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Understanding Uninsurance Celebrating Rural Georgia 2006 Karen J. Minyard, Ph.D., Georgia Health Policy Center Bill Custer, Ph.D., Georgia Health Policy.

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Presentation on theme: "Understanding Uninsurance Celebrating Rural Georgia 2006 Karen J. Minyard, Ph.D., Georgia Health Policy Center Bill Custer, Ph.D., Georgia Health Policy."— Presentation transcript:

1 Understanding Uninsurance Celebrating Rural Georgia 2006 Karen J. Minyard, Ph.D., Georgia Health Policy Center Bill Custer, Ph.D., Georgia Health Policy Center Fellow/Robinson College of Business Beverly Tyler, Georgia Health Policy Center/Georgia Health Decisions

2 Georgia’s Study of the Uninsured Five Years of Study (2000 – 2005) Regional Qualitative and Quantitative Data Learning about the market, opinions, impact and potential policies to affect positive change

3 Georgia’s HRSA State Planning Grant A Partnership among: –The Health Resources and Services Administration –The Governor ’ s Office of Planning and Budget –The Georgia Health Policy Center –Robinson College of Business: Department of Risk Management and Insurance –GSU Center for Health Services Research –Georgia Health Decisions –Community health networks in Atlanta, Brunswick, Dalton and Macon

4 Georgia’s HRSA State Planning Grant Survey of 10,000+ Georgia Households –Enabled modeling of the number of uninsured by location, income, and population characteristics that vary with insurance status Surveys of 2,000+ Georgia businesses in 2002 and 2004 regarding health benefits –Illuminated workforce characteristics and benefit availability Focus groups, public forums, and facilitated listening sessions with residents, key leaders, businesses, and government officials –Understanding attitudes and opinions

5 Georgia’s HRSA State Planning Grant Safety net assessment –Identified the availability of low-cost, sliding-fee, primary care services throughout the state Data analysis and coverage modeling with economic impact –Modeled policy options including Health Savings Accounts, Tax Credits, and High Risk Pools Four community-based pilots of public/private partnerships to expand coverage –Fostered development of four community-based plans that have the potential to reduce the number of working uninsured

6 Rural Development Council Increase local level awareness of the impact of the uninsured Capture rural Georgians’ opinions about policy options to reduce the number of uninsured

7 Community Forums 30 Community Forums 445 Participants –Company executives and small business owners –County commissioners and mayors –Hospital administrators –Physicians and nurses –Public health officials –Non-profit directors –Community volunteers

8 Celebrating Rural Georgia Capstone Module Sneak Preview of Results

9 Covering the Uninsured: A Community Perspective Federal Health Resources and Services Administration Georgia State Planning Grant Team

10 Possible Help for the Uninsured Encourage Change in What and How Health Insurance is Sold in Georgia –Change the regulations governing health insurance to make it more affordable and easier to purchase, such as: establish a high risk pool, allow association plans, promote health savings accounts, etc. Tax Incentives/Subsidies –Financially assist employers and/or individuals/families with the purchase of health insurance through direct payments or tax reductions.

11 Possible Help for the Uninsured Employer Mandates –Require employers of a certain size to offer coverage to their employees. Individual Mandates –Require uninsured individuals to purchase health insurance for themselves and their families, similar to car insurance mandates.

12 Possible Help for the Uninsured Public Expansion –Expand tax-funded programs such as Medicare, Medicaid, and PeachCare to cover more low-income Georgians. Single-Payer System –Establish a system that pays for the health care or health insurance premiums for everyone in Georgia. Do Nothing to Expand Health Insurance Coverage –Keep the current system as is.

13 United Health Foundation 2004 Rankings Georgia is –45 th in the nation in overall health status –Last in Public Health Spending –Last in Per Capita Health Spending –Tied for 6 th as the Most Obese State –4 th worst in Infectious Disease –Tied for 8 th worst in Premature Death –Tied for 7 th highest in Infant Mortality –Tied for 10 th worst in Cardiovascular Deaths

14 What Does Health Care Cost in Georgia? In total, Georgians spent almost $45 billion on health care in The average annual cost for employment-based family coverage is approaching $10,000 per year. Georgia’s Medicaid program cost $5.7 billion in 2003.

15 How Do Georgians Pay for Health Care?

16 Employer Coverage  Most Georgians with private coverage get it through their employer.  Large firms and firms located in urban areas are more likely to offer coverage.

17 Employer Coverage  Employer sponsored coverage is eroding:  3% decline in firms offering between 2002 and 2004  Most decline in coverage at firms with 25 to 99 employees  Most firms that do not offer coverage say it costs too much.

18 Who Are the Uninsured? About 1.5 million Georgians are uninsured. 2/3 of the uninsured work or are the dependents of full-time workers.

19 Who Are the Uninsured? Workers at small firms or who earn low wages are most likely to lack coverage. 71% of workers without coverage work for an employer who does not offer coverage, or they are not eligible for coverage when it is offered.

20 The Uninsured in Georgia Are : –More likely to report fair or poor health. –Less likely to receive preventive care. –More likely to miss school or work. –Less likely to have a usual source of care. –Sicker when they are admitted to the hospital. –More likely to be readmitted for same illness.

21 Poor Health Status and Being Uninsured Seem to be Related

22 How Do the Uninsured Get Care? The uninsured pay out-of-pocket for some of their health care services, but they pay more per unit of service because they do not receive the discounts that are given to insurance companies, Medicare, or Medicaid. The uninsured are more likely to delay seeking care, are less likely to get needed medications for chronic diseases, and are more likely to seek emergency care. Therefore, they access less care, on average, than insured individuals.

23 How Do the Uninsured Get Care? Hospitals that accept Medicare or Medicaid are required to treat and stabilize anyone who comes to their emergency rooms in a health crisis. Although the uninsured receive less care than those with coverage, the care provided to uninsured Georgians costs about $1.5 billion annually

24 Who Pays for the Uninsured?

25 People who pay more taxes and those who use more health care services pay more for the uninsured. A family of three with a household income of $50,000 pays about $800 annually toward the cost of the uninsured.

26 Everyone’s Healthcare is Subsidized Covering the uninsured is costly, but everyone shares in the cost of everyone else’s healthcare. Most employers pay a portion of their employees’ insurance premiums. Insured people who seldom go to the doctor subsidize the care of insured people who go to the doctor more often. Tax dollars, including those paid by the working uninsured, pay for the Medicaid and Medicare program.

27 Trade Offs to Consider Making adjustments to how we sell insurance will not disrupt the current system but will enable a relatively small number of Georgians to gain insurance. Tax credits and subsidies can help those with low incomes afford coverage. To be fair, they must be provided to all who are eligible - even those already insured; thus, the overall cost per newly insured is high

28 Trade Offs to Consider Employer mandates may decrease tax expenditures to cover the cost of the uninsured but may also result in lower take- home pay, and that effect may be greater for small employers than large employers. Mandating individual coverage would require major changes in the market to make insurance affordable and potentially increase the cost for sicker individuals due to reduced pooling of risks, but it might promote greater individual responsibility.

29 Trade Offs to Consider Public expansion may decrease health insurance premiums and out-of-pocket expenditures for everyone, but may also increase taxes for everyone. A single-payer system may eliminate health insurance premiums and out-of-pocket expenditures for everyone and increase access to primary care but will increase taxes and may reduce access to some types of specialized care.

30 Trade Offs to Consider Doing nothing does not disrupt the system but will result in continued health care cost inflation and more uninsured Georgians.

31 Covering the Uninsured: A Community Perspective Federal Health Resources and Services Administration Georgia State Planning Grant Team

32 Most Were Not Surprised by Information “I didn’t think any of it was surprising, but I didn’t know it. The statistics enlightened me.” Marietta Woman

33 They Say Cost is Primary Concern “It’s not the uninsured that’s causing the premiums to go up, or causing the high cost of pharmaceuticals, or causing physician cost and hospital cost and high technology cost.” Savannah man

34 They Say Cost is Primary Concern Overall cost of health care causes the problem of the uninsured Costs are out of control Drug companies and insurance companies make too much profit

35 They Say Cost is Primary Concern Technology contributes to cost Care at the end of life and an aging population adding to the problem Doctors practice defensive medicine Insurance mandates drive up cost of premiums

36 Many Do Not Think Market Forces Work in Health Care “When you go to the doctor, it’s the only place on earth where you don’t know what it’s going to cost you until you leave. You just can’t shop for your medical care like you can everything else.” Newnan Man

37 Many Do Not Think Market Forces Work in Health Care Cannot comparison shop Price does not drive demand – everybody wants everything regardless of cost Concept of supply and demand does not apply

38 They Believe Focusing on Prevention Would Decrease Costs “It would seem to be that we have to do something; not about educating people about their health care options, but about educating people about how not to be obese.” Thomson man

39 They Believe Focusing on Prevention Would Decrease Costs Health status of Georgians is unacceptable and contributes to cost Need more health education, particularly in schools Increase wellness programs offered by employers and insurance companies

40 They Promote Personal Responsibility “I think you area going to have to ask people to take some responsibility for their own health. You can’t let them have a lifestyle that causes the system to spend hundreds of thousands of dollars on them once they have reached the crisis stage.” Valdosta Man

41 They Promote Personal Responsibility Everyone should contribute to the cost of their own care Individuals must take responsibility for lifestyle choices Provide incentives for making healthier choices

42 Coverage for Uninsured Clouded by Other Issues “29% of those offered insurance do not take it. That number is worrisome.” Rome Woman “17% of documented uninsured is a big undercount of actual uninsured in the state. All of the undocumented residents just balloon that number even further.” Lawrenceville man

43 Coverage for Uninsured Clouded by Other Issues Too many of the uninsured do not see health insurance as a priority Uninsured use emergency rooms inappropriately for primary care Rural hospitals are struggling to survive

44 Coverage for Uninsured Clouded by Other Issues Associate problems with Medicaid with the uninsured Concerns about immigration add to confusion

45 But Some Say System is Unfair “Why is it costing somebody that is uninsured more than it’s costing somebody else?” Jonesboro Man

46 But Some Say System is Unfair Low income workers cannot afford insurance Uninsured are charged more for health services

47 They Are Frustrated By Options “I think we need to be a little more creative in our approach to solving these issues.” Macon Man

48 They Are Frustrated By Options Options are more of the same with nothing new being offered Want more details, particularly the cost/benefit of each option Do not want burden placed on business

49 They Are Frustrated By Options More open to discuss single payer as a solution It’s a complex issue A combination of approaches will be necessary

50 But Express A Sense of Urgency “Georgia has to make some changes fast.” Decatur Woman “The whole system is teetering on the brink of collapse.” Albany Man “You’d have to live under a rock not to know that there is a huge health care crisis.” Columbus Man

51 Is Health Care a Right? “The question is whether health care is a right versus something we all have a responsibility to pay for like groceries. That’s the fundamental question. Then, what right should exist? What level of health care?” Griffin Man

52 Understanding Uninsurance Celebrating Rural Georgia 2006 Karen J. Minyard, Ph.D., Georgia Health Policy Center Bill Custer, Ph.D., Georgia Health Policy Center Fellow/Robinson College of Business Beverly Tyler, Georgia Health Policy Center/Georgia Health Decisions


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