Universal Health Insurance Potpourri: SCHIP, Presidential Candidates, State Health Reforms

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Universal Health Insurance PotpourriSCHIP,
Presidential Candidates, State Health Reforms

• Adam Brackemyre
• Director of State Affairs
• National Association of Health Underwriters
• GCNYAHU Meeting 1/15/08

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Universal Care Potpourri

• What is Universal Care?
• What are states doing to increase health
  insurance access?
• SCHIP update
• 2008 Presidential health insurance reform
  proposals

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Universal Care

• Universal Care means everyone is insured
• Publicly
• Privately
• Or a combination thereof
• Single-Payer is the public means of universal
  coverage (Canada)
• Switzerland has an individual mandate for private
  insurance
• Universal coverage without a govt insurer

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Universal Care

• A number of candidates use this term loosely when
  discussing ideas to decrease the number of
  uninsured
• In PA, the proposed Cover All Pennsylvanians
  will not cover all Pennsylvanians
• The details always matter

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Single-Payer

• Single Payer is in the news
• No credible Presidential candidate is proposing
  single-payer
• CT had a single-payer bill last year. It stopped
  moving when the bills cost was estimated to be
  the entire state budget
• ME will probably have a single payer ballot
  initiative in 2008
• ME AHU is working in a coalition to develop a
  free-market alternative

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MA Reform- Cliffs Notes Version

• Many states are watching Massachusetts
• First state to introduce an individual mandate
• Many elements of this reform are influencing
  other state legislatures and Presidential
  candidates (i.e. your Senators)
• Whats working?
• Whats not?

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Aim of MA Reform

• More Massachusetts residents, but not all, will
  be insured by the end of this year
• About 6 percent of residents were uninsured last
  year
• About 4-5 percent are uninsured today
• The reform will take about 3 years to fully
  implement
• New regulatory decisions are made each month
• Goal achieve 99 coverage by 2009

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Politics

• In April 2006, Gov. Romney signed the
  much-discussed insurance reform
• Motivations cover the uninsured and preserve the
  additional 385 million in annual federal funding
• MA had to craft a plan that would reduce the
  number of uninsured to renew federal waiver
  funding
• No reform, no more money

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The Individual Mandate

• All individuals will be required to have
  insurance by December 31, 2007
• First-year penalty Loss of personal tax
  exemption
• Penalty thereafter A fine equal to half the cost
  of the lowest-priced product (about 1,200)
• By January 1, 2009, all Massachusetts residents
  must have coverage that complies with minimum
  coverage standards (minimal creditable
  coverage)
• Policies must have benefits that meet state
  specifications

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Minimum Creditable Coverage

• What is health insurance?
• The Connector board has mandated that all MA
  residents have coverage that includes all MA
  mandated benefits and, probably, prescription
  drugs.
• Individual deductible 2,000 (5,000 OOP)
• Family max deductible 4,000 (10,000 OOP)
• Lifetime maximum benefits TBA
• HSA-compatible plans are exempted

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MassachusettsInsurance Coverage Expansion

• Insurance coverage was expanded in three ways
• Private insurance sold through the Connector
  (over 300 FPL)
• Subsidized Commonwealth Care insurance (100 to
  300 FPL)
• MassHealth (Medicaid) expansions

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The Connector

• The Connector is a purchasing pool that will
  offer HIPAA-compliant individual insurance to
  groups of 1-50
• Small groups can purchase from the Connector or
  the traditional small group market
• The nongroup market is the Connector
• Policyholders pay for the Connectors operations
  through a 4.5 policy surcharge

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Commonwealth Choice

• The Connector sells Commonwealth Choice products
• Unsubsidized individual private plans
• 16,000 enrollees as of January 1st 2008
• Three basic plan designs Gold, Silver and Bronze
  plans
• The Bronze plan is the most basic plan that will
  qualify as minimal creditable coverage.
• The Gold plan is Cadillac coverage
• The next slide shows individual premiums

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Bronze Plan Premiums- Boston
Includes prescription drug coverage
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Gold Plan Premiums- Boston
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What Are You Paid?
Source http//www.mass.gov/Qhic/docs/Broker20Com
mission20Schedule20rev
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Commonwealth Care

• Enrollment as of January 1st is 169,000
• 124,000 do not pay premiums
• Subsidized Medicaid HMOs
• The Connector Board administers this program
• Producers are not compensated participants in
  this program

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Commonwealth Care

• Sliding-scale subsidies provided for those
  earning less than 300 federal poverty level
• Subsidy source Hospitals were reimbursed for
  uncompensated care that funding now provides
  insurance subsidies
• No Commonwealth Care product has a deductible
  co-pays and cost sharing vary by income and plan
  type
• Monthly Sample Premiums (annual salary)
• Single adult (14,000) 18/mo
• Two adults, two children (47,000) 180/mo

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Commonwealth Care Monthly Premiums
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MassHealth (Medicaid)

• The reform has increased Medicaid enrollment by
  about 50,000
• Children whose guardians earn up to 300 FPL are
  now eligible for MassHealth
• Medicaid payments to doctors and hospitals
  increase by
• 90 million in FY 07
• 180 million in FY 08
• 270 million in FY 09

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The Big Questions

• How many people are uninsured?
• The state doesnt know.
• How will the reform contain health care cost
  increases?
• Health costs rose about 14 last year
• Connector wants premium increases to be 5
• How effectively will MA enforce the individual
  mandate?
• How will the public react when people are fined
  for not buying health insurance?

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Purchasing Pools

• The Mass Connector is being explored in other
  states
• CO, KS, MO, MN, OR, UT, MD
• These can be free-market or managed competition
  proposals
• President Clintons 1994 proposal included
  health purchasing cooperatives like these

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Subsidized Insurance

• Healthy Indiana is subsidized insurance, like an
  HSA, for those earning under 200 FPL
• Account contributions matched by state
• Funded by a Medicaid waiver and tobacco tax
• Cover All Pennsylvania- subsidized insurance for
  small businesses
• Concerns about crowd out and sustainable funding
  (business payroll tax is a non-starter)
• Governor wants to start program with medical
  malpractice insurance subsidies

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SCHIP

• SCHIP is the State Childrens Health Insurance
  Program
• Created in 1996-97 to enroll uninsured children
• Greater Medicaid match than normal to facilitate
  more children being enrolled
• States have received waivers to expand coverage
  to wealthier households and some have added
  parents to the program.

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SCHIP

• The program was due to be re-authorized this year
  
• A bi-partisan deal could not be reached
• Program was given funding to last until March
  2009
• NAHU worked closely on the Senate bill
• The House bill was not as favorable to NAHU
  membership
• NAHU strongly supported the premium support
  provisions in the Senate bill

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SCHIP

• As you are probably aware, New York passed
  legislation making children whose parents earn up
  to 400 FPL (84,000 for a family of four)
  eligible for SCHIP
• Federal government will not fund the expansion
• New York will have to fund the expansion itself
• New Jerseys attempt to expand eligibility up to
  350 FPL suffers the same fate

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Presidential Candidates

• This is the most open Presidential race since
  1952
• No President or former VP running for the partys
  nomination.
• Nobody knows who the nominees will be
• We could still have a public mistake (Gov Dean in
  2004, Sen Ted Kennedy in 1980)
• D Nominee Clinton or Obama
• The polls are volatile.
• R Nominee Huckabee, McCain, Romney or Giuliani
• Romney and Thompson are in trouble Romney needs
  to win MI
• Giuliani is betting the farm on Florida

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Presidential Candidates

• Things to watch
• If Edwards loses big again, look for him to
  leave. Either he or Obama would be the
  anti-Clinton.
• Will he endorse Obama or Clinton?
• Who will be the next R to drop?
• Who will he endorse?
• McCain is the moderate. Who will be the
  conservative?

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Presidential Candidates

• Health care will be the top domestic policy issue
  during this extended campaign cycle.
• Many candidates favor comprehensive reform that
  could dismantle the private market
• Single payer, national exchanges, shift away from
  the employer-based system all under serious
  debate.
• 3 Democratic candidates proposing universal
  health care, but not fully single-payer (Hillary,
  Obama, Edwards)
• Many Republicans have yet to announce a health
  care plan

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The Proposals

• Before we begin, the candidates proposals are
  vague
• The greater detail one has, the more he or she
  opens him/herself to criticism
• Some of these plans are ambitious and will cost
  money- and nobody wants to propose tax increases.
• Please remember that Congress must pass any
  health care reform
• President Bush wanted to allow people to invest
  their Social Security accounts in equities.

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Hillary

• Individual Mandate ensures Universal Coverage
• New Regulations
• Guarantee Issue of all products
• High loss ratio standards
• Tight Rating
• Coverage (Plan is Health Care Choices)
• Keep what your private coverage, but Hillary will
  set minimum standards
• Buy into the FEHBP
• Buy into government insurance (i.e. Medicaid)

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Hillary

• New tax credits
• Refundable credits
• New business tax credits
• New business tax credits for retired workers.
• Limit an individuals financial exposure to a
  percentage of income
• Expand Medicaid/SCHIP

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Hillary

• Financing
• Cutting Medicare Advantage payments by 7 billion
• Reduced uncompensated care
• Lower Rx costs through government negotiation
• Increased income taxes by 54 billion
• Hillarys plan is available on her website
  http//www.hillaryclinton.com/feature/healthcarepl
  an/

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Senator Obama

• Wants universal coverage by 2012
• Create a national health insurance exchange with
  federal coverage standards
• Creates a national health benefit (private plans
  would be required to be as generous as government
  option)
• Employer mandate
• No individual mandate
• Compares a health insurance mandate to the auto
  insurance mandate

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Senator Obama

• Proposes to allow the reimportation of Rx
• Expand current public programs
• Force insurers to invest a percentage of premium
  dollars to patient care to areas with no
  competitive plans

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Mayor Guiliani

• 15,000 tax credit for families to purchase
  coverage in the private market
• No new mandates or government programs
• Build on existing private plans and government
  programs though deregulation
• Block grants to states to develop solutions
• Link Medicaid payments to state success rates on
  child obesity and disease management

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Governor Romney

• Deregulate insurance markets
• Empower consumers with lower-cost options and
  transparency
• No new taxes
• Reform tax code to expand HSAs
• Wants to subsidize coverage rather then subsidize
  providers for charity care

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Senator Edwards

• Universal coverage achieved through mandates,
  regulations, and expansion of public programs
• 90-129 B through repeal of Bush tax credits
• Create regional purchasing pools (Health Markets)
  with a pay or play option for employers
• Require insurance companies to spend 85 of
  premiums on patient care

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Governor Huckabee

• Wants to reduce government's role and overhaul
  the current system (not many details on how)
• Electronic medical records
• Portability with your health insurance plan
• Medical malpractice reform
• Expand HSAs
• Allow for an individual tax deduction for health
  insurance premiums
• Offer awards/benefits for healthy lifestyles and
  wellness

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Other Hats in the Ring

• Sen. McCain would like expansion through HSAs,
  tax incentives and community health centers
• Sen. Thompson has not released anything on health
  care and does not address the issue on his
  websiteyet

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The Other Guys

• Sen. Biden wanted to expand covered for children
  and offer catastrophic coverage for all
• Gov. Richardson wanted to GI coverage and focus
  on preventive care while reducing administrative
  costs.
• Sen. Dodd wanted to create a Health Care General
  Fund based on the FEHBP with available premium
  subsidies.
• Supports an employer and individual mandate
• Sen. Gravel (if hes still running) would offer
  government-funded vouchers for all Americans
  based on need

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Wont Win, But

• Rep. Kucinich wants a single-payer,
  not-for-profit, government-run system including
  dental, vision, mental health and LTC
• He also believes in UFOs
• Rep. Paul would expand alternative medicines and
  reduce FDA control
• Rep. Tancredo supports AHPs and would enforce
  immigration laws to pay for health care
• Rep. Hunter remains mum on the subject

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Contact information

• Phone [phone]
• Email abrackemyre_at_nahu.org