In a September report, Georgetown University’s Center on Health Insurance Reforms outlined a three-part approach to strengthen health insurance.
Healthcare costs have ranked as a top economic concern in the United States, according to a KFF poll. Georgetown’s report, backed by the Robert Wood Johnson Foundation, said health plans have addressed steeper provider prices through higher deductibles and tighter prior authorization policies. The researchers proposed federal policies to address growing costs and insurers’ responses, focusing on lowering healthcare costs, reducing complexity and preventing patients from getting entangled in “corporate abuses.”
Here are 11 numbers and data points driving the recommendations:
1. 96.5%. In 15 years, per-enrollee spending in private commercial health insurance has increased by this much.
2. $1,000 and $2,000. Researchers specifically pitched these annual deductible caps for single people and families, respectively.
3. $182 billion. That is how much the federal budget could save in a decade by sunsetting health savings account tax preferences, per the report.
4. $4,000 and $8,000. The researchers requested lowering maximum out-of-pocket limits to $4,000 for a single person and $8,000 for families. The limits are $10,600 for an individual and $21,200 for a family in 2026 and $12,000 for an individual and $24,000 for a family in 2027, according to HealthCare.gov.
5. 267%. As hospital consolidation becomes more common, systems have been charging commercial insurers an average of 267% of Medicare rates, the report said. The report also said limiting commercial hospital prices to 200% of Medicare rates could result in $10 billion in annual out-of-pocket savings, $88 billion in annual premium savings for employers and consumers, and a $216 billion reduction to the federal deficit over 10 years.
6. Three primary care visits. The report called on Congress to require all commercial health plans to cover certain types of visits pre-deductible and without cost-sharing, including up to three primary care, two urgent care, and three outpatient mental health or substance use visits annually.
7. $458 billion to $900 billion. Commercial site-neutral payment reform could lower overall national health spending by $458 billion to $900 billion in 10 years.
8. $4.4 billion. By removing the employer-sponsored insurance “firewall” for low-income workers, which restricts their ability to access premium tax credits, affected consumers could save $4.4 billion per year in out-of-pocket costs. While this would lower employer health spending by $8.1 billion, federal PTC outlays would grow by $17.8 billion annually.
9. 13 hours. Physicians spend this much time per week on prior authorization, on average.
10. $2 billion to $2.5 billion. The report said the No Surprises Act’s dispute resolution process has contributed $2 billion to $2.5 billion annually to health system costs. The researchers instead requested a non-inflationary benchmark, as well as extensions of NSA coverage.
11. 40%. More than 40% of American adults have medical debt, with three-quarters of those people possessing debt owed to acute-care hospitals. The report sought a new Fair Billing Certification program for hospitals.
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