• Reflex: September 26, 2011

    What did the parentheses mean? Jerry Geisel (Business Insurance) reports that the IRS has determined that employers would not be penalized for offering family health insurance coverage no matter how high the employee’s share of the premium.  “The [health reform] law says penalties apply for employers that do not offer coverage to their full-time employees, but puts parentheses around the succeeding words ‘and their dependents.’ […] ‘What the parentheses mean is the million-dollar question,’ said Gretchen Young, senior vp-health care policy with the ERISA Industry Committee in Washington.” Austin’s comment: At issue are whether affordable coverage will be available to dependents, what employers will offer, and what will be the implications for taxpayer costs. According to IRS proposed regulations, so long as an employer’s offer of single coverage is below 9.5% of an employee’s wages, dependents of that employee will not be eligible for exchange-based subsidies. (H/t Igor Volsky)

    Island open but ferries are full on NC Outer Banks, reports Bruce Siceloff. After Hurricane Irene, Dare County officials rushed to open Hatteras Island to tourists, but with the road washed out emergency ferries cannot keep up with demand, complicating matters for still another type of insurance: vacation renter’s insurance. Don’s comment: interesting story to add to the cost/benefit calculus needed to determine the correct mix of policies related to what role collective action should play in making the outer banks accessible. Of course the road/brides being rebuilt are taking tourists to beach homes that can only be insured via the federal government’s National Flood Insurance Program (5 part overview of the program with comparisons to health policy). The President’s proposal (p. 24) to the Super Committee suggests revisions to the NFIP that would end grandfathered premiums that are artificially low, increase premiums on dwellings with repeated losses and expand coverage levels. The Bipartisan Policy Center suggested revisions to NFIP(p. 115) as part of its deficit reduction proposal last December.

    U.S. ranks last among high-income nations on preventable deaths, reports The Commonwealth Fund. “The United States placed last among 16 high-income, industrialized nations when it comes to deaths that could potentially have been prevented by timely access to effective health care… other nations lowered their preventable death rates an average of 31 percent between 1997–98 and 2006–07, while the U.S. rate declined by only 20 percent, from 120 to 96 per 100,000. At the end of the decade, the preventable mortality rate in the U.S. was almost twice that in France, which had the lowest rate—55 per 100,000.” Aaron’s comment: This is no surprise to those of you who have read my 10-part series on quality in the US health care system. It’s a population statistic, and we do pretty badly on all of them.

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    • -It’s worth at least pondering whether or not the distribution of accidental deaths is entirely uniform in the US. If it’s not, it’s probably also worth asking how closely the local variations in the preventable accidental death rate tracks with things that doctors and hospitals can and can’t plausibly have a meaningful effect on. Ditto for insured vs uninsured status. I suspect that the stats are better for Utah than Alabama for reasons that can’t be completely explained by things that doctors, hospitals, and insurance coverage can do much about, but of course I could be wrong.

      -Looks like It wasn’t clear from the link if the statistics were normalized to account for risk (Age, yes. Risk, not clear). It’s not clear that the prevalence of the risk factors for each of the conditions considered is equal in every country. Unless you accurately account for prevalence it’s not clear how valid any conclusions about variations in clinical/health-systems efficacy based on this study or others that use the same methodology are.

      -Ireland’s 42% decline in preventable mortality in the interval under study presumably isn’t explicable in terms of a massive change in the mechanisms that they use to pay for health care. Ditto for pretty much every other country. If you rule out demographic factors – that leaves improved clinical efficacy as the primary driver of the improvements?

      Anyhow – interesting data. Thanks for posting it.