According to some encouraging news on May 24, 2023 from the Congressional Budget Office (CBO), enrollment in both Medicaid and marketplace plans have reached historic highs in 2023, mostly because of temporary policies (developed during the pandemic) that kept beneficiaries enrolled in Medicaid and that enhanced the subsidies for health insurance purchased through marketplaces. The share of the population under age 65 that is uninsured is at an unprecedented low of 8.3%. Medicaid enrollment grew from 60.5 million in 2019 to 76.6 million in 2022. In 2023, Medicaid covers 28.1% of the under-65 population and subsidized marketplace plans cover 5.2%. Employment-based insurance covers more than half (57.3%) of that population. Low-income individuals have seen the largest gains in coverage and the largest declines in the share who lack insurance.
Offsetting the positive news is that during the next year and a half, CBO expects substantial declines in enrollment in Medicaid as the continuous eligibility provisions implemented during the pandemic unwind. CBO projects that 6.2 million of the beneficiaries leaving Medicaid will become uninsured. Also, if the enhanced subsidies expire after 2025, as scheduled, 4.9 million fewer individuals are estimated to enroll in marketplace coverage, instead enrolling in unsubsidized nongroup or employment-based coverage or becoming uninsured. By 2033, the share of the population who is uninsured is projected to be 10.1%.
Non-Compete Agreements, Job Mobility, And Wages
Noncompete agreements (NCAs) can restrict workers from seeking employment with a competitor or from starting a competing business. While helping companies protect confidential information, they also have the potential to lead to less job mobility and lower wages for workers. Employers historically have used these agreements for highly skilled workers and executives with access to trade secrets or other proprietary information. As discussed in a report made available on May 11, 2023 from the Government Accountability Office (GAO), a congressional watchdog agency, employers who were surveyed had all types of workers sign them, from executives to hourly employees, even though many lower wage workers may not have access to confidential information. Meanwhile, identical bills introduced in the Senate (S. 220) and the House (H.R. 731), the Workforce Mobility Act of 2023, would prohibit the use of such agreements except under certain circumstances.
Two occupation-specific studies that examined health care workers found that substantial proportions of certain personnel are subject to NCAs. Primary care physicians in group practices are an example of individuals who had an NCA. Many workers do not have access to employers’ more sensitive information, which often makes this reason for having NCAs irrelevant. Lower-wage workers are unlikely to have access to trade secrets and some health care workers subject to NCAs, such as nurses and nursing assistants, would not have access to proprietary information that would give another hospital a competitive advantage. Also, 78% percent of responding employers with NCAs in the health care and social assistance industry (25 of 32) reported having NCAs to prevent recruitment of their staff, investors, or other resources, compared to smaller proportions of the other most common industries among the responding employers, e.g., 54% of manufacturers (26 of 48).
Sharing Health Information
Epic, a health care software company based in Verona, Wisconsin, favors the goal of exchanging data across the entire health ecosystem. Now that some hospital systems are making a commitment to join the nationwide framework known as the Trusted Exchange Framework and Common Agreement (TEFCA) to share patient health data electronically, Epic announced in late May 2023 its first group of hospitals to take the step. More than 30 hospital systems have indicated they will join, including Kaiser Permanente, Johns Hopkins Medicine, and the Mayo Clinic. TEFCA is a public-private partnership that sets expectations and guidelines for sharing health information. More than half of hospitals are aware of TEFCA and plan to participate. Better sharing of patient records has the prospect of improving health care and avoiding clinical errors. Another item in this June 2023 issue of the newsletter TRENDS is about structural ableism. Electronic health records play an important role in the lives of individuals with a disability. One reason is that it becomes possible to identify patients who require necessary accommodations. Secondly, the electronic health record makes it possible to track the quality of care being provided.