More than 70 percent of people who currently have insurance through the health law’s federal online marketplace could pay less for comparable coverage if they are willing to switch plans, officials said Thursday.

With a Dec. 15 deadline looming for coverage that would begin Jan. 1, current policy holders should come back to healthcare.gov to see if they can get a better deal, the officials said.  They’ll find more plans available and nearly 8 in 10 current enrollees can find coverage for $100 or less a month, with subsidies covering the rest of the cost.

A Department of Health and Human Services analysis of 2015 individual market premium data for 35 of the states participating in the federal marketplace, or exchange, found that premiums for the lowest-cost silver plans will increase on average by 5 percent, while prices will increase on average by 2 percent for the second-lowest-cost silver plans, which is called the benchmark plan because subsidy levels are pegged to its cost. “The plans offering the lowest prices have sometimes changed from 2014 to 2015, so consumers should shop around to find the plan that best meets their needs and budget,” the report advises.

If they stay in their current plan, consumers may discover that their subsidy may not go as far if the price of the benchmark plan declined for 2015.  “We strongly, strongly encourage people to come back to the website and shop,” marketplace CEO Kevin Counihan told reporters during a press call.  Federal marketplace enrollees who do not switch plans by Dec. 15 will be automatically re-enrolled in their current coverage.

The number of companies offering policies for next year has increased by 25 percent.  Consumers can choose from an average of 40 plans for 2015, up from 30 in 2014, based on the HHS analysis, which examined plan rates at the county level.

Consumers have until Feb. 15 to enroll for coverage in 2015, the marketplace’s second year.

The HHS analysis, mirroring other reviews of 2015 premiums, shows that what consumers pay for coverage depends on where they live.  In Juneau, Alaska, for example, a 27-year-old enrolled in the second-lowest-cost silver plan would pay $449 per month for coverage in 2015 before tax credits, a 34 percent increase from 2014.   In Jackson, Miss., that same level of coverage would cost $253, or 24 percent less than $332 charged in 2014.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

A story on NPR earlier this week described the “family glitch” in the Affordable Care Act. That’s  when  people can’t afford their insurance at work but make too much to qualify for subsidies  in the new insurance exchanges. Many of these mostly middle-income Americans will remain uninsured.

It also got us wondering, who else is being left out by the health law? And who is getting coverage?

Official government statistics won’t be out until next year, but several other surveys, including one out just this week from the Urban Institute, all agree that between Sept. 2013 and Sept. 2014, the uninsured rate dropped about five percentage points, which is around a third. That translates into about 10 million more people getting health insurance during the year.

That number is considerably larger than the just under seven million people reported to have bought coverage at a health exchange. It includes exchange customers who were already buying their own insurance. They weren’t uninsured, but their plans might have been cancelled or they shopped in the exchanges to get a subsidy.   Also, several million got coverage through the Medicaid program in states that opted to expand it.  And others got job-based coverage as the economy continued to improve.

A series of surveys looking at who got coverage found the biggest gains have come among groups with large numbers of uninsured people. That includes young adults, who are just starting out in the job market, people of color, people in states that expanded their Medicaid programs, people with lower incomes, and people in rural areas.

Another interesting trend is that the uninsured rate fell more for women than men. That’s a little unexpected because the Medicaid expansion allows low-income men who aren’t parents to qualify for the first time. Women who are pregnant or mothers have long been eligible, so there was a bigger pool of men who could gain coverage.

Who does this leave out?

Several diverse groups. The biggest is probably undocumented immigrants. They are not eligible by law- to purchase coverage in the health exchanges, and in most cases they’re not eligible for Medicaid. President Obama’s executive order from last month didn’t make any new immigrants eligible for health benefits under the ACA.

The next big group is adults with low incomes who aren’t disabled and aren’t parents who live in the 23 states that haven’t expanded the Medicaid program. The law was written to extend Medicaid to all low-income people, so you’re not eligible to buy coverage on the exchanges if your income is under the federal poverty line, which is about $11,700 for an individual this year.

In 2012 the Supreme Court ruled that the Medicaid expansion was optional, and just over half the states have taken the federal government up on its offer to pay nearly all the cost. But several of the states that haven’t – including Texas, Florida, and Georgia – have between them several million people in the Medicaid gap.

Then there are those caught in the so-called family glitch. They’re people who can theoretically afford their own coverage, but coverage for the rest of their family is too expensive.  Because of the way the law is written, those family members aren’t eligible for subsidies in the exchanges.

And finally there are people who don’t want coverage and particularly don’t want to be required by the government to buy it, and people who still don’t know they’re supposed to be covered or else they’ll pay a fine next year.

In fact, many of those who remain uncovered won’t have to pay any fines. There are lots of exceptions to the rules for who will have to pay tax penalties for not having coverage. People who are undocumented are exempt, as are people who don’t earn enough to have to file federal income taxes. Also you’re exempt if the least expensive insurance would cost more than 8 percent of your income.  Case-by-case exemptions can be given for people who claim financial hardships.

The bottom line is the law was never anticipated to cover everyone but to get the insured rate up around 90 percent.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Report shows more options and savings for consumers who shop in the Health Insurance Marketplace in 2015

Thirty-four-year-old Karim works long days as an investment adviser, and when he doesn’t burn the midnight oil, he plays basketball or goes to the gym, hangs out with friends, or heads to coffee shops. You wouldn’t know he has an especially tough-to-treat illness.

“I have multiple-drug-resistant tuberculosis,” he explains.

It’s called that, because at least two of the most potent drugs conventionally used to squelch the tuberculosis bacterium don’t work on the strain of the illness that Karim has. So he needs to take a combination of drugs, with harsher side effects, for 18 months. That’s two to three times longer than the traditional treatment for tuberculosis.

“It has been a very stressful treatment process and a lot to deal with, but, thank God, it’s all going really, really well,” says Karim, who requested that NPR not use his full name out of concern he could be stigmatized for being a carrier of a disease that many people don’t understand.

While Americans debate whether we should quarantine people who might have Ebola but clearly aren’t contagious, others wander among us who are infected with tuberculosis — another disease that’s highly communicable in some forms. Close to 10,000 people in the United States have TB.

Karim doesn’t know how he became infected with TB bacteria, though there’s a good chance it was from someone in Pakistan, where he lived until age 4. Millions of people worldwide harbor a latent (noninfectious) form of TB for decades — it only shifts to an active form in some of them when, for one reason or another their immune system can no longer keep the bacteria in check.

After Karim was diagnosed with infectious TB in Aug. 2013, New York City’s health department took over his treatment — giving him powerful medications and mandating two weeks of home isolation.

Once tests confirmed that the drugs had beaten back the bacteria in his lungs to a noncontagious level, he got the “all clear” to move around the city freely again.

Today, he continues to take three very powerful antibiotics every morning, while an official from the health department watches him take the pills, via a smartphone. It’s the city’s standard practice for all TB patients.

“In the beginning, I was kind of frustrated with having to report or show that I’m taking my treatment all the time,” Karim says, “but at the end of the day this is something that could get out of hand. You just don’t want to risk it. It is a highly contagious disease, and if you’re not taking your meds, you’re just putting other people at risk.”

The state of New York allows the city to impose a strict quarantine on TB patients; some can even be detained in a lockup at Bellevue Hospital. But those drastic steps are only taken with highly infectious people who repeatedly don’t take their medications — a small handful of people each year, according to Dr. Joseph Burzynski, head of the New York City Health Department’s bureau of tuberculosis control.

“Most of our patients that get to that point have had significant substance abuse issues or mental health problems that are not being addressed,” Burzynski says. “Those are the reasons they’re being nonadherent.”

But most of the city’s 650 or so residents each year who have active TB manage their treatment like Karim. Only a small number of people very close to him know he carries the disease. He thinks even if he explained to friends and colleagues that he isn’t contagious anymore, they’d still treat him differently. He worries it could affect his business relationships.

“I don’t blame people,” Karim says. “I don’t get angry. I understand. There are parts of my family — when they found out, there was kind of a stigma there. I don’t think there’s enough information about it.”

All the news about the Ebola virus has made both Burzynski and Karim think about how people understand infectious diseases. Burzynski says it makes sense that people are afraid of Ebola — it’s frequently lethal. But looking more closely at the TB experience could ease some of those fears.

“We know that patients with tuberculosis are not infectious, except when they have a high degree of disease that’s not being treated and they’re coughing,” Burzynski says. “We know that persons with Ebola disease are only infectious once they develop symptoms and transmit the disease through the spread of bodily fluids. So there’s really no reason to quarantine somebody who’s not a high risk to the public.”

Meanwhile, Karim is looking forward to a day, he hopes early next spring, when his 18-month drug regimen will be finished, and he’ll be free of TB. He says at that point he’ll tell more people about his ordeal — and do more for an organization he’s started working with that’s trying to find better, shorter treatments for the disease.

This story is part of a reporting partnership with NPR, WNYC and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

National health spending grew 3.6 percent in 2013, the lowest annual increase since the Centers for Medicare and Medicaid Services (CMS) began tracking the statistic in 1960, officials said Wednesday.

Spending slowed for private health insurance, Medicare, hospitals, physicians and clinical services and out-of-pocket spending by consumers.  However, it accelerated for Medicaid and for prescription drugs, according to the report, published online by the journal Health Affairs.

Health care spending has grown at historically low rates for the past five years, which is consistent with declines generally seen during economic downturns, such as the Great Recession that crippled the U.S. economy at the end of 2007.  Looking ahead, “the key question is whether health spending growth will accelerate once economic conditions improve significantly; historical evidence suggest that it will,” noted the authors, who are from the CMS Office of the Actuary.

They also pointed out, however, that in the near term, the health sector will “undergo major changes that will have a substantial impact” on consumers, providers, insurers and sponsors of health care. These are the result of the health law’s creation of online marketplaces, its expansion of Medicaid, a shared federal-state health care program for the poor and disabled, and restraints the law made to the Medicare program, the analysts found.

“The balance of these and many other factors over the next few years will determine how the historically low health spending growth from 2009 to 2013 is viewed: as the temporary aftermath of the great recession or the beginning of a new era,” the authors wrote.

The study found that health care spending rose to $2.9 trillion, or $9,255 per person, in 2013. As a share of gross domestic product, health care remained at 17.4 percent, the same share since 2009, the CMS researchers found.

The 3.6 percent spending growth for 2013 tracks a CMS estimate from September and is 0.5 percentage point lower than 2012.

Spending on Medicare grew 3.4 percent in 2013, down from the 4 percent growth in 2012. The difference was due mostly to slower growth in enrollment and spending changes included in the health care law, including reductions in federal payments to the private Medicare Advantage plans that offer an alternative to traditional Medicare. The automatic 2 percent federal budget payment cuts, known as sequestration, also played a role in reducing Medicare spending, which was nearly $586 billion in 2013. The program accounted for 20 percent of national health spending, according to the report. Fee-for-service expenditures, which account for 72 percent of total Medicare spending, were up 1.7 percent in 2013. Medicare Advantage spending increased 7.8 percent in 2013, a slower growth rate that the 10.6 percent increase in 2012.

The growth in Medicare per-enrollee spending was relatively flat, increasing 0.2 percent after a growth rate of less than 0.1 percent in 2012. The authors credited younger and healthier baby boomers entering the program.

Medicaid spending increased 6.1 percent in 2013, following growth rates of 2.5 and 4 percent, respectively, in 2011 and 2012.  A variety of factors, including increases in hospital care – which accounts for 36 percent of Medicaid spending — contributed to the cost increase.  The federal government and state and local governments spent $449.4 billion in 2013 on Medicaid, accounting for 15 percent of total national health expenditures.

Medicaid enrollment grew 2.7 percent during that time frame, the first acceleration since 2009.  Some of the 2013 increase was due to new beneficiaries who enrolled as part of the health law’s provision that allowed states to expand their Medicaid programs ahead of the 2014 expansion.

Other key takeaways from the report include:

– Nearly 190 million people – or 60 percent of the population – were covered by private health insurance in 2013.  Premiums grew 2.8 percent, compared to an increase of 4 percent in 2012. Low overall enrollment growth, greater usage of high deductible plans and other benefit design changes and the health law’s medical loss ratio and rate review provisions contributed to the decline, CMS found. Private health insurance enrollment increased 0.7 percent last year, the third straight year of growth.

– Consumer out-of-pocket spending, including co-payments and deductibles or payments for services not covered by a consumer’s health insurance, was $339.4 billion in 2013, or 12 percent of national health expenditures.  The 2013 growth was down from the 3.6 percent growth in both 2011 and 2012.

– Spending for physician and clinical services grew 3.8 percent in 2013 to $586.7 billion, a slowdown from 2012 when spending grew 4.5 percent. Expenditures for hospital care increased 4.3 percent in 2013, slower than the 5.7 percent rate of growth in 2012. Total spending growth for retail prescription drugs rose 2.5 percent last year, compared to 0.5 percent in 2012.  Drug spending growth increased in 2013 for several reasons, among them higher prices for brand-name and specialty drugs.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.