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K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 State Health Reform: Lessons for the Nation Jennifer Tolbert Principal Policy Analyst.

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Presentation on theme: "K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 State Health Reform: Lessons for the Nation Jennifer Tolbert Principal Policy Analyst."— Presentation transcript:

1 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 State Health Reform: Lessons for the Nation Jennifer Tolbert Principal Policy Analyst Kaiser Commission on Medicaid and the Uninsured Kaiser Family Foundation for Healthcare Leaders Forum Detroit Regional Chamber and Federal Reserve Bank of Chicago Detroit, MI March 31, 2009

2 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 1 SOURCE: KCMU and Urban Institute analysis of March 2008 CPS million Employer- Sponsored 53% Uninsured 15% Medicaid/ SCHIP 13% Private Non- Group 5% Medicare 14% Military/VA 1% 45.0 million uninsured Adults 36.1 Children 8.9 Health Insurance Coverage of the Total Population, 2007

3 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 2 IL Uninsured Rates Among the Nonelderly, by State, AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA TX FL AL 13-17% (19 states ) ≥ 18% (18 states) < 13% (13 states & DC) US Average = 18% NE SOURCE: Urban Institute and KCMU analysis of the March 2007 and 2008 Current Population Survey. Two-year pooled estimates for states and the US ( ).

4 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 3 Availability of Employer-Based Coverage Family Work Status of Uninsured, 2007 Total = 45 million uninsured 1 or More Full- Time Workers 69% No Workers 19% Part-Time Workers 12% * Estimates are statistically different from each other within category (p<.05) SOURCE: KCMU/Urban Institute analysis of March 2008 CPS; Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2007 Small Firms (3-199 workers) Large Firms (200+ Workers) Lower Wage Firms Higher Wage Firms Percentage of Firms Offering Health Benefits, 2007

5 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 4 Affordability of Health Coverage Family Income of Uninsured, 2007 Total = 45 million uninsured The federal poverty level was $22,050 for a family of four in SOURCE: KCMU/Urban Institute analysis of March 2008 CPS. $4,704 $12,680 Average Annual Premium Costs, 2008

6 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 5 Cumulative Changes in Health Insurance Premiums, Inflation, and Workers’ Earnings, Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), ; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, (April to April).

7 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 6 Role of Public Programs Total = 45.0 million uninsured *National median Medicaid income eligibility level for working parents in SOURCE: KCMU/Urban Institute analysis of March 2008 CPS. Adults without Children 21% <200% FPL 200% FPL + Federal Poverty Line (For a family of four is $22,050 per year in 2009) Nonelderly Uninsured, 2007 Median Medicaid/CHIP Income Eligibility Thresholds, 2008 Adults without Children 35% Parents 17%

8 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 7 Medicaid Enrollees are Poorer and Sicker Than the Low-Income Privately-Insured Percent of Enrolled Adults : Poor Health Conditions that Limit Work Fair or Poor Health SOURCE: Coughlin et al, “Assessing Access to Care Under Medicaid: Evidence for the Nation and Thirteen States,” Health Affairs, July/August Medicaid Low-Income and Privately Insured

9 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 8 Cutting Back Care Due to Cost Put off or postponed getting health care you needed Skipped a recommended medical test or treatment Not filled a prescription Cut pills or skipped doses of medicine Had problems getting mental health care Percent of nonelderly adults who say because of cost they or a family member has: SOURCE: Kaiser Health Tracking Poll: Election 2008, October 2008 (conducted October 8 – 13, 2008)

10 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 9 States Tackle Health Reform Initially, states focused on improving coverage through public program expansions and private market reforms As economy deteriorated, efforts broadened to address system reform –care coordination –system efficiency –quality improvement Most states remain committed to implementing coverage expansions

11 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 10 Public Program Expansions Expanding coverage for children –11 states pursuing universal coverage for children Raising Medicaid eligibility levels for parents (examples: Maryland, New Jersey) Using/expanding Medicaid waivers to cover childless adults (examples: Wisconsin, Minnesota) Using Medicaid funding to purchase private insurance (examples: Indiana, Vermont)

12 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 11 Employer Incentives and Requirements Partnering with small employers –three-share models to assist employers in offering coverage –tax incentives for small employers –state examples: Maine, Montana, Oklahoma, Tennessee Employer Section 125 requirements –Allows employees to pay premiums on a pre-tax basis Pay or Play requirements –Require employers to provide coverage to employees or contribute toward the costs of coverage –Massachusetts, Vermont, San Francisco

13 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 12 Pay or Play in San Francisco Upheld San Francisco requires employers to make defined contribution toward health care for employees 9 th Circuit Court of Appeals upholds requirement, saying no ERISA violation Implications for other states –cannot require employers to provide health coverage –must create universal coverage programs funded partly with employer assessments –cannot specify what employer coverage must look like to qualify for credit against the assessment

14 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 13 New Options for the Uninsured Premium subsidies for state-administered plans –Plans offered through contracts with private insurers –state examples: Connecticut, Massachusetts, Vermont Benefit plan redesign –Wellness plans: emphasize preventive care, with financial incentives for participation in wellness programs state examples: Maryland, Rhode Island –Low-cost plans: preventive benefit packages (usually include service limits and some do not cover hospitalizations) state example: Florida

15 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 14 Improving Access to Care Medical homes –link patients with provider teams responsible for coordinating full range of care –enhanced payment for care coordination Improving reimbursement for primary care Strategies to address primary care workforce shortages –Scope of practice for non-physician providers –Loan forgiveness programs

16 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 15 Improving System Efficiency and Quality Cost and quality transparency –require provider reporting of cost and quality data –comparison tools for consumers Inpatient quality initiatives –non-payment for “never” events –reporting of hospital-acquired infections Promoting HIT adoption –statewide HIT infrastructure and standards for EHRs –e-prescribing Provider payment reform???

17 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 16 Comprehensive Reform—The Massachusetts Model Individual Mandate –Mandate enforced through tax filings Employer Assessment –Employers with >10 employees that don’t offer coverage must pay $295 per employee per year Subsidized Coverage –Sliding scale subsidies for individuals <300% FPL –Full subsidies for those <150% FPL The Connector –Links consumers & small employers to insurance –Establishes affordability standards and certifies insurance products Medicaid Expansion to Children <300% FPL

18 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 17 Massachusetts Health Reform Successful in Improving Health Coverage SOURCE: Massachusetts Division of Health Care Finance and Policy, Health Care in Massachusetts: Key Indicators, November Total = 442,000 Newly Insured Commonwealth Care 40%

19 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 18 Minnesota: Focus on System Improvement Comprehensive reform passed May 2008 Expands MinnesotaCare to 250% PFL for childless adults Requires employers to establish Sec. 125 plans Provides tax credit for uninsured with access to Sec. 125 plans Requires care coordination for people with chronic conditions –Will establish standards for medical homes and pay care coordination fee Creates tools for comparing providers on cost and quality measures; available to providers and public Establishes “baskets of care” to promote transparency and payment reform Requires e-prescribing by 2011

20 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 19 Looking Forward Economic picture remains bleak –8.1% unemployment in Feb (up from 4.9% in Dec. 2007) –46 states facing budget shortfalls of $350 billion for the rest of 2009 through 2011 –Growing uninsured and increasing Medicaid and CHIP enrollment Federal legislation will help states –CHIP reauthorization: bonuses to enroll currently eligible children in Medicaid plus federal funding for expansions –American Recovery and Reinvestment Act: increased federal Medicaid matching funds for states Despite challenges, state continue to innovate and lead the way on health reform –many health reform strategies being discussed at national level are currently being tested in the states

21 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 20 For more information Coming soon… Health reform webpage on kff.org


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