1. The Cost of Health Insurance Coverage in New York James R. Tallon, Jr. United Hospital Fund October 25, 2005

2. 2 Profile of the Uninsured in New York State, 2002-2003  2.9 million are uninsured, nearly one in five.  The uninsured in New York are largely:  Low-income (63%)  Adults (83%)  Workers and their dependents (78%)  Working in small firms (54%) Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement. Tabulations prepared for the United Hospital Fund by the Urban Institute. Note: Data are for 2002 and 2003 and include persons below age 65. Low income is defined here as no greater than 200% of the federal poverty level (FPL). Adults are defined as persons aged 19-64. Workers include persons aged 19-64 who work full- or part-time and self-employed workers. Small firms are defined as those with fewer than 25 workers and include self-employed workers.

3. 3 Eligibility for an Employer-Sponsored Coverage Offer Among Uninsured Workers, New York State, 2001 More than eighty percent of uninsured workers do not have access to employer sponsored coverage. 1.3 million uninsured workers Source: Urban Institute tabulations of a merged file of the 2001 February and March Current Population Surveys, prepared for the United Hospital Fund.

4. 4 Eligibility for an Offer, By Income of Workers New York State, 2001 Low-income workers are least likely to be offered and eligible for coverage by their employer. Source: Urban Institute tabulations of a merged file of the 2001 February and March Current Population Surveys, prepared for the United Hospital Fund. Note: Data includes workers age 19-64 who work part-time or full-time and excludes self-employed workers. Low income is defined here as no greater than 200% of the federal poverty level (FPL),

5. 5 Workers Eligibility for an Offer By Firm Size New York State, 2001 Workers in small firms are far less likely to be offered and eligible for coverage by their employer. Source: Urban Institute tabulations of a merged file of the 2001 February and March Current Population Surveys, prepared for the United Hospital Fund. Note: Data includes workers age 19-64 who work part-time or full-time and excludes self-employed workers. Small firms are defined as those with fewer than 25 workers.

6. 6 Between 2000 and 2003, rates of public health insurance coverage increased, offsetting declines in employer-sponsored coverage. As a result, the uninsured rate in New York State remained stable. Distribution of Health Insurance Coverage Among the Non-elderly New York State, 2000-2001 and 2002-2003 2002-2003 2000-2001 N = (in millions) Source: March 2001, 2002, 2003 and 2004 Current Population Survey, Annual Social and Economic Supplement. Tabulations prepared for the United Hospital Fund by the Urban Institute. Note: Data are for 2000-2001 and 2002-2003 and include all persons below age 65. Numbers may not add to 100% due to rounding. *Change from the previous year is statistically significant at the.05 level. * 10.1 0.60.72.72.93.0

7. 7 New York’s uninsured rate fell below the national average in 2004. Uninsured Rates Among the Non-elderly, New York State and United States, 2004 Source: US Census Bureau, Current Population Survey, 2005 Annual Social and Economic Supplement. Note: Data are for 2004 and include all persons below age 65.

8. 8 Range of Monthly Insurance Premiums, Individual Coverage New York City and Albany, January 2005 $1,000 United $620 Atlantis $707 GHI $409 HIP $209 HealthNow $158 Empire BC/BS $972 MVP $651 Empire BC/BS $851 MVP $380 Empire BC/BS $257 HIP $182 Atlantis New York City Albany Source: Premium data compiled from United Hospital Fund tabulations of New York State Insurance Department data. Note: Healthy New York premiums include prescription drug coverage.

9. 9 $2,604 MVP $1,695 GHI $1,999 United $1,505 Oxford $3,000 United $1,856 Atlantis $785 HIP $547 Atlantis $2,280 MVP $1,140 EmpireBC/BS $593 HealthNow $467 GHI Range of Monthly Insurance Premiums, Family Coverage New York City and Albany, January 2005 New York City Albany Source: Premium data compiled from United Hospital Fund tabulations of New York State Insurance Department data. Note: Healthy New York premiums include prescription drug coverage.

10. 10 Average Monthly Employer-Sponsored Insurance Premiums Individual Coverage, New York State, 2003 Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, 2003 Medical Expenditure Panel Survey-Insurance Component. (2-50 workers) (50+ Workers)

11. 11 Average Monthly Employer-Sponsored Insurance Premiums Family Coverage, New York State, 2003 Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, 2003 Medical Expenditure Panel Survey-Insurance Component. (2-50 workers) (50+ Workers)

12. 12 Two-Year Growth in Average Employer-Sponsored Insurance Premiums, Individual Coverage, New York State and the United States, 2001-2003 and 2003-2005 Source: “Employer Sponsored Health Insurance in New York: Findings from the 2003 Commonwealth Fund/HRET Survey,” The Commonwealth Fund, May 2004. and Kaiser Family Foundation/HRET Employer Health Benefits, 2005 Annual Survey. Data includes all firm sizes and all types of plans. Note: Data refer to the percentage change in premiums over two years.

13. 13 Two-Year Growth in Average Employer- Sponsored Insurance Premiums, Family Coverage, All Firm Sizes, New York State and United States, 2001-2003 and 2003-2005 Source: “Employer Sponsored Health Insurance in New York: Findings from the 2003 Commonwealth Fund/HRET Survey,” The Commonwealth Fund, May 2004. and Kaiser Family Foundation/HRET Employer Health Benefits, 2005 Annual Survey. Data includes all firm sizes and all types of plans. Note: Data refer to the percentage change in premiums over two years

14. 14 When compared to a low-wage worker’s annual income, health insurance in New York City is costly. $15/hr.$7/hr. Annual Income vs. Average Annual Premiums, Individual and Family Coverage, Direct Pay and Employer-Sponsored Insurance, New York City, 2003 Individual Coverage Family Coverage Annual Income Source: Premium data compiled from United Hospital Fund tabulations of December 2003 New York State Insurance Department data and “Employer Sponsored Health Insurance in New York: Findings from the 2003 Commonwealth Fund/HRET Survey,” The Commonwealth Fund, May 2004. Note: Direct Pay average premium is for HMO coverage, employer premium data is for all types of plans.

15. 15 Characteristics of health insurance to consider in the discussion of coverage affordability: Health insurance in New York is principally comprehensive coverage. New York State insurance laws require open enrollment and community rating for firms with 50 or fewer employees. Health insurance is costly because it reflects underlying characteristics of our health care system. HCRA add-ons such as Graduate Medical Education and bad debt charges are built into premiums. Profit and administration are built into premiums. Pooling health insurance risk helps to make coverage more affordable.

16. 16 Uninsured rates increase as the cost of health insurance consumes a larger percent of income Note: Refers to percentage uninsured among workers and per capita health spending divided by median income, 1979-2002. Source: Gilmer and Kronick, “It’s the Premiums, Stupid: Projections of the Uninsured Through 2013.” Health Affairs Web Exclusive, April 5, 2005.

17. 17 Note: Figure based upon percentage of people eligible to participate in Medicaid who enroll. Probabilities of enrollment initially based upon the percentage of people without insurance who purchased non-group coverage by family income as a percentage of income. Source: Lewin Group estimates. Participation rates in subsidized insurance programs decline rapidly as the cost of coverage consumes a larger share of income. Estimated Percentage of People Who Will Take Subsidized Coverage by Premium Cost as a Percentage of Family Income

18. 18 To solve the problem of the uninsured, we must resolve the mismatch between the cost of coverage and the resources of low-income New Yorkers. It is estimated that those with low-incomes can afford to spend–-at most—5% of their income on health insurance. For someone earning $30,000 per year, this means spending $125/month on health insurance. The unsubsidized cost of coverage in New York is much higher than what low-income New Yorkers can afford.

19. 19 % of Federal Poverty Level (FPL) Public Assistance Need Standard (varies by county) 200% 133% 250% ** 87% 100% 150% 250% ** 200% Infants Children Age 1-5 Pregnant Women Parents † Childless Adults †† New York State Eligibility Rules for Medicaid, Child Health Plus, Family Health Plus, and Healthy New York* Employed Individuals Small Business 208% No Ceiling Children Age 6-18 *** 100% 250% **

20. 20 *Medicaid and Child Health Plus A, and Healthy New York eligibility are expressed in net income while Child Health Plus B and Family Health Plus eligibility are expressed in gross income, as written in HCRA 2000 and Medicaid law. The 2005 Federal Poverty Level (FPL) is $9,570 for an individual. ** Children with gross family income above 160% FPL are charged an income-related premium. Premiums for children with gross family income between 160-222% FPL are $9/month/child up to $27; for children with gross family income between 223-250% FPL premiums are $15/month/child up to $45. ***Through March 2005, the Child Health Plus A eligibility level for children ages 6-19 was 133% FPL. Effective April 2005, the Child Health Plus A eligibility level for children ages 6-19 years was lowered to 100%FPL, at which time children in that age range with gross family income between 100%FPL and 133% FPL who had been enrolled in Child Health Plus A were shifted into Child Health Plus B. † “Parent” is defined as a parent of a child under 21 years who lives in the household. Medicaid eligibility includes disabled adults and 19- and 20-year-olds up to 87% FPL. FHP eligibility includes 19- and 20- year-olds living with their parents up to 150% FPL. †† “Childless adult” is defined as a non-disabled adult aged 21 years and over who does not have a child living in the household. FHP eligibility includes 19- and 20-year-olds not living with their parents up to 100% FPL. Note: Low-income, uninsured women who are diagnosed with breast or cervical cancer through screenings in New York’s Healthy Women Partnerships program are eligible for Medicaid coverage. Women must have income levels below 250% FPL to qualify for the screenings. Females and males of childbearing age with income up to 200% FPL are eligible for Medicaid Family Planning Services. As of July 2003, disabled workers aged 16-64 with net income of up to 250%FPL and non-exempt resources up to $10,000 are eligible for Medicaid coverage through the Medicaid Buy-In for Working People with Disabilities program (MBIWPD); enrollees with incomes above 150% FPL will eventually be subject to an income-related premium. Notes to New York State Eligibility Chart