Fulfilling the promise of coverage and care for the medically underserved

A Presentation of the Colorado Health Institute1576 Sherman Street, Suite 300Denver, Colorado 80203-1728www.coloradohealthinstitute.org@CoHealthInst (Twitter)

Fulfilling the promise of coverage and care for the medically

underserved

National Health Reform: A Colorado Perspective

2010 Annual ConferenceCoalition for the Medically UnderservedOctober 8, 2010The Children’s Hospital – Anschutz Medical Campus

The COVERAGE CONTEXT: Who are the medically underserved in Colorado? How will their numbers change after health reform?

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What was the insurance status of Coloradans pre-health reform (2008-09)?

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SOURCE: 2008-09 Colorado Household Survey, Colorado Department of Health Care Policy and Financing, analyzed by the Colorado Health Institute

One-third of Coloradans were medically underserved (uninsured or underinsured) in 2008-09

Adequately

insured

Underinsured

Uninsured at some point

in 12 months prior to survey

Insured, but with an uninsured

family member

Number

3,069,545

649,632 973,396 317,822

Percent 61% 13% 19% 6%


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Different points in time for measuring uninsurance yield different rates

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Number of months Coloradans were without health insurance, 2008-09

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Uninsurance rates by age and gender, Colorado, 2008-09

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Uninsurance rates by % of federal poverty level (FPL), Colorado, 2008-09

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Cost is the most frequent reason that Coloradans are uninsured, but…

Reasons why Coloradans are uninsured

% of uninsured individuals

citing reasonCost of health insurance is too high 88%Working family member is not offered or eligible for health insurance 41%Insured family member lost job or changed employers and lost health insurance 37%Lost eligibility for Medicaid or CHP+ 19%Have pre-existing medical condition and cannot obtain health insurance 14%Do not know how to get health insurance 14%Do not need health insurance 11%

SOURCE: 2008-09 Colorado Household Survey, Colorado Department of Health Care Policy and Financing, analyzed by the Colorado Health Institute.NOTE: Individuals could indicate multiple reasons for not having health insurance

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Underinsured Coloradans by source of coverage, 2008-09

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SOURCE: 2008-09 Colorado Household Survey, Colorado Department of Health Care Policy and Financing, analyzed by the Colorado Health InstituteNOTE: Underinsured is defined as 10% of household income spent on health care (not including health insurance premiums)

The PARADOX: Coloradans 65+ have the highest rates of underinsurance AND are adequately insured


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The COVERAGE CONTEXT: Who are the medically underserved in Colorado? How will their numbers change after health reform?

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Major coverage provisions in PPACA

• Individual mandate– all citizens and legal residents must

purchase health insurance by 2014 or pay a penalty

– Low-to-middle income individuals subject to the individual mandate (at or below 400% of FPL) eligible for a subsidy

• Expanded adult and child eligibility for Medicaid (at or below133% of FPL)

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The state’s role in expanded access to new models of care delivery

• Set up a health insurance exchange(s) for individuals and small firms to purchase health insurance

• Determine eligibility and enrollment mechanisms for Medicaid and private insurance subsidies [through health exchange(?)]

• Ensure that comparative information is transparent, understandable and accessible to end users

• Experiment, experiment, experiment … new models for delivering integrated whole person health care, new payment mechanisms that reward health outcomes, community innovations in health care delivery

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Establishing a Health Insurance Exchange—the “shopping mall” for health insurance

• All individuals and small employers will have access to an exchange, either established by the state or federally administered

• Colorado (HCPF) just received a 1-year planning grant from the federal government to plan the details of Colorado’s Exchange, stay tuned and stay involved!

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372,000 uninsured Coloradans will be subject to the individual mandate


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Over 13 percent of uninsured Coloradans subject to the individual mandate have no adult family member employed


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Working Coloradans (not offered ESI) subject to the individual mandate by size of employer


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HB 09-1293: Child coverage expansions

• On May 1, 2010, the Colorado Healthcare Affordability Act (HB09-1293) raised eligibility for low-income children from 205% of the federal poverty level (FPL) to 250% of FPL*

• CHI estimated that 11,953 children will become eligible for CHP+ under the state expansion (2008)

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* In 2009, the FPL for a family of four was $22,050

Medicaid expansions, uninsured working-age adults (ages 19-64 yrs) in Colorado, 2008

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Source: CHI analysis of the 2008 American Community Survey, U.S. Census Bureau

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• Please insert map 10 (without map 10 in title) with safety net layer on top of it.

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THE CARE CONTEXT: Access to care for the medically underserved in Colorado after health reform—Where will access to care be most challenged? Will quality be a part of the equation? Who will provide it?

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• Insert map 3 from scopes of care report

• PC Workforce (physicians and APNs overlayed with pop. below 200% of FPL)

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A Presentation of the Colorado Health Institute1576 Sherman Street, Suite 300Denver, Colorado 80203-1728www.coloradohealthinstitute.org@CoHealthInst (Twitter)

Quality improvement initiatives

A multi-faceted approach to promote clinical quality improvement

1)Expand use of quality metrics and use of quality data

2)Quality improvement and patient safety

3)Care coordination and health services delivery reforms

4)Quality improvement reforms across all payers, private insurers, Medicare and Medicaid

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Care coordination initiatives

• Grants to promote community health teams to support patient-centered medical homes

• Grants to develop medication management programs for chronic disease patients

• Grants to facilitate shared decision-making in treatment planning between patients, caregivers and clinicians

• Demonstration programs for community patient navigator programs

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Improving access to health care services

• Reauthorizes/increases federally qualified health centers (FQHCs) grants to $11 billion (FY2011-FY2015)

• Review of criteria for designating medically underserved areas/populations (MUAs/MUPs) and health professions shortage areas (HPSAs)

• Authorizes a grant program for the development and operation of school-based health centers

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Maternal and child health provisions

Three new grant programs:• Early childhood home visitation programs

($1.5 billion for FY2010-FY2014)• Pregnancy Assistance Fund – ($250

million for 10 years)• Post-partum depression services ($15

million for 5 years)

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So, what are the challenges and opportunities for fulfilling the Promise??

Be diligent in ensuring the coverage expansions and subsidies occur in a way that is equitable, inclusive and promotes the dignity and individual responsibility of all Coloradans– Can we work as a state to de-couple

Medicaid from welfare?– Can we ensure that all individuals subject

to the individual mandate get the information they need to make responsible decisions?

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Acknowledgements

• CHI served as administrator of 2008-09 Colorado Household Survey working in partnership with the Colorado Department of Health Care Policy and Financing

• Survey funded by The Colorado Trust

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Questions?

Please contact:Pam Hanes, PhDPresident and CEO [email protected] x221

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mailto:[email protected]

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Fulfilling the promise of coverage and care for the medically underserved