRFSS is only one of several data sets that monitor rates of obesity in the United States. When considering these other data sets, including the National Health and Nutrition Examination Survey (NHANES), the obesity epidemic is still a major public health problem.

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