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Key Points: Question: Do health care workers benefit from improved health sector finances? Findings: In this difference-in-differences study, only health care workers in higher-earning occupations (eg, registered nurses, physicians, and managers) experienced increases in annual income after state-level Medicaid expansion, which has been shown to improve health care organization finances. Health care workers in lower-earning occupations (eg, health aides, attendants, service staff) were more likely to report coverage under the Medicaid program after expansion and less likely to hold employer–sponsored health insurance. Meaning: Improved health care organization finances may increase inequality in the health care workforce, with implications for compounding structural inequalities within the industry and worker and patient health and well-being. Importance: The extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known. Objective: To assess the association between state adoption of the Affordable Care Act's Medicaid expansion—which led to substantial improvements in health care organization finances—and health care workers' annual incomes and benefits, and whether these associations varied across low- and high-wage occupations. Design, Setting, and Participants: Difference-in-differences analysis to assess differential changes in health care workers' economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys. Exposure: Time-varying state-level adoption of Medicaid expansion. Main Outcomes and Measures: Primary outcome was annual earned income; secondary outcomes included receipt of employer–sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits. Results: The sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P =.005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (β coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P <.001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer–sponsored health insurance and increases in SNAP following Medicaid expansion. Conclusion and Relevance: Medicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being. This study examines the difference in health care worker compensation between states that expanded and those that did not expand Medicaid after the passage of the Affordable Care Act. [ABSTRACT FROM AUTHOR]

This study uses National Health Interview Survey data from 2000 to 2020 to examine reported differences between US men and women aged 19 to 64 years with employer-sponsored insurance in obtaining affordable health care. [ABSTRACT FROM AUTHOR]

An editorial is presented discussing the effects of Medicaid expansion under the Affordable Care Act on health care workers' financial outcomes, particularly examining whether the increased revenue for provider organizations is passed on to workers. Topics include the methodological considerations of the study, the impact on low and high-income workers, and the broader implications for the allocation of public resources in the healthcare sector.

This Viewpoint discusses potential benefits and unintended consequences of out-of-pocket cost caps in Medicare and the employer-sponsored health insurance market and provides suggested policy opportunities to address shortcomings. [ABSTRACT FROM AUTHOR]

This study uses IBM MarketScan database data to describe trends in zolpidem and low-dose trazodone dispensing among adults with employer-sponsored insurance or Medicare supplemental plans between 2011 and 2018, before and after a 2017 clinical practice guideline discouraged trazodone use for insomnia. [ABSTRACT FROM AUTHOR]

Health Agencies Update The Biden-Harris administration finalized a rule to fix the "family glitch": a regulatory flaw in the Affordable Care Act (ACA) that rendered many family members of people with employer-sponsored health insurance ineligible for subsidized coverage. ACA regulations deemed employer-based health insurance affordable if coverage for employees themselves was reasonably priced; the affordability of family coverage wasn't considered. [Extracted from the article]

The article discusses an overview of the 40% excise tax to be implemented on January 1, 2018 addressing the tax exemption of employer-sponsored health coverage, its regressive effect on the employees, and the proposal for its modification to an employment-based exclusion cap.

This Viewpoint describes the problem of rising out-of-pocket costs for individuals with employer-sponsored insurance, the causes of this issue, and possible solutions. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the things to be done to truly improve access to health care and make health care coverage more affordable in the U.S. Also cited are the steps that Democratic presidential candidate Joe Biden should take if he wins like implementing automatic enrollment, eliminating the employer-sponsored health insurance, and reforming the tax breaks provided to employer-sponsored plans.

This study uses Health Care Cost Institute data to assess the share of total health care spending on primary care among individuals younger than 65 years covered by employer-sponsored insurance from 2013 to 2017. [ABSTRACT FROM AUTHOR]

Context: With drug spending rising rapidly for working-aged adults, many employers and health insurance providers have changed benefits packages to encourage use of fewer or less expensive drugs. It is unknown how these initiatives affect drug costs. Objective: To examine how innovations in benefits packages, such as those that include multitier formularies and mandatory generic substitution, affect total cost to insurance providers for generic and brand drugs and out-of-pocket payments to beneficiaries. Design and Participants: Retrospective study from 1997 to 1999 linking claims data of 420 786 primary beneficiaries aged 18 through 64 years who worked at large firms (n = 25) with health insurance benefits that included outpatient drugs. Main Outcome Measures: Overall drug costs; generic, single-source brand, and multisource brand costs; and drug expenditures by health insurance providers and out-of-pocket costs for beneficiaries. Results: For a 1-tier plan with a $5 co-payment for all drugs, the average annual spending was $725 per member. Doubling co-payments to $10 for all drugs reduced the annual average drug cost from $725 to $563 per member (22.3%, P<.001). Doubling co-payments in a 2-tier plan from $5 for generics and $10 for brand drugs to $10 for generics and $20 for brand drugs reduced costs from $678 to $455 (32.9%, P<.001). Adding an additional co-payment of $30 for nonpreferred brand drugs to a 2-tier plan ($10 generics; $20 brand) lowered overall drug spending by 4% (P<.001). Requiring mandatory generic substitution in a 2-tier plan reduced drug spending by 8% (P<.001). Doubling co-payments in a 2-tier plan increased the fraction beneficiaries' paid out-of-pocket from 17.6% to 25.6%. Conclusions: Adding an additional level of co-payment, increasing existing co-payments or coinsurance rates, and requiring mandatory generic substitution all reduced plan payments and overall drug spending among working-age enrollees with employer-provided drug... [ABSTRACT FROM AUTHOR]

Presents a proposal for expanding Medicare and employer-based health insurance plans to achieve a universal health insurance in the U.S. Responsibilities of employers for providing health insurance for their employees; Changes in the beneficiaries of the Medicare program; Details on the state Medicaid plans.

Discusses the problems of access and cost of health insurance in the U.S. Role of the Public Sponsor agency in health insurance reform; Benefits of managed care plans; Implementation of mandated employer-provided health insurance.

Reduction in the cost of health care claims among hypertensive employees was examined over a 4-year period after exposure to a 3-year blood pressure control program, to see whether work-site monitoring and counseling produced a subsequent benefit. Hypertensive employees at three experimental sites (N = 183 to 367 subjects) were compared with subjects at a control site (N = 169) who had received no postscreening follow-up or monitoring, and with matched normotensive employees. The cost of subsequent health care claims for hypertensive employees at the experimental sites was lower than claims for those at the control site, but there was no significant difference across the sites in claims for normotensive employees. After adjusting to a standard 1982 dollar, the data showed from $1.89 to $2.72 in reduced health care claims per dollar spent operating the hypertension control program. [ABSTRACT FROM AUTHOR]

Today, steadily increasing numbers of hospitals and health plans are publicly releasing performance reports on the quality of care to permit comparisons across different providers. Our experience in recent years has provided important new evidence of what public quality reporting can accomplish and the difficulties it faces. Several years ago, the most important impediments to quality reporting may have been the availability of acceptable quality indicators and the feasibility of voluntary, standardized data collection by health plans. We have made strides in these areas. The Health Employer Data and Information Set (HEDIS) has expanded, and there have been new innovations in collecting data on quality from both patients and physicians. Hundreds of health plans have begun to report standardized quality data on a routine basis either voluntarily or in response to requirements from the Health Care Financing Administration, state Medicaid agencies, or private payers. Now, the more formidable barriers to the use of quality report cards may relate to the ways we report the data and use it. We need to find acceptable middle ground for those who believe information on individual physicians is critical and those who believe it is harmful. We need to reap the advantages in different modalities of data collection and different tools for quality management. Most of all, we need to find better ways to use quality reporting to empower purchasers and consumers and improve quality of care. [ABSTRACT FROM AUTHOR]

This article presents the authors' views on health care in the U.S. and who should share in the responsibility of paying for it. They argue that there is no such thing as shared responsibility because individuals pay for health care, not employers or the government. They discuss workplace health insurance and benefits, along with economic theory. The article concludes by stating that sustainable health care reform is impossible until individuals understand that they pay for their health care.

This Viewpoint argues for reform of the US health care system, starting with the elimination of employment-based insurance. [ABSTRACT FROM AUTHOR]

Editorial. Discusses strategies for health care and health insurance reform to improve medical care access among uninsured people in the U.S. Results of a public opinion poll regarding health care access in the country; Implementation of a compulsory private insurance provided by employers; Use of tax credits for purchase of private health insurance.

An editorial is presented which addresses what the authors refer to as the challenges that are associated with the process of measuring the affordability of health care in the U.S. as of 2017, and it mentions another article in the same issue of the journal which deals with a proposed Affordability Index and household expenditures for medical care in America. Employer-sponsored insurance plans and government subsidies for health insurance and health insurance premiums are assessed.

An editorial is presented which addresses the affordability and sustainability of American health care spending and policy as of 2017, and it mentions U.S. gross domestic product (GDP) and funding for the nation's Medicare health insurance program. An article in the journal which examines a proposed Affordability Index is mentioned, along with annual surveys of employer-sponsored insurance (ESI) and information about the Milliman Medical Index (MMI) data bank.

The article offers the author's insights on precondition for payment in managed behavioral health care organizations(MBHOs). Topics discussed include the contracting of technology company International Business Machines Corp. (IBM) with an MHBO for its mental health benefits, the obligation and responsibility of MHBO of discharge of patients, and psychiatric costs.

A response to a letter to the editor on the U.S. Marriage Equality Act and changes to health insurance coverage is presented.

The article focuses on the aspects of the implication of the minimum wage policies and the support and opposition against Affordable Care Act of the U.S. presidential candidates. Topics discussed include the expansion of the coverage of the health insurance, the impact of between the wages and the employer-sponsored coverage, and the impact of socioeconomic status on health benefits.

The article looks at the U.S. Patient Protection and Affordable Care Act (ACA) and health care reform in the U.S. The author offers recommendations for modifications to the law which he says would render the U.S. health care system more rational and consistent. Topics include the tax exemption for employer-provided health insurance, the health insurance exchanges and subsidies for purchasing health insurance in them created under the ACA, and proposed changes to Medicare and Medicaid.

The article reports on the efforts of the health care industry to improve the health status of its employees. Topics discussed include the advantages that health care has over other industries in terms of improving its employees' health and lowering their medical costs, the factors that influence the success or failure of employee health programs in the health care industry and the steps for establishing an effective employee-centered health management program.

The article discusses a section in the Affordable Care Act (ACA) about shared responsibility for employers which will take effect on January 1, 2015. Topics discussed include the employer mandate's requirement for large employers to offer affordable minimum-value health insurance to employees and their dependents and the provision's aim to offset the public cost of subsidies to employees who are in need of health insurance.

The article comments on the Omnibus Final Rule released by the U.S. Department of Health and Human Services in January 2013. The rule modified the privacy and security standards under the Health Insurance Portability and Accountability Act (HIPAA). The rule is expected to pose administrative and technical challenges for covered entities and for business associates. The rule's creation of a chain of health insurance accountability is also discussed.

In this article, the authors reflect on role of business enterprises in providing health care reforms to their employers in the U.S. The authors state that business enterprises plays significant role in the success or failure of major initiatives to reform health care in the U.S. They discuss the measurements offered by the U.S. Affordable Care Act to strengthen the employers. They suggest employers to reprise their role in health care reform efforts in a way that will help advance their shared goal of better health with physicians. care reform in the U.S.

A correction to the article "Eligibility and Coverage Trends in Employer-Sponsored Insurance," which appeared in the May 3, 2016 issue, is presented.

A letter to the editor on the U.S. Marriage Equality Act and changes to health insurance coverage is presented.

The authors comment on a proposed excise tax on high-cost employer-sponsored health insurance under a health care reform plan being considered in the U.S. Senate Finance Committee. They explain why the proposed new tax represents an important development in health care financing in the country. They offer an overview of the proposed tax-free treatment of employer-sponsored insurance. The authors also suggest that policymakers will face formidable political and policy challenges in changing the rules.

The article reports that U.S. health care professionals and citizens met in response to a request by the organization the Obama-Biden Transition Project to address issues related to health care reform. The project was formed to solicit community input for U.S. President Barack Obama's agenda. Attendees of community meetings were asked to respond to questions including choosing physicians and hospitals, difficulties in paying medical bills, and employer-based coverage. They were also asked to complete a survey which asked them for input about the best ways for policy makers to develop plans to address problems. An analysis of the responses is presented.

Warns that increased out-of-pocket expenditures for pharmaceuticals will lead to an increase in prescriptions not being filled, prompting higher overall health care costs. Indication of rising cost of pharmaceuticals; Statistics which indicate reduced cost to insurance provider with higher out-of-pocket costs imposed on the insured.

The article discusses how U.S. President George W. Bush discussed health insurance reform during his 2007 State of the Union address. Bush proposed changes to the tax code that would give breaks to people who acquired lower-cost health insurance plans on their own or though their employers. Bush proposed expanding health savings accountants and reducing costs and medical errors with better medical information technology. The health care proposals were rejected by the Democratic-controlled Congress.

This article discusses a bill being considered by the U.S. government that would allow small companies to offer affordable heath insurance to their employees through the formation of association health plans. These associations would allow trade associations and small businesses to offer group health coverage to their employees by banding together. These benefits are being considered on a nationwide basis and are a response to rapidly increasing health insurance costs. U.S. Senator Mike Enzi, the chairman of the Senate Health, Education, Labor and Pensions Committee, is promoting this bill to relieve financial burdens from small businesses and families without health insurance.

Reports that the United States Department of Defense is expanding its Tricare health plan to include retirees over 65 years. The previous policy, which dropped retirees once they qualified for Medicare; Tricare's efforts to remedy the situation; Details of benefits, including prescription drug coverage; Increased benefits for active-duty personnel and families.

Editorial. Presents proposals on how to achieve a universal form of health care coverage in the United States. Increase in the provision of employer-provided health insurance to all working individuals; Extension of health care insurance to uninsured.