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STATE STRATEGIES TO EXPAND OR MAINTAIN HEALTH CARE COVERAGE Presentation to the Citizens’ Health Care Working Group May 12, 2005 Linda T. Bilheimer, Ph.D.

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Presentation on theme: "STATE STRATEGIES TO EXPAND OR MAINTAIN HEALTH CARE COVERAGE Presentation to the Citizens’ Health Care Working Group May 12, 2005 Linda T. Bilheimer, Ph.D."— Presentation transcript:

1 STATE STRATEGIES TO EXPAND OR MAINTAIN HEALTH CARE COVERAGE Presentation to the Citizens’ Health Care Working Group May 12, 2005 Linda T. Bilheimer, Ph.D.

2 Overview  Variation in nature of the problem among the states  Strategies affecting private health insurance  Public program strategies  Impact of current fiscal constraints  Future directions

3 Variation in the Uninsured Problem Among States *U.S. estimates are for Source: Kaiser Commission on Medicaid and the Uninsured, statehealthfacts.org. Estimates based on pooled data from the 2003 and 2004 March Supplement to the Current Population Survey.

4 Variation in the Relative Size of the Poverty Population Among States Source: U.S. Census Bureau, Income, Poverty and Health Insurance Coverage in the United States: Estimates from the 2003 and 2004 Current Population Survey, Annual Social and Economic Supplements.

5 Efforts to Improve Availability and Affordability of Private Coverage  Underwriting and rating reforms in individual and small-group markets  Exemptions from mandated benefits  Group purchasing arrangements  Reinsurance  High-risk pools  Tax incentives

6 Expansions of Public Coverage: Income Eligibility  Focus on low-income children, following enactment of SCHIP in 1997  Most states at 200% FPL or above for Medicaid/SCHIP children, by July 2004  Expansions for low-income parents and other adults, in some states  Income eligibility standards generally much lower for adults

7 Variation in Medicaid Income Eligibility for Parents Source: Kaiser Commission on Medicaid and the Uninsured, statehealthfacts.org.

8 Expansions of Public Coverage: Facilitating Enrollment  Outreach  Simplification of enrollment and re- enrollment processes  Coordination among public coverage programs

9 Strategies for Enrolling More Children in Medicaid/SCHIP, April 2003  No interview at renewal (49 states)  No interview at application (46 states)  No asset test (44 states)  12-month renewal period (41 states)  12-month continuous eligibility (14 states)  No income verification by family (12 states)  Presumptive eligibility in Medicaid (8 states) Source: Donna Cohen Ross and Laura Cox, “Preserving Recent Progress on Health Coverage for Children and Families: New Tensions Emerge,” Kaiser Commission on Medicaid and the Uninsured, July 2003.

10 Effects of Economic Turndown on State Medicaid Programs  Reductions or slower growth in state revenues  Counter-cyclical enrollment growth in Medicaid

11 Recent Rapid Growth In Medicaid Enrollment Source: Eileen R. Ellis, Vernon K. Smith and David M. Rousseau, Medicaid Enrollment in 50 States: June 2003 Data Update. Kaiser Commission on Medicaid and the Uninsured, October 2004.

12 Effects of Recession on Coverage of Children and Adults Employer Medicaid/SCHIP Other Uninsure d Source: Urban Institute estimates from the 2001 and 2004 March Supplement to the Current Population Survey.

13 Medicaid’s Fiscal Burden on the States Source: National Association of State Budget Officers, 2003 State Expenditure Report.

14 State Attempts to Control Costs and Maintain Coverage (1)  Scaling back eligibility (MO, TN)  Cutting optional benefits (vision, dental, podiatry, Rx)  Freezing or cutting provider payments  Initiating or increasing premiums and cost-sharing  Shifting more beneficiaries into managed care  Restructuring benefits, to expand limited coverage to a broader population (UT, NJ, OR, MI)  Using Medicaid to help low-income workers pay employer premiums (ID, OR, MI, NM)

15 State Attempts to Control Costs and Maintain Coverage (2)  Shifting care from hospitals and nursing homes to home settings (NY)  Restructuring public coverage programs, with beneficiary incentives to control costs, adopt healthy behaviors (FL, SC)  Restructuring health care system in the state (ME, MA )

16 HRSA Grantees: A Look at the Future?  , State planning grants (SPGs) to study demographic and health insurance trends  More recently, pilot planning grants (PPGs) to:  Plan for implementation of policy option  Test option among population subgroup  Implement plan  SPG research findings: large majority of uninsured are workers or their dependents  Focus on employment-related strategies

17 Other Strategies Explored by SPG Grantees  Outreach to eligible unenrolled people  Expansions of public coverage to adults  Health savings accounts  Single-payer and multipayer universal coverage models

18 PPG Strategies  “Three-share” models to subsidize employer premiums (DE, GA, IL)  Other premium subsidies for employer coverage (CT, IN, OK, KS)  Purchasing pools (IL, OK, VI)  Reinsurance mechanisms (IL, KS)

19 Growing State Interest in Employer Mandates Legislation Pending as of March 2005  Employer mandates (10 states)  Conditioning state contracts and business tax breaks on covering employees (11 states)  Reporting on employees enrolled in Medicaid and SCHIP (20 states) Source: HR Policy Association, Policy Brief, April 1, 2005.

20 Governors’ Proposals for Medicaid  Restructure the Medicaid program with different benefits for different sub- populations  Relatively healthy, low-income people  SCHIP model, with different benefits & cost-sharing for different groups  Ability to coordinate with tax credits, employer buy-ins, etc.  Disabled  More consumer choice, with focus on improving quality  Elderly  New alternatives for financing long-term-care (LTC) and end-of-life care  Slow the growth of low-income people becoming Medicaid eligible  Refundable individual tax credits  Employer tax credits  State purchasing pools  Reinsurance or other risk-sharing models for insurers  Slow the growth of Medicaid long-term care (LTC) spending  Tax subsidies for LTC insurance  LTC partnerships


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