Considerations for Moving Forward

Considerations for Moving Forward

Cindy MannExecutive Director

Georgetown University Health Policy InstituteCenter for Children and Families

Health Foundation of Greater CincinnatiAugust 17, 2007

Trends & Current Status

44.8

43.543.4

42

39.8

38.438.8

1999 2000 2001 2002 2003 2004 2005

The Uninsured in America

Number of Total Uninsured in Millions

Source: U.S. Census Bureau, Current Population Survey, 2000 to 2006 Annual Social and Economic Supplements, (released June 28, 2007)

22.3%

21.5%

20.1% 20.0%

18.0%

15.8% 15.9%

14.9%15.2%

1997 1998 1999 2000 2001 2002 2003 2004 2005

Uninsured rate of low-income children under 19

Trends in the Uninsured Rate of Low-Income Children, 1997- 2005

Source: CCF analysis of National Health Interview Survey.

Note: “Low-income” is defined as having income below 200% of the federal poverty line, which in 2005 was $32,180 for a family of 3.

Why the Big Difference?

• ESI declining for adults and children

• Children much more likely to be eligible for public programs (Medicaid/SCHIP) which fill in the gaps

Premiums for Employer-Sponsored Coverage Are Growing Faster than Workers Earnings

13.9%

7.7%

3.8%

5.3%

8.2%

10.9%

12.9%

11.2%

9.2%

3.8%2.7%

2.1%3.0%

2.6%

4.0%3.9%3.6%

4.4%

0%

2%

4%

6%

8%

10%

12%

14%

16%

1998 1999 2000 2001 2002 2003 2004 2005 2006

Health Insurance Premiums Workers Earnings

Note: The annual growth for premiums is statistically significant from the prior year at p<0.05 for every year except 2003.

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006, (September 2006).

Changes in Health Insurance Coverage, 2000-2004

-4.6% -4.6%

1.2%

5.2%

2.7%

-0.7%

Employer Medicaid/SCHIP Uninsured

Adults Children

Source: Urban Institute, 2005, for Kaiser Commission on Medicaid and the Uninsured

(6.3 million more uninsured adults)

(300,000 fewer uninsured children)

10.4%

29.7%

Kentucky, 17.8%

Ohio, 14.3%

U.S. Average, 19.7%

State Uninsurance Rates of Nonelderly Adults (2005)

Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).

20%

4.8%

Kentucky, 7.8%

Ohio, 8.1%

U.S. Average, 11%

State Uninsurance Rates of Children (2005)


Where Do We Go From Here?

Employer62%

Individual5%

Medicaid/SCHIP

14%

Other Public

2%

Uninsured

17%

Sources of Coverage for Nonelderly Americans, 2004-2005

256 Million Nonelderly Americans


Sources of Coverage for Nonelderly Kentuckians & Ohioans, 2004-2005

Employer62%

Individual4%

Medicaid/SCHIP15%

Other Public

4%

Uninsured15%

3.6 Million Nonelderly Kentuckians


Employer68%

Individual4%

Medicaid/SCHIP13%

Other Public

2%

Uninsured13%

9.9 Million Nonelderly Ohioans

Characteristics of the Nonelderly Uninsured, 2005

Adults 19-3440%

Adults 35-6440%

Children under

1920%

200-399% FPL23%

400%+ FPL10%

100-199% FPL30%

< 100% FPL37%

Age

Source: Urban Institute, 2005, for Kaiser Commission on Medicaid and the Uninsured

Part-time

worker11%

No worker

19%

1 or more full-

time worker

70%

Work StatusIncome

44.4 Million Nonelderly Americans

Health Care Is An Important Priority for Americans

1. Iraq (20%)

2. Terrorism/national security (17%)

3. Economy/jobs (17%)

4. Health care (16%)

5. Immigration (10%)

6. Education (8%)

7. Environment (7%)

The most important issue to voters in deciding who they would like to see elected president (July 2007):

Source: CBS News/New York Times Poll, July 9-17, 2007.

Private Dollars15%

Federal Dollars58%

State Dollars27%

Payment Sources for Uncompensated Care, 2004

Total = $40.7 Billion

Source: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, (October 2006).

There Is Not A Consensus on Solutions

The public’s most preferred policy option to help the uninsured:

12%

13%

15%

17%

17%

23%

Expand Medicare to cover uninsuredpeople 55 and over

Require businesses to offer insurance

Create a national, single-payer healthplan

Offer tax incentives to the uninsuredto help them purchase insurance

Expand Medicaid, SCHIP, and otherstate programs

Offer tax incentives to businesses tohelp provide insurance

Source: Kaiser/Harvard Health Care Agenda for the New Congress Survey (conducted November 4-28, 2004).

A Big Divide?

• “We need universal health care coverage in this country, not stale ideas and savings account schemes.”

- AFL-CIO President John Sweeney (February 1, 2006)

• “I emphasize private insurance, the best health care plan -- the best health care policy is one that emphasizes private health. In other words, the opposite of that would be government control of health care.”

- President George W. Bush (June 27, 2007)

More Action at the State Level

• Children’s coverage

• Universal coverage

• In between?

• Insurance reforms, tax changes

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

IL

KY

TNNC

NH

MA

VT

PA

VAWV

CT

NJ

DE

MD

RI

HI

DC

AK

SC

NMOK

GA

Source: As of August 2, 2007 based on CCF review of state initiatives.

TX

IL

FL

AL

Implemented or Recently Adopted Legislation to Improve Children’s Coverage (26 states and DC)

Considering Significant Proposal to Improve Children’s Coverage (2 states)

States are Moving ForwardOn Children’s Coverage

Americans Support Covering Children

91%91%July 23, 2007

Source: Poll conducted by Lake Research Partners and American Viewpoint, national survey of 1,002 American voters from June 26 - July 1, 2007 for the Center for Children and Families

200%

65%

Children Parents

But Their Parents Are Often Left BehindMedicaid/SCHIP Eligibility Levels for Children and

Parents With Earnings in the Median State

Source: CBPP survey for KCMU, January 2007.Note: In 2007, 65% of the FOL is equal to $11,161 for a family of 3.

Income Eligibility Levels Expressed as a Percent of the Federal Poverty Level

“Universal” Coverage

• Enacted: Massachusetts, Vermont

• Partial: Maine

• Under active debate: California, Illinois, Maine, Pennsylvania, Washington

• Commissions, studies going on in several states

23.90%

40.20%

11.30%

U.S. Kentucky Ohio

Solutions Are At Hand

Decline in the Rate of Uninsured Children, 1997/1998 to 2004/2005

Source: RWJF, Protecting America’s Future: A State-by-State Look at SCHIP & Uninsured Kids, (August 2007).

Elements For Success

• It doesn’t happen overnight• Advocacy/organizing capacity is essential

– Look for opportunities for common ground

• For several reasons, public program coverage is key

• Solutions are at hand, but they aren’t free• Much can be done at the state level but the

federal government will need to step to the plate

Documents

Considerations for Moving Forward