Whats To Be Done About The Uninsured

1
Whats To Be Done About The Uninsured?
Charles N. Kahn III President Federation of
American Hospitals January 25, 2002 Leonard
Davis Institute of Health Economics, 2002 Health
Policy Seminar Series
2
Policy Possibilities for the Uninsured

• The Issue
• Themes and Responses 1991-01
• Current Political Context
• 2002 Political / Policy Bidding
• Battlelines Or Compromises of the Future

3
Epidemic Continues
Source Kaiser Family Foundation, Sources of
Health Insurance and Characteristics of the
Uninsured Analysis of the March 2001 Current
Population Survey, December 2001
4
The Uninsured Will Continueto Climb
61 Million
55 Million
Recession
Inflation
1999 42.1 Million

Source The Changing Sources of Health Insurance,
William S. Custer, Ph.D., Pat Ketsche, Ph.D.,
M.H.A.
5
Employers Cover Over 172 Million Americans, 9 out
of 10 of Those With Private Insurance
Source Employee Benefit Research Institute,
December 1998
6
Recovery Slow
Source Kaiser Family Foundation, Sources of
Health Insurance and Characteristics of the
Uninsured Analysis of the March 2001 Current
Population Survey, December 2001
7
Employers Responsible for Recent Decline in
Uninsured
Non-elderly Americans. From Custer and Ketsche,
The Changing Sources of Health Insurance
Coverage, HIAA, December 2000.
8
Poor Americans Are More Likely to Be Uninsured
400 Of FPL
0-199 Of FPL
200-399 Of FPL
Source HIAA
9
Low-Wage Workers Less Likely to Accept Coverage
Source Employment-Based Health Insurance
Coverage, William S. Custer, Ph.D., Pat Ketsche,
Ph.D., M.H.A.
10
Increasingly Worrisome Cost Growth
Employer premiums
Percentage Growth
National Health Expenditures
Consumer price index
2001 estimated
Source For 1989 - 1991, HIAA Employer Survey
KPMG Employer Survey and Bureau of Labor
Statistics, various years, Health Care Finance
Administration W.M. Mercer CBO, July 2000
11
Cost Containment Success Likely Over
Source KFF/HRET Survey of Employer-Sponsored
Health Benefits 1999, 2000, 2001 KPMG Survey of
Employer-Sponsored Health Benefits 1988, 1993,
1996
12
Policy Possibilities for the Uninsured

• The Issue
• Themes and Responses 1991-01
• Current Political Context
• 2002 Political / Policy Bidding
• Battlelines Or Compromises of the Future

13
Themes and Responses 1991-01

• 1992 Recession - Clinton Initiative
• Kasenbaum/Kennedy - HIPAA
• Hatch/Kennedy SCHIP
• Later-90s - Parents
• Strange Bedfellows - 28 Billion in FY02 Budget
• 2001 Recession Stimulus Package

14
Stimulus Package

• GOP
• Tax Credit for Unemployed

• Democrats
• COBRA Subsidy
• Expand Medicaid
• Increase Medicaid Match

15
Policy Possibilities for the Uninsured

• The Issue
• Themes and Responses 1991-01
• Current Political Context
• 2002 Political / Policy Bidding
• Battlelines Or Compromises of the Future

16
2002 Political Landscape

• September 11
• Unprecedented Views Of Govt And The President
• Back To Politics As Usual
• Election Prospects

17
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2002 Political Landscape

• September 11
• Unprecedented Views Of Govt And The President
• 2002, Back To Politics As Usual
• Election Prospects

19
Patriotism Index(Since September 11th, have you
done any of the following)
Source American Viewpoint January 2002
20
Bush Job Approval
Strength of GWB performance is reflected in 10
consecutive post 9/11 Gallup polls with ratings
between 84 -90 13 previous ratings between May
and early September were between 51-54
Sources WSJ, ABC News, NBC News, CNN, US Today,
Gallup, American Viewpoint
21
Direction of Country
Source American Viewpoint January 2002
22
Trust In Government
Source National Election Studies / Washington
Post
Source American Viewpoint January 2002
23
Role of Government

• First time a majority has called for a greater
  role of government since Clinton elected.
• Presents a significant challenge for Republicans
  as a plurality of GOPers say government should do
  more.

Source American Viewpoint January 2002
24
2002 Political Landscape

• September 11
• Unprecedented Views Of Govt And The President
• 2002, Back To Politics As Usual
• Election Prospects

25
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(No Transcript)
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2002 Political Landscape

• September 11
• Unprecedented Views Of Govt And The President
• 2002, Back To Politics As Usual
• Election Prospects

28
Primary Factors In Off Year Elections

• Economy
• Presidential Popularity
• Seniors

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(No Transcript)
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Off-Year Elections
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Is 2002 The Exception or The Expectation?

• Redistricting stalemate
• Only 24 hotly contested House seats
• House Democrats Must Score Net Gain Of 6 Seats
  Must Win 18 Of 24 Hot Races (75 success rate)

32
Generic House Ballot
Source, American Viewpoint, Gallup
33
United States Senate 2002 Outlook 34 Races in
2002, Current Senate Composition 50 DEM, 49 GOP,
1 IND
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Policy Possibilities for the Uninsured

• The Issue
• Themes and Responses 1991-01
• Current Political Context
• 2002 Political / Policy Bidding
• Battlelines Or Compromises of the Future

35
FY 2003 Budget

• Process
• State of the Union
• President's Budget
• Budget Resolutions

• Environment
• War National Security
• Recession
• Deficit Spending
• Election Year

36
Health Agenda 2002

• Drugs (Reform Rhetoric)
• Patient Protection
• Bio-terrorism
• Nurse Training Grants
• Medicare Provider Payment
• Regulation Reform
• Medicaid Relief

37
Policy Possibilities for the Uninsured

• The Issue
• Themes and Responses 1991-01
• Current Political Context
• 2002 Political / Policy Bidding
• Battlelines Or Compromises of the Future

38
Battlelines Vs Compromise

• Battlelines
• Politics Defining Issue
• Ideology - Reform Imperative
• Cost

• Compromise
• Common Definition
• Second Choices
• Coverage Without Reform