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New Mexico Health Choices Market-based universal coverage.

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Presentation on theme: "New Mexico Health Choices Market-based universal coverage."— Presentation transcript:

1 New Mexico Health Choices Market-based universal coverage

2 An unhealthy cycle Employers and individuals have seen premiums increase 10-20% a year since 2000 Around 400,000 New Mexicans have no health insurance Doctors and hospitals are forced to overcharge some patients to make up for those who cannot pay

3 NM Health Choices 1.3 - LHHS 3 Why so many uninsured? Low-wage jobs, seasonal, contract and part-time work, rural unemployment, prevent many New Mexicans from getting medical insurance. Premiums are not affordable Employment-based insurance cannot reach everyone Many just don’t want to pay for health insurance Family medical insurance costs $10,000 – one quarter of a typical household income. Businesses that offer high benefits get higher costs, less profit than their competitors. 100,000 uninsured say they’re healthy or have access to healthcare anyway. Some businesses believe that health insurance is not their responsibility.

4 NM Health Choices 1.3 - LHHS 4 So then health insurance must be… Small tax rebates, purchase pools, high deductibles are not enough. Individual payments must be scaled with personal income. Businesses must pay less for PT/short- term workers. Affordable Benefits should survive changes in job situations and family status, even local economic downturns. Separate from employment Everyone already has a right to healthcare: now everyone must have an obligation to pay their fair share. Required

5 Concepts

6 NM Health Choices 1.3 - LHHS 6 Proposal goals Health insurance for all New Mexicans Bringing public spending under control Improving healthcare quality & safety Fair financing Reducing premiums and administrative costs Phasing out employer-based insurance Limiting the role of government Helping businesses and our economy … and Feasibility Improving consumer choice & cost awareness NMHC Score

7 NM Health Choices 1.3 - LHHS7 Market-based universal coverage means everyone gets health insurance. Universal Coverage Market-Based means consumers purchase their own health insurance plan from commercial carriers. A balanced mix of existing public funds, mandatory employer and individual contributions, and voluntary supplements makes the system flexible and affordable. Proposal solution

8 NM Health Choices 1.3 - LHHS 8 The proposal is NOT… A single payer plan. The government does not decide benefits, administer claims, set provider prices or interfere with facility budgets. An entitlement program. The government does not make qualitative benefit commitments which can easily cost more than predicted. Benefits are known dollar amounts, determined annually based on revenue projections. Simply universal access to care, which can be achieved with a safety net of public facilities or indigent care funds. Universal coverage grants everyone rightful access to all our high-quality healthcare facilities, without needing any government intervention. A complete solution to rising costs. Other initiatives focusing on quality of care, public health research & education, IT, administrative costs, medical recruitment etc., must complement this plan.

9 NM Health Choices 1.3 - LHHS9 How does it work? Employer Healthcare Contribution Individual Healthcare Contribution Existing State + Federal Funds Statewide Healthcare Account Personal HSAs Insurers Health Plans Disabled, Long-term care & Special programs Allocated non-cash credit + Personal dollars

10 NM Health Choices 1.3 - LHHS 10 Benefit allocation Money collected for healthcare financing is redistributed to individuals in the form of non-cash credits to purchase commercial health insurance. Standard benefit allocations would allow buying low-cost HMO-type plans or higher-deductible indemnity plans. Low-income families need a higher benefit allocation to buy more comprehensive, low-coinsurance plans. When possible they should enroll in Medicaid to maximize federal funding. Individual choices: buying a basic plan at no additional cost; upgrading coverage by paying supplements; or getting a cheaper high-deductible plan and placing the difference in a tax-free Healthcare Savings Account.

11 NM Health Choices 1.3 - LHHS11 Source: US Census Bureau, CPS March 2004, NM Population 0-64 by household income

12 NM Health Choices 1.3 - LHHS 12 Enrollment  An annual benefit enrollment period is held before the start of the fiscal year  A central web site or portal, printed materials, phone lines, the press and local volunteer groups help insurance buyers compare plans side by side.  Enrollment is tracked in a central database to ensure that everyone is assigned the correct credit amount, and has selected a plan or is automatically enrolled in one.  Monthly updates track new and departed residents and other changes.

13 NM Health Choices 1.3 - LHHS 13 Insurance offering requirements All products are community-rated with no cherry picking. To maximize choice, savings and economic benefits there may be:  Offer presentation requirements (geographic zones, price categories, disclosures, add-ons)  Minimum and maximum out-of-pocket costs  Anonymous claim utilization reports for public health analysis and to help track/manage costs  Uniform penalties for costly behavior  Standardized, rapid enrollment procedures  Limits on advertising and marketing expenses  New Mexico-based personnel requirements

14 Funding


16 NM Health Choices 1.3 - LHHS 16 Existing funding sources  Medicare funding and benefits are unchanged  Medicaid federal funding ($1.9 billion + $0.7 billion in state funds) is our largest resource and must be preserved or expanded. New revenues and centralized enrollment allow the state to maximize existing waivers or request new ones.  Some state health program funds can be redirected to the Statewide Healthcare Account. Some city & county money is freed for tax cuts or local use.  Federal grants & IHS funds: TBD (est. small cut) ALL NUMBERS ARE PRELIMINARY ESTIMATES

17 NM Health Choices 1.3 - LHHS 17 Business Healthcare Contribution  Recommended: a fixed dollar amount per employee hour with rates tiered by company size. For example: - Private & non-profits under 100 employees: $1.00 - 100-499 employees: $1.15 - 500+ employees: $1.30 - State & local governments: $1.50 Yields $1.9 billion (incl. $0.5 billion from governments)  Optional: index these amounts for inflation  Alternative 1: a percentage rate on total payroll (6%-7.50% tiered rates would yield the same revenue). Helps low-wage employers, but discourages businesses from raising wages.  Alternative 2: a low percentage of gross income (revenue minus cost of goods sold). Helps labor-intensive industries, but may be more difficult to put in place. ALL NUMBERS ARE PRELIMINARY ESTIMATES

18 NM Health Choices 1.3 - LHHS 18 Individual Healthcare Contribution  Medicare & other federal beneficiaries are exempt.  Recommendation: low flat percentage of total personal income with low-income exemption (insufficient data).  Next best: 3% flat adjusted gross income tax on all residents except under 100% of FPL = $650 mil (exemption cost $70 mil)  Optional: cap on income tax (e.g. $3000, cost $120 mil)  Alternative: based on taxable income with higher progressive rates (e.g. 0% under $11,000, 6% above yields same revenue as 3% AGI with exemption) ALL NUMBERS ARE PRELIMINARY ESTIMATES

19 NM Health Choices 1.3 - LHHS 19 Possible revenue complements The following are options, not recommendations.  General sales tax: 1% raise yields $320 million  Alcohol/tobacco taxes: increasing cost of alcohol and tobacco products by 25% yields $100 million  Repealing 50% capital gains exemption: $25+ million  Property taxes: not recommended  Oil & gas windfall may help cover short-term costs of transition, not ongoing costs ALL NUMBERS ARE PRELIMINARY ESTIMATES

20 Other Proposal Benefits

21 NM Health Choices 1.3 - LHHS 21 Anticipated savings Estimated savings of $400 million, or 6% of non- Medicare spending, include:  Reduced overhead in state programs  Reduced benefit administration costs for employers  Reduced insurance plan administration  Reduced provider administration (eligibility, COB)  Reduced broker commissions They are hard to quantify, but let’s not forget:  Physical & mental health benefits for formerly uninsured ALL NUMBERS ARE PRELIMINARY ESTIMATES

22 NM Health Choices 1.3 - LHHS 22 Information technology opportunities  Electronic verification of benefits and treatment authorizations  Routing claims through a common clearinghouse, potentially: -Populating electronic health records of willing patients -Automating real-time public health data collection -Better detecting fraud based on utilization patterns -Analyzing cost drivers to anticipate demand, develop targeted provider and public education efforts -Encouraging electronic claims, reducing errors & data entry by auto-populating patient info from enrollment Having a single enrollment system and unique patient identifier can facilitate industry-led healthcare IT initiatives = Huge potential for less cost & better care

23 NM Health Choices 1.3 - LHHS 23 Economic development benefits  Healthcare is already the largest employer and B2B customer in many areas of the state.  Greatly reduced uncompensated care will help doctors stay in New Mexico.  Higher demand will drive increased hospital investment.  An expanding healthcare infrastructure will help attract retirees, their pensions and their families.  Reduced healthcare costs, risks and hassles will help attract large and medium-size businesses, with a multiplier effect on local small businesses.  Healthcare coverage reduces personal bankruptcies  It improves workforce mobility and productivity

24 NM Health Choices 1.3 - LHHS24 What’s next?  Validate economic models, update cost estimates.  Set up advisory groups for stakeholders to refine the proposal and help solve technical issues (insurance product design, Medicaid integration, revenue collection, Indian and rural health issues, information technology).  Governments, legislators, employers, providers, insurers, brokers, tribes, unions, consumers, retirees should be involved.  Prepare for a public education campaign. Objective: developing consensus legislation by 2007 2005-2006: Creating & funding a non-profit organization to: New Mexico Health Choices Initiative

25 NM Health Choices 1.3 - LHHS25 We can do this!

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