Expanding Health Coverage to the Uninsured

1
Expanding Health Coverage to the
Uninsured

• Diane Rowland, Sc.D.
• Executive Director
• The Kaiser Commission on Medicaid and the
  Uninsured
• March 2006

2
Number of Uninsured Children and Adults, 2000 -
2004
In millions
45.5 M
44.7 M
43.3 M
40.9 M
39.6 M
Note Sums may not equal totals due to rounding.

SOURCE
KCMU and Urban Institute estimates based on the
March Current Population Surveys, 2001-2005.
3
Health Insurance Coverage of Children and
Non-elderly Adults, 2004
Children
Adults under 65
Total 77.8 million
Total 177.3 million
Note Medicaid also includes S-CHIP, other state
programs, Medicare, and military-related
coverage. SOURCE KCMU and Urban Institute
estimates based on March 2005 Current Population
Survey.
4
Barriers to Health Care by Insurance Status, 2003
Percent experiencing in past 12 months
Notes Experienced by the respondent or a member
of their family. Insured includes those covered
by public or private health insurance. SOURCE
Kaiser 2003 Health Insurance Survey.
5
The Consequences of Being Uninsured

• Research demonstrates that the uninsured
• use fewer preventive and screening services
• are sicker when diagnosed
• receive fewer therapeutic services
• have poorer health outcomes (higher mortality and
  disability rates) and
• have lower annual earnings because of poorer
  health.

SOURCE Hadley, Jack. Sicker and Poorer The
Consequences of Being Uninsured A Review of the
Research on the Relationship between Health
Insurance, Medical Care Use, Health, Work, and
Income, Medical Care Research and Review (602),
June 2003.
6
Characteristics of the Uninsured, 2004
Income
Work Status
Age
Part-Time Workers 13
Children Under 19 20
No Workers 19
1 or More Full-Time Workers 69
Total 45.5 million uninsured
Note The federal poverty level was 19,307 for a
family of four in 2004. SOURCE KCMU and Urban
Institute analysis of the March 2005 Current
Population Survey.
7
Uninsured Rates Among the Nonelderly by State,
2003 - 2004
lt13 Uninsured (14 states)
National Average 18
13 to lt18 Uninsured (18 states DC)
gt18 Uninsured (18 states)
SOURCE KCMU and Urban Institute analysis of the
March Current Population Survey, 2003 and 2004,
two-year pooled data.
8
The Nonelderly Uninsured by Race, 2004
Distribution by Race/Ethnicity
Risk of Being Uninsured
Total 45.5 Million
Asian group includes Pacific Islanders American
Indian group includes Aleutian Eskimos. SOURCE
KCMU and Urban Institute analysis of the March
2005 Current Population Survey.
9
Health Insurance Coverageby Poverty Level, 2004
Employer/ Other Private
Notes The federal poverty level was 19,307 for
a family of four in 2004. SOURCE KCMU and
Urban Institute analysis of the March 2005
Current Population Survey.
10
Health Insurance Offer Rates by Firm
Characteristics, 2005
Percent of firms offering health benefits
(200 Workers)
(3-199 Workers)
SOURCE Kaiser/HRET Survey of Employer-Sponsored
Health Benefits, 2005.
11
Access to Employer-Based Coverage by Family
Income, 2001
(Family Income lt100 FPL)
(Family Income 400 FPL)
SOURCE Garrett B. Employer-Sponsored Health
Insurance Coverage Sponsorship, Eligibility, and
Participation Patterns in 2001. KCMU report. July
2004.
12
Increases in Health Insurance Premiums Compared
to Other Indicators, 1988-2005
13.9
Estimate statistically different from previous
year shown, plt0.05. Estimate statistically
different from previous year shown, plt0.1. Note
Data on premium increases reflect cost of
premiums for family of four. SOURCE KFF/HRET
Survey of Employer-Sponsored Health Benefits,
1999-2005 KPMG Survey of Employer-Sponsored
Health Benefits, 1993, 1996 HIAA, 1988, 1989,
1990 Bureau of Labor Statistics, Consumer Price
Index (U.S. City Average of Annual Inflation,
1988-2005 Bureau of Labor Statistics, Seasonally
Adjusted Data from the Current Employment
Statistics Survey, 1988-2005.

13
Average Annual Premium Costs for Covered Workers,
2005
10,880
4,024
Note Family coverage is defined as health
coverage for a family of four. SOURCE
Kaiser/HRET Survey of Employer-Sponsored Health
Benefits, 2005.
14
Health Insurance Coverage of Low-Income Adults
and Children, 2004
Poor
Children
Near-Poor
Parents
Adults without children
Notes Medicaid also includes SCHIP, other state
programs, Medicare and military-related coverage.
Poor refers to family incomes lt100 of poverty,
and near-poor to incomes 100-199 of poverty.
The federal poverty level was 19,307 for a
family of four in 2004. SOURCE KCMU/Urban
Institute analysis of March 2005 Current
Population Survey.
15
Fiscal Pressures on Medicaid
Number of states implementing Medicaid cost
containment strategies over the past four years
(FY 2002 FY 2006)
Controlled Drug Costs
Reduced or Froze Provider Payments
Reduced or Restricted Eligibility
Reduced Benefits
SOURCE KCMU survey of Medicaid officials in 50
states and DC conducted by Health Management
Associates, June and December 2002, September
2003, October 2004, October 2005.
16
Public Support for Strategies to Expand Health
Insurance Coverage
Percent choosing as single best option for
guaranteeing health insurance for more Americans
Use taxes to finance a single, national
government health plan for all Americans
Expand state programs for low-income people
Offer tax credits or other assistance to help
businesses provide coverage for employees
Mandate businesses to offer coverage
Offer tax credits or other assistance to help
purchase private coverage
Expand Medicare to uninsured under 65
SOURCE Kaiser Family Foundation Health Poll
Report, January/February 2003.
17
Current Strategies Proposed to Expand Health
Insurance Coverage

• Expanding public coverage
• Expansions of Medicaid/S-CHIP at the state level
• National health insurance program - Medicare
  for All
• Expanding private group coverage through current
  employer-sponsored system
• Financial incentives for employers to provide
  coverage
• Employer mandates
• New group insurance options, especially for small
  employers
• Subsidizing purchase of private health insurance
  through tax credits and deductions
• Individual tax credits/deductions to subsidize
  insurance premiums
• Increased utilization of Health Savings Accounts
  (HSAs) for certain types of
  health insurance

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Evaluating Expansion Proposals

• Who will be assisted?
• Targeting expansion to currently uninsured
• Take-up rates based upon income
• What is the scope of benefits?
• Importance of comprehensive benefit packages
• Catastrophic coverage
• Will coverage be affordable?
• Level of subsidy
• Method of subsidy
• How much will it cost?
• Public or private financing
• Efficient targeting of expansion financing
• Impact on existing system?
• Adverse risk selection
• Incentives for quality/efficiency

19
Challenges for the Future

• Problem growing
• Employer coverage erosion
• Incomes shifting downward
• Medicaid cutbacks
• Costs rising
• Increasing health costs
• Rising premiums
• Public resources limited
• Federal deficits
• State budget crunch
• No consensus on reform strategy or willingness to
  pay

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Related Resources
The Uninsured A Primer http//www.kff.org/uninsu
red/7451.cfm StateHealthFacts.org http//www.st
atehealthfacts.org/cgi-bin/healthfacts.cgi?action
comparewelcome1categoryHealthCoverage26Uni
nsured Expansion Proposals http//www.cmwf.org/
publications/publications_show.htm?doc_id469753
Cover the Uninsured http//covertheuninsured.or
g/ National Governors Association http//www.ng
a.org/portal/site/nga/menuitem.8274ad9c70a7bd616ad
cbeeb501010a0/?vgnextoidc0294bf37ebdff00VgnVCM100
0001a01010aRCRD