Presentation on theme: "A Look At the Problem Cover the Uninsured Week 2005 National Advocacy Center of the Sisters of the Good Shepherd."— Presentation transcript:
A Look At the Problem Cover the Uninsured Week 2005 National Advocacy Center of the Sisters of the Good Shepherd
Covering the Uninsured I.Understanding the Problem Who are the uninsured? Why are they uninsured? Consequences of uninsurance and underinsurance II.Role of Public Programs Medicare, Medicaid and SCHIP – How do they work and who’s covered? Limitations of public coverage III.Exploring Solutions Catholic Social Teaching and the Good Shepherd context Principles for evaluating proposals First steps – Broad policy recommendations Legislative landscape – the good, the bad, and the political climate
I. Understanding the Problem
SOURCE for graph : Kaiser Commission on Medicaid and the Uninsured (KCMU)/Urban Institute 2004, Sums may not equal totals due to rounding. The United States has the highest health care spending of any country, yet we are the only major industrialized nation not to provide health insurance coverage for all. Despite health care expenditures in 2002 of $1.6 trillion or 14.9 percent of the gross domestic product, close to 44 million Americans went without health insurance for the whole year M40.9 M 43.3 M 44.7 M In Millions
Who Are the Uninsured? Mostly low and moderate income families and individuals Two-thirds of those without insurance have incomes less than 200% of poverty and over 80% come from working families Predominately adults Adults are roughly 80% of the uninsured population. Young adults (18-34) are more likely than older populations to be uninsured and uninsurance levels appear to decline with age Disproportionately from minority groups African-Americans are nearly twice as likely as non-Hispanic whites to be uninsured, and Latinos are three times as likely as non-Hispanic whites to lack coverage. The uninsured are a diverse and fluid population; however, there are some dominant characteristics:
Characteristics of the Uninsured, 2003 IncomeWork Status Total = 44.7million uninsured Age Note: Percentages may not total 100% due to rounding. SOURCE: KCMU and Urban Institute analysis of the March 2004Current Population Survey. (latest data available)
Faces of the Uninsured Family profile: Darrell and Mary have two children at home Employment: Mary is a home health aide and Darrell works at a fast food restaurant Location: Baltimore, MD Annual income: $26,400 (143% of the federal poverty level) Health insurance: whole family uninsured Mary and Darrell, Baltimore, MD Source: Kaiser Commission on Medicaid and the Uninsured (KCMU), Challenges and Tradeoffs in Low-Income Family Budgets, April 2004
Facing the Facts Discrimination exists in health coverage. More than a third of the Hispanic population and over a quarter of Native Americans are uninsured compared to 13% of whites. The uninsured rates among African Americans (21%) and Asian Americans (20%) are also much higher than that of whites. These differences are only partly explained by income disparities. (The Uninsured: A Primer, KCMU, Nov. 2004) Having a job does not ensure health insurance coverage. 27 million workers were uninsured in that year because not all businesses offer health benefits, not all workers qualify for coverage, and many employees cannot afford their share of the health premium (The Uninsured: A Primer, KCMU, Nov. 2004) These numbers don’t even take into account the number of underinsured individuals.
Reasons for Uninsurance Cost – Affordable coverage is difficult to find - insurance premiums continue to rise faster than earnings and inflation Lack of employer-sponsored coverage – individual coverage in the private market is even more expensive A small percent (5-6%) of the uninsured say they “don’t want” or “don’t need” coverage
Insurance Costs Employer-sponsored group plans cost on average $3,695 per year for individual coverage and $9,950 for family coverage in Since 2000, employer-sponsored health coverage premiums have increased by nearly 60 percent for family coverage. $9,950 $3,695 Source: Kaiser/HRET Survey of Employer- Sponsored Health Benefits: 2004.
Insurance is Unaffordable to Low and Moderate Wage Workers Over one-fifth of uninsured workers – 3.5 million people – are eligible for employer health insurance coverage but fail to take it up, largely because of the high cost of their share of the premium. Seventeen percent of workers making less than $10 an hour declined coverage, compared with 8 percent of those making $15 an hour or more. Employer based coverage has NEVER been able to fully cover all non-elderly Americans (Karen Davis, The Commonwealth Fund, Testimony before the House Ways and Means Committee, Jan. 2004) Without an employer’s contribution, a family insurance policy comparable to the average employer-based coverage in 2003 would consume over 25 percent of pretax family income for a family at 200 percent of the federal poverty level ($36,800 annually for a family of four in 2003). However, most directly purchased private plans are even more expensive than employer-based coverage and have more limited benefits and higher out-of-pocket costs.
Lack of Employer-sponsored Coverage In 2001, 64% of the uninsured were not offered benefits through their own job; 17% worked in firms that offered benefits, but they were not eligible for them. Health coverage also varies by industry and job type. (The Uninsured: A Primer, KCMU, Nov. 2004) Low-wage workers are half as likely as high-wage workers to have employer-provided insurance. Women low-wage workers are half as likely as male low-wage workers to have health insurance through their own employer. (Improving Access to Health Insurance, Heather Boushey and Marya Murray Diaz, CEPR, April 2004) The recent economic downturn and rising health costs have lead to an overall decline in employer-sponsored coverage. The share of non-elderly Americans with employer-sponsored health insurance decreased for the first time since 1993 in 2001, and decreased from 66% in 2000 to 62% by (The Uninsured: A Primer, KCMU, Nov. 2004)
Health care costs, especially prescription drug prices, are rising much faster than inflation and health insurance premiums are increasing at an even more rapid rate. Premiums rose 13.9 percent in 2003, faster than the 8.5 percent growth in health care costs and MUCH faster than the 2% inflation rate. The estimated premium growth rate for 2004 is 11.2% High Health Care Costs
Consequences of Uninsurance
For Individuals and Families Health Less access to a regular source of health care Fewer preventive and screening services Delaying or forgoing treatment and filling prescriptions Poorer health outcomes and higher mortality rates Delays in development for uninsured children Financial Higher out-of-pocket expenditures for health care services and higher charges for procedures Problems paying medical bills – credit history affected by medical debts Lower annual earnings as a result of poorer health Lower standard of living
Notes: *Experienced by the respondent or a member of their family. Insured includes those covered by public or private health insurance. Source: Kaiser Family Foundation, Kaiser 2003 Health Insurance Survey. Percent experiencing in past 12 months:* Barriers to Health Care by Insurance Status, 2003
Consequences For Communities Reduced access to and availability of health services, particularly hospital-based services and emergency/trauma care Higher taxes to pay for the costs of uncompensated care Greater burden on public health facilities, such as community health centers
Consequences For the Nation Uncompensated care costs were estimated to be about $41 billion for Public programs such as Medicare, SSI, and criminal justice likely face higher budgetary costs than they would if all Americans under 65 were insured Higher insurance premiums to help offset costs of uncompensated care Diminished public health, lower productivity, and increased mortality – a cost of between $65 and $130 billion per year (Institute of Medicine, Hidden Costs, Value Lost, June 2003)
60 million Uninsured individuals and members of their families have less financial security and increased life stress due to lack of insurance. 41 million Uninsured adults and children are less likely to receive preventive and screening services. All of them are at risk for the health consequences shown above. 8 million Uninsured people with chronic illness receive fewer services and have increased morbidity and worse outcomes. Acutely ill uninsured children and adults receive fewer and less timely services, leading to increased morbidity and worse outcomes. People living in communities with above average uninsurance rates are at risk for reduced availability of health care services and overtaxed public health resources. Breakdown of Consequences from the Institute of Medicine SOURCE: Institute of Medicine, Hidden Costs, Value Lost, June All Americans 18,000 die prematurely. The value of health capital foregone each year due to uninsurance is estimated at between $65 and $130 billion.
II. Role of Public Programs
Medicare Created in 1965, Medicare has ensured nearly universal coverage for Americans age 65 and older. One in seven Americans (41 million total) is covered by Medicare. Despite continuing debates about what benefits Medicare should provide, the adequacy of coverage, and how the program should be structured, Medicare is a major reason that seniors are only a small percentage of uninsured.
Medicaid Also created in 1965, Medicaid covers over 52 million people Medicaid primarily serves low-income children, people with disabilities, low-income elderly, and some low- income parents Medicaid is a complicated program because, unlike Medicare, it is run as a partnership between the federal and state governments with states given a lot of flexibility in deciding who to cover and what benefits to provide – There are essentially 50 different Medicaid programs. Medicaid pays for nearly 1 in 6 health care dollars; 43% of long-term care dollars in the U.S.; and over half of public mental health spending In 2003, Medicaid served 25 million children (roughly 25% of American children), 14 million adults (primarily in low-income working families), 5 million seniors, and 8 million people with disabilities. Source: KCMU, The Medicaid Program at a Glance, January 2005
Medicaid is an entitlement, meaning that anyone who meets eligibility requirements and enrolls is guaranteed coverage. The federal and state governments share financing of the program. The federal government “matches” state expenditures at a certain rate based on state per capita income. This federal matching percentage or FMAP varies from 50% to 77% (for every dollar states spend, they receive between roughly $1 and $3 from the federal government) Medicaid is more cost efficient than private insurance, but in some cases has higher per capita expenditures because its enrollees are in poorer health than those with private insurance Medicaid is limited in the amount of cost-sharing it can impose on beneficiaries
Who’s Eligible – The Basics Mandatory Pregnant women and children under age 6 with incomes under 133% of the Federal Poverty Level (FPL) Children ages 6 to 18 in families with incomes under 100% FPL Supplemental Security Income (SSI) recipients (adults and children with disabilities and the elderly) Parents in with dependent children in extremely low-income families Optional Low-income pregnant women and children with incomes above mandatory eligibility levels Certain “medically needy” populations Individuals age 65 or older at or below 100% FPL Additional low-income parents
Sandy Prisk is a certified nurse assistant and her husband Rob Prisk is a self-employed carpet layer in East Hartford, Connecticut. They have three children all under ten years old—Matthew 5, Jessica 8, Katie 10. Sandy and Rob know the importance of health coverage, but neither of them receives health insurance through work. Their children qualify for Medicaid because of the family’s low income. Medicaid covers sudden expenses such as emergency dental work or antibiotics for a throat infection Source: Faces of Medicaid, Kaiser Commission on Medicaid and the Uninsured, April 2004
Medicaid Benefits Physicians services Laboratory and x-ray services Inpatient hospital services Outpatient hospital services Early and periodic screening, diagnostic, and treatment (EPSDT) services for individuals under 21 Family planning and supplies Federally-qualified health center (FQHC) services Rural health clinic services Nurse midwife services Certified nurse practitioner services Nursing facility (NF) services for individuals 21 or over Prescription drugs Medical care or remedial care furnished by licensed practitioners Diagnostic, screening, preventive, and rehab services Clinic services Dental services, dentures Physical therapy Prosthetic devices, eyeglasses TB-related services Primary care case management ICF/MR services Inpatient/nursing facility services for individuals 65 and over in an institution for mental diseases (IMD) Inpatient psychiatric hospital services for individuals under age 21 Home health care services Respiratory care services for ventilator-dependent individuals Personal care services Private duty nursing services Hospice services “Mandatory” Items and Services“Optional” Items and Services
Note: Total expenditures on benefits excludes DSH payments. SOURCE: Kaiser Commission on Medicaid and the Uninsured estimates based on CMS, CBO, and OMB data, Total = 52 millionTotal = $252 billion * Medicaid Spending Breakdown, 2003
State Children’s Health Insurance Program (SCHIP) Created in 1997 to expand coverage to more low-income children – target population: children under 200% of FPL SCHIP is Not an entitlement - $40 billion block grant to states over 10 years through an “enhanced” matching rate to encourage states to participate States could choose to create a new program, expand Medicaid, or take a combined approach – so, programs vary from state to state In 2003, SCHIP covered roughly 4 million children nationwide.
Who’s Not Covered? Adults who are not disabled, pregnant, or elderly and have no minor children generally cannot qualify for Medicaid regardless of their degree of impoverishment. Nearly 13 million or 71% of low- income uninsured adults were ineligible for public coverage in 2002 including 5.3 million poor adults. A total of 8.2 million adults without dependent children and 4.6 million parents were uninsured and ineligible for public coverage. * Immigrants- With the passage of welfare reform in 1996, lawful permanent residents became ineligible for Medicaid until they reside in the country for at least five years. *Note: Low-Income is less than 200% FPL or $31,340 for a family of three and $18,620 for an individual in Medicaid also includes fully state-funded public coverage. Source: Urban Institute analysis of National Survey of America’s Families, 2002.
Problems Facing Medicaid and SCHIP Not all who are eligible are covered Medicaid and SCHIP have the potential to cover nearly all (96%) low-income uninsured children. However, complicated enrollment procedures, confusing eligibility requirements, and, in the case of SCHIP, limited funding have prevented full participation Remember that elephant? Medicaid costs have been increasing because of rising health care costs Many states have started implementing “cost control” measures, which are just euphemisms for cutbacks in coverage or reductions in eligibility State fiscal pressures State budget deficits over the past few years have made it difficult for them to maintain their share of program financing. Threats to cap funding at the federal level President Bush’s “block grant” proposal would combine Medicaid and SCHIP funding and place an overall limit on the amount sent to states each year
III. Exploring Solutions
Catholic Social Teaching Human Dignity Any politics of human life must work to resist the violence of war and the scandal of capital punishment. Any politics of human dignity must seriously address issues of racism, poverty, hunger, employment, education, housing, and health care. - Living the Gospel of Life, #22 Human Rights and Economic Justice Beginning our discussion of the rights of the human person, we see that everyone has the right to life, to bodily integrity, and to the means which are suitable for the proper development of life; these are primarily food, clothing, shelter, rest, medical care, and finally the necessary social services. Therefore a human being also has the right to security in cases of sickness, inability to work, widowhood, old age, unemployment, or in any other case in which one is deprived of the means of subsistence through no fault of one's own.- Peace on Earth, #11
The Common Good The very nature of the common good requires that all members of the state be entitled to share in it, although in different ways according to each one's tasks, merits and circumstances. For this reason, every civil authority must take pains to promote the common good of all, without preference for any single citizen or civic group. - Peace on Earth, #56 Where such social provisions as health and education are concerned, the common good requires a supervising authority that can step in with remedies as soon as deficiencies become apparent, rather than waiting until the logic of the market causes failing institutions to close, harming those who must still rely on them. - The Common Good and the Catholic Church's Social Teaching, #82
Option for the Poor "If someone who has the riches of this world sees his brother in need and closes his heart to him, how does the love of God abide in him?" (1 Jn 3:17). It is well known how strong were the words used by the Fathers of the Church to describe the proper attitude of persons who possess anything towards persons in need. To quote Saint Ambrose: "You are not making a gift of your possessions to the poor person. You are handing over to him what is his. For what has been given in common for the use of all, you have arrogated to yourself. The world is given to all, and not only to the rich."- On the Development of Peoples, #23 As followers of Christ, we are challenged to make a fundamental "option for the poor" -- to speak for the voiceless, to defend the defenseless, to assess life styles, policies, and social institutions in terms of their impact on the poor. This "option for the poor" does not mean pitting one group against another, but rather, strengthening the whole community by assisting those who are the most vulnerable. As Christians, we are called to respond to the needs of all our brothers and sisters, but those with the greatest needs require the greatest response. - Economic Justice for All (Pastoral Message), #16
Role of Government The complex circumstances of our day make it necessary for public authority to intervene more often in social, economic and cultural matters in order to bring about favorable conditions which will give more effective help to citizens and groups in their free pursuit of man's total well-being. -The Church in the Modern World, #75 As for the State, its whole raison d'etre is the realization of the common good in the temporal order. It cannot, therefore, hold aloof from economic matters. On the contrary, it must do all in its power to promote the production of a sufficient supply of material goods, "the use of which is necessary for the practice of virtue." It has also the duty to protect the rights of all its people, and particularly of its weaker members, the workers, women and children. It can never be right for the State to shirk its obligation of working actively for the betterment of the condition of the workingman. - Mother and Teacher, #20
Good Shepherd Context How does the Good Shepherd mission of reconciliation and justice relate to health care and the uninsured? What do we learn from Good Shepherd programs and from the people participating in them? + Our principle means is charity, that charity which should lead us to follow in the footsteps of the divine Shepherd and go in search of the poor sheep, who, having strayed from the fold of Jesus Christ, are becoming the outcasts of the world + Respect for people is recognizing them as children of God. + It is true sympathy that enables one to understand and to realize what another needs. -St. Mary Euphrasia
Principles for Moving Forward Health coverage should be universal – no one should be excluded on the basis of socioeconomic status or health condition. Health coverage should be affordable and sustainable for both individuals and families and society as a whole. The health of the nation and its populace are a shared responsibility and the burden of coverage must be distributed broadly. Health coverage should ensure equal access to high- quality care and a benefit package that includes, at a minimum: preventive and screening services, outpatient and hospital care, mental health services, and prescription drug coverage – delivered in a safe, timely, and patient-centered manner. The federal government must take a leadership role in facilitating coverage; the market had failed to resolve current inequities and state governments do not have the resources to fully implement current programs with sustained national investment. (From IOM Recommendations)
First Steps Passage of Legislation Directing Congress to Provide Health Care Access to all Americans It’s time Congress made a commitment to addressing the problem Mental Health Parity Mental health coverage is one of the largest gaps in health insurance. Protection and Expansion of Medicaid and SCHIP Let’s build on what we’ve already got while trying to find the best way to universal coverage. Public programs tend to be more efficient (less administrative cost), obtain better prices for services (volume buyer), and have more due process and consumer protections than private insurance
…and the WRONG prescriptions Medicaid/SCHIP “block grant” A block grant would turn Medicaid from an entitlement into a capped funding stream that would no longer be able to guarantee coverage for all who are eligible Current proposals for individual tax credits to purchase insurance Tax cuts do little or nothing for most of the uninsured. Many low-income uninsured owe no taxes in the first place and the tax credit is too small to purchase a plan in the private market. Health Savings Accounts (HSAs) HSAs primarily benefit healthier and wealthier individuals and undermine the principle of risk-sharing in insurance Current proposals for Association Health Plans for small businesses These would allow small businesses to band together to purchase insurance, but would exempt the plans from important regulations and provide more limited benefits
Missed Opportunities !!! Source: Universal Healthcare Action Network, Seeking Justice in Healthcare, April 2004