In The News > How Healthcare Has Evolved Over the Past Decade

How Healthcare Has Evolved Over the Past Decade

From Obamacare to the opioid epidemic, healthcare-related issues have made headlines over the past decade. And it’s inevitable that they’ll only continue to evolve and impact the decade ahead.

With the 2020s underway, let’s take a look back at five key milestones and issues that marked the evolution of healthcare over the past decade.

1. The Affordable Care Act became the law.

Just months into 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. The Affordable Care Act, often referred to the ACA or Obamacare, changed the nation’s health insurance landscape as we knew it.

The healthcare reform law brought about numerous changes to help make health insurance more affordable and accessible to as many Americans as possible. Some key provisions include:

  • The creation of a health insurance marketplace in every state to provide consumers with a place to purchase health insurance.
  • Income-based subsidies, including premium tax credits and cost-sharing reductions, for those who purchase individual coverage through the health insurance marketplace (i.e., the state-based and federal exchanges).
  • A requirement that insurance plans cover young adults on their parents’ policies to age 26.
  • Guaranteed issue and renewal of policies.
  • Premium rating rules that limited pricing to five things: location, age, tobacco use, individual or family enrollment, and plan category (i.e., bronze, silver, gold, platinum, catastrophic).
  • An individual mandate requiring most Americans to have health insurance that qualified as minimum essential coverage or pay a tax penalty, unless they qualified for an exemption. (As of Jan. 1, 2019, the tax penalty has been rescinded).
  • Medicaid expansion to those with incomes below 138% of the federal poverty level, in participating states.

Ten years later, uninsured rates have declined. In 2010, nearly 16% of Americans were uninsured. But in 2016, the uninsured rate hovered just above 8% -- its lowest point in the decade. It started to increase again slightly in 2017.

But premiums increased 105% from 2013 to 2017 while the market adjusted to enrollment numbers and the resulting risk pool. Premiums have begun to stabilize over the past two years.

2. Short-term health insurance kept its stride.

Short-term health insurance is temporary insurance that provides coverage in certain medical situations like an unexpected accident or illness. However, it doesn't include the same essential health benefits that ACA plans do, making them a more affordable insurance option for many.

Short-term health insurance remained a relevant health insurance option throughout the decade, despite renewed scrutiny. Short-term medical plan sales increased sharply after the ACA took full effect in 2014. And these plans became an attractive option for people who were exempt from the individual mandate or opted to pay a penalty for not having an ACA-compliant health plan.

Obama limits short-term policies

Concerned that short-term health insurance was impacting ACA enrollment, the Obama administration created regulations that limited their availability. In 2016, short-term policies were capped at three months.

Trump expands short-term policies

In 2018, the Trump administration lifted Obama-era limits. Policies can now last up to 12 months and can be renewed for up to 36 months, depending on state laws. Arizona, for example, has adopted the Trump administration’s regulation. Some states, such as Oregon, still limit short-term plans to less than 90 days.

3. High-deductible health plans grew in popularity.

High-deductible health plans were introduced in the early 2000s, but they were considered "mainstream plans" by 2012. In fact, HDHP enrollment jumped from 10 million people to 11.4 million people in one year (from January 2010 to January 2011).

People can obtain HDHP plans through their employer/group based plan (if offered), the healthcare exchange, or private insurers.

By 2015, HDHPs accounted for 60% to 80% of plans offered in the individual health insurance marketplace. In 2019, the IRS high-deductible health plan as any plan with a deductible of at least $1,350 for an individual and $2,700 for a family. The average annual deductible for individual coverage through a group plan was $1,655 in 2019.

But while consumers can appreciate the lower monthly premium of a high-deductible insurance plan, they also tend to delay or skip medical care because of the high out-of-pocket costs associated with HDHPs.

The popularity of HDHP may be slowing - at least in the group market. The percentage of employers offering a high-deductible health plan as the only option is projected to decrease in 2020, with more and more employers beginning to offer additional coverage options once again.

4. Healthcare spending continues to climb.

If it seems like your healthcare costs increased throughout the past decade, it probably did.

In 2018, the average American household spent $5,000 on healthcare, with nearly 70% of the $5,000 going towards health insurance.

The more staggering fact? Medical bills are reported to be the number one cause of bankruptcies nationwide. And today, medical costs are considered America’s "real healthcare crisis". And while politicians continue to debate issues including health insurance reform and prescription drug pricing, they have not agreed upon a clear solution.

Until things change, consumers must continue to find ways to save on their own, from finding flexible and affordable health insurance options and taking advantage of preventive care, to comparing provider rates before seeking services and seeking alternative healthcare through things like telemedicine.

5. An Opioid epidemic devastates our nation.

The opioid epidemic might be the most daunting and complex public health crisis of our time.

Heroin-related overdoses increased 286% from 2002 to 2013, with a significant spike around 2010. Another wave of opioid-related deaths hit around 2013 - this time, synthetic opioids like fentanyl were behind the surge. The crisis continued to escalate from there, with prescription drugs playing a significant role.

Opioid overdoses accounted for more than 42,000 deaths and increased to 47,600 people in 2017.

By 2019, more than 90 Americans per day were dying from opioid overdose. And prescription opioid abuse was costing the nation $78.5 billion per year.

The epidemic impacted people in both rural and urban environments. But overdose deaths in rural communities surpass deaths in urban settings.

So what’s being done about it? In early 2019, the Trump administration launched a $353 million initiative to cut opioid overdoses by 40% over the next three years.

The federal government is also working to hold drug companies accountable. For example, top executives at Insys Therapeutics were found guilty of racketeering conspiracy— a charge typically assigned to drug dealers and mob bosses.

In 2018, the CDC reported that drug overdose deaths decreased for the first time since 1990.

The healthcare debate continues

Discussions about healthcare reform and our healthcare landscape did not stop when the ACA was passed. Conversations about legal challenges continue to this day.

And, there has been proposed legislation to repeal and replace the ACA under the Trump administration. While no legislation has passed so far, new tax legislation did pass in December 2017, changing one key aspect of the ACA. Previously, you could be penalized for not having health insurance, but the Congress and President eliminated the mandate rule for all coverage beginning Jan. 1, 2019.

The 5th Circuit also recently ruled in Texas vs. United States that the individual mandate is unconstitutional. A Texas Judge will be deciding what, if any, of the ACA still stands. And it’s unclear if the case will head to the Supreme Court.

With 2020 being an election year, the future of healthcare in America stands at a crossroads:

  • Democrats remain divided on the best course of action moving forward. Their focus is on the expansion of health insurance coverage with tactics like Medicare for all, building on the ACA’s foundation, and rethinking the entire system.
  • Republicans do not have a healthcare plan in place. Should Trump be reelected, his administration would likely continue its efforts to dismantle the ACA and pass new legislation in its place.

What happens in November 2020 will no doubt influence how healthcare plays out over the next decade. We’ll continue to follow the trends and changes as well as their impacts on our nation.

What you should read next

Our latest national consumer survey reaching 1,000 registered voters measured feelings about the U.S. healthcare system, the U.S. economy during the coronavirus pandemic, the 2020 Presidential election and telemedicine. The survey comes at a crucial decision-making time of the year when the U.S. Presidential election, health insurance open enrollment period, and the Medicare Annual Enrollment Period are fast approaching for many Americans. The United States Healthcare System When rating the U.S. healthcare system: 36% said fair. 27% said good. 24% said poor. 11% said excellent. 2% were unsure. When asked if our healthcare system has changed for the better or worse due to COVID-19: 45% felt it was unchanged. 33% felt it was worse. 14% said it was better. 8% were unsure. Also of note, 69% said giving more control to patients and doctors is the key to improving the United States healthcare system. Meanwhile, 11% chose giving more control to government officials and bureaucrats. And 20% were not sure how to improve it. Participants were also asked about the quality of U.S. healthcare services since the Affordable Care Act (ACA or “Obamacare”) was enacted: 31% said the quality of healthcare has gone down, while 29% said it’s gone up. Lastly, 84% of our respondents said the cost of all health care services, procedures, and medications should be made available in advance to patients. The 2020 Presidential Election Our survey also honed in on what’s most important to people in the 2020 U.S. Presidential election: healthcare reform, the economy, civil rights, law and order, government corruption, and our response to COVID-19. Here’s how our participants responded: 95% said the U.S. economy is an important issue. 91% said government corruption is an important issue. 88% said our nation’s response to COVID-19 is an important issue. 88% said healthcare reform is an important issue. 86% said civil rights is an important issue. 85% said law and order is an important issue. Health Insurance in the United States Our survey also gauged feelings on an array of health insurance and employment topics, including consumer feelings about health insurance, a proposal to ban private insurance, and COVID-19 impacts on health insurance. When it comes to our respondents’ feelings on their health insurance: 38% rated their health insurance as good. 26% rated their health insurance as excellent. 23% rated their health insurance as fair. 10% rated their health insurance as poor. And when asked what type of health insurance has the best medical care coverage: 40% said employer-sponsored coverage. 21% said Medicare. 19% were unsure. 12% said Medicaid. 9% said Obamacare. Of note, 25% of our respondents have lost or know someone who lost their health insurance during COVID-19. For those who are employed, 38% are reluctant to switch jobs right now because they want to keep their current health insurance. Last but not least, the survey gauged a possible proposal to ban all private health insurance companies and require every American to get their coverage through the federal government. When asked about this concept, 15% of respondents strongly favored the proposal, while 35% were strongly opposed. As for the rest of the group, 19% were somewhat in favor and 18% were somewhat opposed to the proposal. Employment and Working From Home Our national survey also covered what’s important when considering or accepting a new job. In the “very important” category: 78% said salary. 66% said health insurance. 49% said time off. 33% said working from home. Although working from home has the lowest percentage on the “very important” scale, it turned out to be top-of-mind for some respondents. 49% felt that working remotely is better for overall health and well-being, and 40% would take a pay cut to work from home. Pulse Check on COVID-19 Testing Over the course of our survey series, we’ve gathered opinions about Coronavirus testing. Here are the latest findings: 60% were not worried about the cost of Coronavirus treatment - a decrease from the percentage we’ve seen over the past few months. 52% thought frequent COVID-19 testing is the best way to control the spread. 52% thought every child should be tested for COVID-19 on a weekly basis. The Latest on Telemedicine Telemedicine use during the coronavirus pandemic is another topic we’ve kept an eye on. In our latest survey, 79% had not used telemedicine prior to the pandemic, but 43% have used telemedicine during the pandemic. While highlighting several advantages of telemedicine versus visiting a doctor in person, we asked our respondents which telemedicine perk is most appealing to them. 55% said avoiding the waiting room. 47% said convenient scheduling. 47% said the wait times were better. 38% said getting care from home. Full Current Events in the United States Survey Results Click here to download the full results. Our Survey Methodology The above survey results were gathered through a national survey of 1,000 registered voters, which was conducted September 4 - 8, 2020. The survey has margin of sampling error of +/- 3.1 percentage points. See More Surveys August 2020: Multigenerational Perspectives on COVID-19 July 2020: Medicare Eligible Seniors Survey Findings: Technology, COVID-19, the 2020 Election and More June 2020: Healthcare Technology, Self-Care and More May 2020: Testing, Mental Health, and More April 2020: Economic Impacts and Health Insurance Trends March 2020: Telemedicine Usage During COVID-19
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Telemedicine usage, financial insecurity, healthcare technology, and a digital detox: These are just some of the topics we covered in our most recent COVID-19 survey. But this time, we heard from a multigenerational mix of millennials, Generation X, and Baby Boomers. And the results were pretty eye-opening. Multigenerational Survey Highlights Telemedicine Usage and COVID-19: Now vs. Then Across the three generations, 60% are more comfortable with using telemedicine now than they were six months ago overall. Gen X stood out as the age group that was the most comfortable with using telemedicine. 54% of our multigenerational respondents plan to use telemedicine with the coronavirus pandemic is over. Once again, GenXers were most receptive to this virtual healthcare alternative. 52% have had their doctors encourage a telemedicine appointment versus an in-office visit. COVID-19 and the Digital World Across the three generations, 71% of our respondents have found themselves on the computer or phone more frequently during the pandemic. So it’s no surprise that 39% feel they need a “digital detox” now more than ever. Millennials, especially, felt the need to take a break from scrolling Instagram feeds or sending memes to friends: 51% would take the digital detox. And how about the use of streaming devices, social media platforms, wearables, and online retailers during COVID-19? Here are the popular picks across the three generations: Binge Watching: 27% are watching their favorite shows from their Smart TVs. Social Media: 61% are using Facebook the most. And it’s especially a fan favorite for 75% of our Baby Boomer respondents. Wearable Technology: 47% use wearables to monitor their health. 25% of them are using the Apple Watch to track their fitness activity. Online Shopping: 72% are shopping online more frequently than they did before the pandemic. (Our guess is Amazon, Instacart, and maybe a little UberEats). Coronavirus Vaccine, Masks and More Across the three generations, 87% are comfortable having their temperatures checked before entering an establishment. 69% will get a COVID-19 vaccine once it becomes available. 41% feel that masks are the most effective way to prevent the spread of coronavirus. The State of Healthcare, Economy and Finances During COVID-19 Across the three generations, 82% feel the U.S. healthcare system is broken, and 35% feel it will take 2 years for our economy to recover from COVID-19. 77% have made efforts to support small businesses during COVID-19, while 53% feel that small businesses will recover after the pandemic. 51% have experienced financial insecurity due to COVID-19, which could be why 43% have put off medical care due to cost concerns. Full Multigenerational Survey Results Click here to download the complete multigenerational survey results broken down by generation. Multigenerational Survey Methodology The above multigenerational survey results were gathered through an online poll of 1,595 Americans aged 24-74. The poll was conducted August 6-7, 2020, gleaning representative samples from each state based on population. Samples were weighted for even sample results for Millennials (ages 24-39), Gen X (ages 40-55) and Baby Boomers (ages 56-74). Percentages have been rounded to the nearest full percentage point. Explore More Survey Findings July 2020: Medicare Eligible Seniors Survey Findings: Technology, COVID-19, the 2020 Election and More June 2020: Healthcare Technology, Self-Care and More May 2020: Testing, Mental Health, and More April 2020: Economic Impacts and Health Insurance Trends March 2020: Telemedicine Usage During COVID-19
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Our previous surveys have paid close attention to how COVID-19 is impacting our economy, mental health, telemedicine usage, self-care and more. But our most recent survey focuses on an important group: Seniors. In our Medicare Eligible Seniors survey, more than 1,000 Americans ages 64 and up weighed in on life during the Coronavirus pandemic, their use of technology, their Medicare plans, their feelings toward the 2020 election, and more. Medicare Eligible Seniors Survey Results One important takeaway from this survey is that seniors are embracing technology in new ways during the coronavirus pandemic. More than half of the respondents agreed that they have been using technology more during the pandemic. Seniors are using technology for the following: Healthcare: they are receiving virtual care through telemedicine, ordering prescriptions online and monitoring their health through wearables. Information: they are using social media to stay informed on relevant news. Communication: they are staying in touch with family and friends via texting, phone calls, video chat, and social media. Entertainment: they are binge watching their favorite shows on smart TVs and streaming devices. Technology Use Among Seniors in 2020 89% have a smartphone 83% use Facebook the most 75% have a smart TV or streaming device 73% use social media 68% have an iPad or other type of tablet 66% still have cable TV 61% feel they have embraced technology more during the COVID-19 pandemic 54% video chat with their kids and grandkids 50% have video chatted more since the start of COVID-19 47% binge watch shows 43% would wear a device that helped maintain appropriate social distance during the COVID-19 pandemic and alert others if they are too close 42% prefer talking on a cell phone as their method of communication 32% video chat with their friends 30% use social media to staying in touch with friends 29% prefer texting as their method of communication 28% monitor their health using a wearable (Apple Watch, Fitbit, etc.) 22% use social media to stay in touch with family 21% use social media for news 11% started using a smartphone or tablet during the pandemic Life During COVID-19 64% have only left the house to go food shopping or to the pharmacy during COVID-19 62% have you seen their kids or grandkids in person since mid-March 54% have put off a dentist appointment because of COVID-19 27% have left their house whenever they wanted during COVID-19 2020 Medicare Usage and Preferences 97% say their doctor accepts Medicare 84% are not looking to switch doctors because they don’t accept medicare 69% with a Medicare Advantage plan are happy with it 51% think the age to be eligible for Medicare should be lowered to 60 39% look for a Medicare a plan that accepts their doctor 37% think seniors who have a Medicare Advantage plan and who contract COVID-19 are getting better care 26% look for a Medicare plan with low monthly premiums and copays 26% intend to switch from an Original Medicare to a Medicare Advantage plan in the next enrollment period 22% look for a medicare plan that has extra benefits (ie. dental, vision, hearing, fitness programs) 22% intend to change their prescription drug plan in the next enrollment period 20% plan to adjust their Medicare plan during the next annual enrollment period (Oct. 15 - Dec. 7) 12% used the special enrollment period to enroll in Medicare during COVID-19 Prescription Drugs 89% think prescription drug prices are too high 36% spend more than $50 a month on prescription drugs 34% order prescriptions from an online pharmacy Medical Costs 66% are worried about out-of-pocket costs 62% are you worried about receiving an unexpected medical bill 50% have money set aside for their children or family to use for their health needs 36% have put off seeing a doctor because of cost 35% are worried about contracting COVD-19 because they may be hit with a surprise bill Telemedicine Usage 68% of those who haven’t used telemedicine during COVID-19 say its because they haven’t needed to 58% have used telemedicine just once during COVID-19 44% have used telemedicine during COVID-19 43% intend on using telemedicine once COVID-19 passes 30% have used telemedicine once a month during COVID-19 10% used telemedicine before COVID-19 The 2020 Presidential Election 92% say lowering drug prices is an important topic in the upcoming election 84% haven’t seen the country more divided in their lifetime than it is now 68% say the economy and healthcare are the two most important issues to them in the 2020 election 58% will vote via mail-in ballot in November 42% will vote in person in November Methodology The above results were gathered through an online poll of more than 1,000 Medicare eligible Americans ages 64+. The poll was conducted from July 20, 2020 to July 21, 2020, gleaning representative samples from each state based on population. Explore More Survey Findings June 2020: Healthcare Technology, Self-Care and More May 2020: Testing, Mental Health, and More April 2020: Economic Impacts and Health Insurance Trends March 2020: Telemedicine Usage During COVID-19
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