The results are astonishing. Due entirely to the avoidance of excess regulation in their states of residence, 12 million more people would become covered, cutting the rate of non-insurance by one-fourth. This is without any federal expenditures – no tax credits, no subsidies, no change in tax law.

An important new study on interstate purchase of health insurance was released at a briefing of the American Enterprise Institute. It looks at the potential reduction of the uninsured by moving to a national market as envisioned by the legislation introduced by Rep. John Shadegg (R-AZ) and Sen. Jim DeMint (R-SC) allowing the interstate purchase of health insurance.

Produced by Steve Parente, Roger Feldman, Jean Abraham, and Yi Xu, all of the University of Minnesota, the study simulates three scenarios (a) a national market in which each consumer can choose insurance from the least regulated state in the country, (b) a regional market where people are confined to choosing coverage from the least regulated state in their region, and (c) a large-state scenario in which only the five largest states are allowed to offer cross-border coverage. The study provides minimum, midpoint, and maximum estimates of the changes in enrollment under each scenario. It finds the national market model would have the greatest impact.

The state-by-state impact is even stronger, especially for the most highly regulated states. New Jersey would increase its insured population 49%, Oregon 25%, Massachusetts 23%, New York 22%, and West Virginia 21%.

Obviously, this is an extremely complex simulation. The authors needed to calculate the cost of several areas of regulation including mandated benefits, guaranteed issue, community rating, and any willing provider laws, on a state-by-state basis and apply those costs to several different types of coverage. But there is no team of economists in the country better equipped to tackle the challenge, and these results should be taken very seriously, indeed.

The latest study blasting consumer driven health care is making the media rounds. It is remarkable how every teensy study that is critical of these approaches gets massive media attention, while all of the positive results are ignored.

In fact, CDHP has been subjected to a level of scrutiny that is unprecedented for any benefits innovation I can remember. Wellness programs provide an interesting contrast. Like CDHPs, they are being rapidly adopted in employer benefit programs. But I have yet to see any suggestion that they may appeal more to the "healthy and wealthy," or that people with chronic conditions may not benefit much, or that poor people are less likely to participate. Indeed, about the only question asked of wellness programs is whether employers get a return on their investment in the program.

So, what does this latest study say? [read here]

HSA Bank has released the results of a survey it conducted of 733 respondents drawn from its "employer relationships" and their employees, with and without HSA programs. The survey found that, "high deductible health plan respondents are more likely to be engaged consumers who ask about costs prior to making an appointment, seek information about generic prescription alternatives and select lower cost treatment alternatives," according to a press release from the company.

It also found –

When rating their overall health, no statistically significant difference exists between the respondents with a high deductible health plan and those in a traditional health plan.

Respondents with a high deductible health plan were no more or less likely to decide against or delay treatment due to cost when a treatment was recommended in the past 12 months.

Nearly 73 percent of the respondents with a high deductible health plan chose that plan over a traditional health plan option.

A new paper [gated, but with summary] by Sharon Long about the Massachusetts experience was published in Health Affairs. It is quite a nice look at how things changed from the fall of 2006 and the fall of 2007. The state did indeed reduce the numbers of uninsured and secured better access to health care services for it residents. Curiously, though, the improvement in access to services was not as dramatic as the reduction in uninsured. Continue reading Report on Mass Health Care →

The Employee Benefits Research Institute and Commonwealth Fund have come out with their third annual survey of "Consumerism in Health." This edition is an improvement over earlier versions, though the commentary is every bit as negative as before. Under the headline, "Enrollment remains low," they say that consumer driven health plans (CDHPs) now cover 2% of the population. Yet, they also say that last year's survey found only 1% of the population being covered by CDHPs. This is a pretty amazing finding that should probably be headlined, "Enrollment in CDHPs Doubles in One Year!"