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Expanding Health Insurance Coverage James R. Tallon, Jr. President, United Hospital Fund Bipartisan Congressional Health Policy Conference January 13,

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Presentation on theme: "Expanding Health Insurance Coverage James R. Tallon, Jr. President, United Hospital Fund Bipartisan Congressional Health Policy Conference January 13,"— Presentation transcript:

1 Expanding Health Insurance Coverage James R. Tallon, Jr. President, United Hospital Fund Bipartisan Congressional Health Policy Conference January 13, 2007

2 Three questions in expanding health insurance coverage: 1.Who pays? 2.Is it voluntary or mandatory? 3.How is the program designed? Public vs. private Federal vs. state roles Pooling risk Benefit package Cost control features

3 UHF-Commonwealth Fund Blueprint for Universal Coverage Principles for Reform: Access and affordability for all Administrative simplicity Stability of coverage Shared responsibility Continuity with existing programs Choice Pooled risk Efficiency and quality

4 Blueprint Building Blocks Public Programs –Simplification –Eligibility Expansion –Family Health Plus “Buy-In” Purchasing Entity –Administer the Family Health Plus “buy-in” –Make coverage available to individuals at group rates Mandates –Two versions of employer assessment for those not providing coverage –Individual mandate, with income protection

5 Comparing Massachusetts and New York Prior to Reform New York has a larger share of low-income people and a larger share of uninsured low-income people New York has a lower rate of employer-sponsored insurance New York has a larger eligible but uninsured population (41% vs. 23%)

6 51% 19% 15% 43% Current DistributionPost-Reform: Public Changes Employer- Sponsored 8.3 m Employer- Sponsored 9.7 m Distribution of Health Insurance Coverage, Before and After Reform: Combined Public Program Changes Note: “Post-Reform” scenario includes the combined administrative simplification, expansion of Family Health Plus to 150% FPL, and subsidized buy-in to Family Health Plus ( % FPL). “Medicare and Other Public” category includes dual eligibles and persons covered by CHAMPUS. Data include persons of all ages. Numbers may not sum to 100% due to rounding million people 2% 13% 2% 24% 8% 13% 10%.3 m 4.5 m.5 m 3.6 m 2.5 m 2.8 m 1.5m 2.5 m 2.0 m Medicaid/ FHP/CHP FHP Buy-In (through Insurance Exchange) Directly Purchased

7 43% 24% 10% 45% Post Reform: Public ChangesPost-Reform: Public Changes, Individual Mandate, Modest Employer Assessment Employer- Sponsored 8.7 m Employer- Sponsored 8.3 m Distribution of Health Insurance Coverage, Before and After Reform: Public Program Changes Alone Compared with Public Program Changes, Individual Mandate, and Modest Employer Assessment Note: “Public Changes” includes the combined administrative simplification, expansion of Family Health Plus to 150% FPL, and subsidized buy-in to Family Health Plus ( % FPL). “Medicare and Other Public” category includes dual eligibles and persons covered by CHAMPUS. Data include persons of all ages. Numbers may not sum to 100% due to rounding million people 2% 13% 2% 26% 12% 13% 2%.3 m 5.0m 1.5 m 4.5 m 2.5 m 2.0 m 2.2m 2.5 m.4 m Medicaid/ FHP/CHP Insurance Exchange Directly Purchased 8% FHP Buy-In (through Insurance Exchange) Directly Purchased.3m

8 Overview of Results Public program changes achieve a one-third reduction in the uninsured Significant subsidies are needed to gain participation and protection of low-income persons Universal coverage requires mandatory features –Employer mandates alone are not enough –Individual mandates are necessary for universal coverage

9 Spitzer Agenda Restructure: Close and consolidate certain hospitals Shift spending from institutional nursing homes to community and home-based care Negotiate lower prices for prescription drugs Aggressively fight Medicaid fraud Reinvest: Universal coverage for children (year one) Streamline enrollment in order to enroll eligible but uninsured adults (over 4 years) Better management of high-cost cases


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