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Aging and Health: Health Affairs' January Issue

Bethesda, MD--The January issue of Health Affairs includes a number of studies examining issues pertaining to aging and health or health care. Other subjects covered include: the effect of Medicare's Hospital Compare quality reports on hospital prices, how provisions of the Affordable Care Act (ACA) impact Americans shouldering high medical cost burdens, if California's Hospital Fair Pricing Act has benefitted uninsured patients, and more.
Content on aging and health was supported by the John A. Hartford Foundation.
Has California's Hospital Fair Pricing Act reduced the prices paid by uninsured patients?  
Ge Bai of the Williams School of Commerce, Economics, and Politics at Washington and Lee University studied the 2006 law's impact on protecting uninsured patients from paying hospitals' full, undiscounted prices. She found that the price actually paid by uninsured patients shrank from 6 percent higher than Medicare prices in 2004 to 68 percent lower in 2012, and that the amount hospitals actually collected from uninsured patients for every dollar charged dropped from 32 cents in 2004 to 11 cents in 2012. Although hospitals have been increasingly less able to collect from uninsured patients since the passage of the law, they have raised the proportion of services provided to them. The author says that the effect of the law could offer lessons to Congress and state legislatures seeking to similarly protect financially vulnerable patients.
Will the ACA benefit Americans previously shouldering high medical cost burdens? 
Peter J. Cunningham of Virginia Commonwealth University's School of Medicine found that the percentage of Americans with high medical cost burdens--those who spend more than 10 percent of their family income on out-of-pocket health care expenses--increased to 19.2 percent in 2011, after having stabilized at 18.2 percent during the 2007-9 recession. The results show that people enrolled in nongroup coverage before the ACA were incurring high medical cost burdens--with about half spending more than 10 percent of their family income on health insurance and health care. The author notes that new coverage options offered by the insurance Marketplaces should allow many of them to reduce both premiums and out-of-pocket costs. 
Can Medicare's Hospital Compare positively impact hospital prices? 
Avi Dor of the George Washington University's Milken Institute School of Public Health and coauthors looked at the effects of Hospital Compare quality reporting on prices for two common, costly cardiac procedures--coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). While prices for both continued to rise after initiation of Hospital Compare quality scores, the rate of increase was significantly lower in states that did not mandate quality reporting metrics prior to the introduction of Hospital Compare rankings. After accounting for general rates of inflation, annual rates of increase for PCI were 4.4 percent in states with no previous reporting metrics versus 8.7 percent in states that mandated public reporting systems. For CABG, it was 3.9 percent versus 10.6 percent, respectively. The authors note that Hospital Compare provided leverage for moderating price increases, while adding competitive pressures on hospitals.
How your current household size affects your future long-term care planning. 

Carrie E. Henning-Smith and Tetyana P. Shippee of the University of Minnesota's School of Public Health examined expectations about future need for long-term services and support among adults ages 40-65, including how these differed based on current living arrangements. The results showed a disconnect between current perceptions and likely realities in the future. Respondents currently living with minor children were the least likely to expect to need long-term care. In contrast, those living alone were the most likely to say it was "very likely" they would need such support. Overall, 40 percent of all respondents believed they were likely to need long-term services and supports in the future. In contrast, evidence suggests that almost 70 percent of older adults will need them at some point. The authors say the findings underscore the need for programs encouraging people to plan appropriately for long-term care needs.

Switching between Medicare Advantage and traditional Medicare--how common? 
Gretchen A. Jacobson and Patricia Neuman at the Henry J. Kaiser Family Foundation and independent consultant Anthony Damico examined whether the 2006-11 growth in private Medicare Advantage plans was primarily a result of new beneficiaries choosing Medicare Advantage from the onset of their eligibility or because beneficiaries enrolled in traditional Medicare were making a switch. They found that most new Medicare Advantage enrollees each year were people who switched from traditional Medicare. In 2011, 78 percent of newly eligible beneficiaries enrolled in Medicare while less than one-quarter (22 percent) chose Medicare Advantage from the onset. That was up from 2006, when 15 percent of newly eligible beneficiaries enrolled directly in Medicare Advantage. Nonetheless, relatively few beneficiaries (less than 5 percent each year) changed their source of coverage, either traditional Medicare or Medicare Advantage, indicating that initial coverage choices have long-lasting effects.
Other papers of interest in the January issue include:  

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.