CHILDREN’S HEALTH CARE WHY MORE INSURANCE WON’T SOLVE THE PROBLEM OF THE UNINSURED: Georganne Chapin, MPhil, JD Hudson Health Plan Hudson Center for Health Equity & Quality
Presentation Delivered at the Conference on the Uninsured & Underinsured W ashington, DC December 11, 2007 draft – for final copy contact
POPULAR POSITIONS – 2007 The uninsured population is growing Something needs to be done At the least, all children deserve coverage More insurance is the answer
Sources of Insurance for Children Private coverage As dependents of insured parents Public coverage Medicaid SCHIP
INSTABILITY OF PRIVATE INSURANCE FOR CHILDREN Unstable parental employment Rising co-premiums for employer coverage Aging-out of employer-based plans
INSTABILITY OF PUBLIC INSURANCE FOR CHILDREN All-or-nothing income limits Lack of continuous coverage Barriers to recertification Administrative errors Change in residence “Churning”
PROBLEMS WITH INSURANCE Temporary nature Costs of underwriting Administrative costs Costs of regulation Cost of churning Adverse selection
INSURANCE IS TEMPORARY Limited eligibility periods Tension between policing the rolls (fraud phobia) and ensuring coverage & access
UNDERWRITING IS EXPENSIVE & REQUIRES: Predicting costs of care Paying costs of administration Ensuring adequate reserves Taxes Ensuring profits/surpluses Multiple layers of underwriting/risk-sharing
ADMINSTRATIVE COSTS … pervade the system Insurer level Provider level Government
CHURNING COSTS MONEY ACROSS THE SYSTEM Costs to insurers Costs to states/government Costs to patients/families Costs to providers Pent-up demand/deferred care Cost-shifting
Adverse Selection Crowd-out rules Co-premiums or “buy-in” plans Selection bias caused by individual mandates Other ….
EXPANDING EXISTING INSURANCE PROGRAMS WILL ONLY EXPAND EXISTING INSURANCE PROBLEMS
So … What do we do?
BIG IDEA: If we want to ensure that all children have health care, then……
Make health care available to all children
Children are a Low Risk Population Children’s Health Care is Mostly Predictable Immunizations Well-child screening & monitoring URIs Children All Need Primary & Preventive Care
REINFORCE EXISTING PRIMARY CARE SYSTEM Fund additional capacity & facilities directly Establish permanent eligibility for all “children” <18? <21? <25?
Use “medical home” model Fund primary care providers based on assigned population Establish integrated primary care model with electronic interfaces Establish large risk pools for catastrophic events
Wrap-up Somebody (Winston Churchill?) once said: You can count on the Americans to get it right, but only after they’ve tried everything else. Georganne Chapin (914)