Publications

Long-Term Care Insurance: An Assessment of States' Capacity to Review and Regulate Rates

February 2002

For an AARP Public Policy Institute issue paper, Long-Term Care Insurance: An Assessment of States' Capacity to Review and Regulate Rates, The Lewin Group conducted a survey of state insurance departments' current practices relating to the regulation of long-term care insurance rates and assessed their ability to effectively regulate premiums for the long-term care insurance market. Several reports in the last decade question the adequacy of state regulatory efforts, citing insufficient regulatory efforts to protect consumers and chronic shortages of staff and resources. In addition, large increases in rates by some companies raise concerns about state efforts to ensure accurate pricing for long-term care insurance. Large rate increases, or a series of rate increases over time, could: (1) threaten consumers' ability to continue paying for coverage; and (2) erode confidence in the products being offered by the industry. The paper presents findings from the survey and ratings of states' current pricing review practices, as well as recommendations.

Client Area: Associations
Expertise Area: Aging and Disability

The Burden of Gastrointestinal Diseases

May 2001

This study, conducted by The Lewin Group for the American Gastroenterological Association, analyzed major national and local databases to assess prevalence and cost of 17 digestive conditions: gastroesophageal reflux disease (GERD), gallbladder disease, irritable bowel syndrome (IBS), peptic ulcers, chronic liver disease and cirrhosis, chronic hepatitis C**, chronic diarrhea, diverticular disease, diseases of pancreas, Barrett's esophagus, ulcerative colitis, colorectal cancer, Crohn's disease, pancreatic cancer, liver cancer, foodborne illness and non-foodborne gastroenteritis. An article based on the study was published in the May 2002 issue (Volume 122 No 5) of the journal Gastroenterology.

Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness

Costs of Obesity

December 2000

This study estimated the direct costs of obesity to healthcare and found that the cost of all treatments for obese adults (defined as having a body mass index greater than 30) would be $238 billion in 1999, which includes $102 billion for 15 diseases that the project team specifically identified as associated co-morbidities. The study also found that approximately 75% of the direct costs were attributed to five diseases: Type II Diabetes, Heart Disease, Stroke, Hypertension, and Arthritis. The American Obesity Association sponsored the study, and the results were presented at the first annual Obesity Conference that took place in Washington, DC on September 15th, 1999. The study presentation was revised September 13, 2000 to include slides on the cost of obesity in children

Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness

Analysis of the Costs and Impact of Universal Health Care Models for the State of Maryland

May 2000

The purpose of this analysis was to explore the expected costs and impacts of two alternative universal health reform plans for Maryland. Both of these reform scenarios would greatly redistribute health care costs across families in various income groups by shifting from today's premium based system to a tax based system where individual payments for health coverage increase in proportion to income. In this report, we present our analyses of the financial impact of these health reform models on various payers for health care including state, local, and federal governments.

Client Area: Associations
Expertise Area: Health Reform

Briefing Chartbook on the Effect of the Balanced Budget Act of 1997 and the Balanced Budget Refinement Act of 1999 on Medicare Payments to Skilled Nursing Facilities

May 2000

A new Lewin study shows that Medicare's funding of skilled nursing care has been significantly reduced by nearly twice as much as Congress intended. Currently, CBO budget figures show Medicare spending for SNF services from 1998 to 2002 will be $12.2 billion less than originally projected when the Balance Budget Act (BBA) was enacted in 1997; and $15.8 billion less when extended to 2004. Due to BBA payment reductions, the current low inflation rate, provider concerns about fraud and abuse, etc., Medicare SNF spending actually decreased from $13.6 billion in 1998 to $12.3 billion in 1999. These funding reductions have forced approximately 1600 SNFs that participate in Medicare into bankruptcy, and have markedly diminished the industry's ability to attract capital financing.

Client Area: Associations
Expertise Area: Medicare

The Impact of the Medicare Balanced Budget Refinement Act on Medicare Payments to Hospitals

February 2000

In May of 1999, The Lewin Group prepared a report for the American Hospital Association (AHA) showing the impact of the Balanced Budget Act of 1997 (BBA) Medicare provisions on America's hospitals and health systems. The BBA reduced payments for most hospital-based services, e.g. inpatient acute care, outpatient care, home health care, skilled nursing care, medical education, indigent care, and many other services.

Client Area: Associations
Expertise Area: Medicare

Health Insurance and Taxes: The Impact of Proposed Changes in Current Federal Policy

October 1999

In this report we analyzed several proposals to modify the current tax treatment of health benefits and expenditures. The current tax code will provide about $125.6 billion in tax subsidies for the purchase of health insurance and health services in 2000. While the current tax treatment of health benefits has encouraged employers to offer coverage, it has been criticized as inequitable and a major contributor to health care cost inflation. We examined various tax credit proposals and modifications to the current tax-exemption for health care and estimated the impacts of these proposals on health insurance coverage levels and costs to governments, employers and families.

Client Area: Associations
Expertise Area: Health Reform

The Impacts of an Increase in the Social Security Retirement Age and Medicare Eligibility Age on Social Security Disability Insurance, Medicare, and Employment

August 1999

AARP's Public Policy Institute published a Lewin Group report on the potential impacts of jointly raising the Normal Age of Retirement (NAR) and Medicare Eligibilty Age (MEA) from age 65 to 67. Under this proposed policy, a significant portion of peopled aged 65 to 66 would lose their Social Security benefits and Medicare coverage. Some portion of these individuals, however, could potentially retain both their Social Security benefits and Medicare eligiblity by meeting the qualifications for the Social Security Disability Insurance (DI) program. Using data from the Survey of Income and Program Participation and Medicare Current Beneficiary Survey, we estimate that 11.7 percent of the population aged 65 to 66 would have retained their benefits under DI if the NAR and MEA were increased in 1993 to age 67. We also estimated that 11.4 percent of the population aged 65 to 66 would have retained their Medicare coverage under this policy change.

Client Area: Associations
Expertise Area: Medicare

Implications of the Medicare Home Health Interim Payment System of the 1997 Balanced Budget Act

May 1999

The Medicare Home Health Interim Payment System (IPS) raises concerns for beneficiaries and providers. A temporary plan proposed until HCFA develops a home care PPS, the IPS may cause the number of home health agencies (HHAs) exceeding the Medicare cost limits to more than double and the published cost limits to decrease 21% on average overall. HHAs may operate without knowing the per-beneficiary limits for up to 6 months of the initial IPS cost reporting period. Strategies developed by HHAs to cope with this reduction may include increasing the proportion of low-end users with fewer visits and restraining costs per visit and number of visits per beneficiary. Some of these strategies could have considerable consequences for high-use home health clients.

Client Area: Associations
Expertise Area: Medicare

The Balanced Budget Act and Hospitals: The Dollars and Cents of Medicare Payment Cuts

May 1999

The Balanced Budget Act (BBA) of 1997 is projected to cut $71 billion in Medicare payments to hospitals, which may cause 7 out of 10 hospitals to have negative total Medicare margins by the year 2002. For all hospitals, total Medicare margins are projected to be around negative 4.4 percent, and margins for outpatient, hospital-based home health, and PPS-exempt services will all be negative under the BBA. The BBA reduced payments for most hospital services, including inpatient acute care, outpatient care, home health care, skilled-nursing care, medical education, and indigent care. The study included hospital specific analyses for inpatient PPS and PPS-exempt hospital services, hospital-based home health services, and outpatient hospital services. The findings report Medicare payments and margins for these services, as well as total Medicare payments and margins.

Client Area: Associations
Expertise Area: Medicare