Access to Health Care Coverage: Why Does It Matter

1
Access to Health Care Coverage Why Does It
Matter?

• Partners in Perinatal Health Sharing Solutions
• Pre-Conference
• March of Dimes Town Hall Meeting
• December 12, 2006

2
Uninsurance Nationwide

• In 2005, 46.6 million Americans were uninsured.
• One in five women (12.9 million) of childbearing
  age (15-44) were uninsured in 2005.
• They represent 28 of all uninsured Americans
• 60 of them have family incomes below 200 of
  poverty (33,200 for a family of 3 in 2006).
• Nine million (11.6) children were uninsured in
  2005. (First increase since 1998)
• Sixty-two percent (62) lived in families with
  incomes below 200 of poverty, and may have been
  eligible for Medicaid or SCHIP.
• Source Changes in Economic Conditions and
  Health Insurance Coverage, 2000-2004 Health
  Affairs (web edition). November 1, 2005. John
  Holahan and Allison Cook.

3
Who Are the Uninsured?

• 8 out of 10 of those without insurance are in
  working families.
• In 2005, Hispanic women of childbearing age were
  more likely than whites to be uninsured (39,
  compared with 15). Thirty-six percent (36) of
  Native American women, 24 of African American
  women, and 22 of Asian/Pacific Islander women in
  this age bracket were uninsured.
• Among Hispanics, Mexican (43) and Central/South
  American (38) women were uninsured at highest
  rates, compared with 20 of Puerto Ricans and 26
  for all other Hispanic women.
• Hispanic children were nearly 3 times as likely
  as whites to be uninsured 22, compared with
  less than 8. Twenty-seven percent (27) of
  Native American children, 13 of African American
  children, and 13 of Asian/Pacific Islander
  children were uninsured.
• Source U.S. Census Bureau, 2006 Current
  Population Survey Annual Social and Economic
  Supplement. Data prepared for the March of
  Dimes.

4
What Does Being Uninsured Mean?

• Having insurance coverage affects how people use
  health care services.
• The uninsured report poorer health status.
• The uninsured are less likely to have a usual
  source of medical care.
• The uninsured are more likely to delay or forgo
  needed health care services.
• Source IOM, Coverage Matters Insurance and
  Health Care, 2001.

5
For Uninsured Pregnant Women?

• According to the Institute of Medicine (IOM),
  uninsured women receive fewer prenatal services
  and report greater difficulty in obtaining needed
  care than women with insurance.
• A study in 1999 for MOD showed over 18 of
  uninsured pregnant women reported going without
  needed medical care during the year in which they
  gave birth. (Compares with 7.6 of privately
  insured pregnant women 8.1 of pregnant women
  covered by Medicaid.) (Bernstein, 1999)

6
For Uninsured Children?

• According to the IOM, health insurance status is
  the single most important influence in
  determining whether health care is accessible to
  children when they need it.
• Though uninsured newborns are more likely than
  insured babies to be sick, they receive fewer
  hospital services. (IOM)
• Uninsured children are the most likely to have no
  usual source of medical care 28.8, compared
  with only 2.5 of privately insured youngsters
  5.5 of children in public insurance programs.
  (Newacheck, et al. 1998)

7
Why is Uninsurance on the Rise?

• Decrease of jobs since 2000 though there was a
  slight pick-up between 2003-04, most of these
  were service industry jobs, which are less likely
  to offer health insurance as a fringe benefit.
• Median household incomes declining
• Rate of employers offering health coverage
  declining (of the 1.3 million who lost coverage
  in 2005, 960,000 had jobs, but no longer received
  benefits)
• 60 of firms offer health benefits to workers
  down from 69 in 2000.
• Shift in employment from large and midsize firms
  to self-employment and small firms
• Poverty rate increasing
• Bottom line U.S. health insurance system is
  affected by underlying economic conditions.
• Source Changes in Economic Conditions and
  Health Insurance Coverage, 2000-2004. Health
  Affairs, November 1, 2005. John Holahan and
  Allison Cook.

8
Safety Net Programs for Women and Children

• Medicaid and SCHIP have helped to serve as a
  safety net for women and children.
• While 9 million children remain uninsured, the
  number would be much higher without these
  programs.
• Medicaid finances over one-third of all U.S.
  births (over 40 of births in Florida)
• Most women enrolled in Medicaid are of
  reproductive age (over 9 million)
• 74 of uninsured children are eligible, but not
  enrolled in Medicaid or SCHIP
• Sources NGA MCH Update (September 28, 2006,
  www.nga.org) and Dubay, L., et. Al., The
  Uninsured and the Affordability of Health
  Insurance Coverage (November, 2006,
  www.healthaffairs.org)
• Source the Uninsured and the Affordability of
  Health Insurance Coverage. Health Affairs,
  November 30, 200. Lisa Dubay, John Holahan and
  Allison Cook.

9
Impact of Medicaid on Coverage for Pregnant Women

• Uninsured Women of Childbearing Age
• 22
• Uninsured Pregnant Women at Time of Delivery
• 8
• Source Ken Thorpe and others, The Distribution
  of Health Insurance Coverage During Pregnancy,
  1996 -2001. Prepared for the March of Dimes

10
Is Floridas Medicaid Reform Working?

• Governor-elect Crists Prescription to Keep
  Florida Healthy includes evaluation and
  expansion of Medicaid Reforms to ensure that
  all patients have access to the best care.
• Fast approval process by federal government means
  its important to monitor closely progress and/or
  problems identified by state advocates
• How are pregnant women, infants, and children
  faring in new premium-based system? Is funding
  sufficient under new budget neutrality agreement?

11
SCHIP Coverage for Pregnant Women

• At the federal level, MOD is seeking a statutory
  change that would allow states to cover pregnant
  women through SCHIP including the 60-day
  postpartum period as recommended by ACOG
  without having to apply for a waiver.
• Until this happens, states should be encouraged
  to apply for waivers to cover these women.
• No waiting period should apply for participation
  in the program.
• States should use presumptive eligibility or
  accelerated eligibility determinations to bring
  women into SCHIP early in their pregnancies.

12
Covering Pregnant Women Unborn Child
Regulation

• In 2002, HHS revised the SCHIP definition of
  children to include the unborn as a means of
  funding prenatal services.
• Since the child is the covered person, the
  regulation has become a way for states to extend
  prenatal, labor and delivery care to otherwise
  ineligible women immigrants.
• However, since the child is the covered person,
  postpartum care, which is part of the set of
  comprehensive services recommended by the
  American College of Obstetricians and
  Gynecologists, is not covered.
• As of 8-1-06, eight states use this provision
  AR, IL, MA, MI, MN, PA, RI, WA
• Sources National Conference of State Legislatures

13
Barriers to Enrollment

• Complexity of the application process (e.g.,
  financial and citizenship documentation, etc.)
• Aspects of program management (inconvenient
  locations, lengthy processing time, etc.)
• State program policies (asset tests, premiums,
  absent parent medical requirements, etc.)
• Enrollment procedures
• Language, literacy, cultural, etc. complexities
• Lack of coverage prior to pregnancy
• Lack of awareness regarding Medicaid eligibility
• Source See KFF, Outreach Strategies for
  Medicaid and SCHIP An Overview of Effective
  Strategies and Activities, May 2006

14
Some Ways to Improve Enrollment

• Presumptive eligibility
• Continuous eligibility
• Elimination of asset tests
• Source March of Dimes, Maternal, Infant, and
  Child Health in the United States, 2005

15
Outreach and Enrollment of Pregnant Women in
Medicaid

• New study undertaken by MOD in 2006 with the
  Urban Institute and National Academy for State
  Health Policy will
• include a literature review, a survey of all 50
  states as well as site visits to between 4-6
  states.
• Identify effective strategies in encouraging
  timely and simplified eligibility determination
• Provide recommendations to improve linkage of
  Medicaid-enrolled pregnant women with high
  quality providers of maternity services

16
March of Dimes OGA Contacts and Resources

• Colleen Sonosky, Public Policy Research
• Melanie Lockhart and Hilary Pool, State Affairs
• Emil Wigode and Amanda Molk-Jezek, Federal
  Affairs
• Marina L. Weiss, Senior Vice President, Public
  Policy and Government Affairs
• 202-659-1800
• 1146 19th Street, NW, 6th Floor
• Washington, DC 20036