Shana Alex Lavarreda, PhD, MPP Sacramento, CA 2/10/2010 The Uninsured and National Health Care Reform

46 Million Adults and Children are Uninsured in the United States Notes: Numbers may not add to 100% due to rounding. Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements).

Health Insurance Coverage During Last 12 Months Among Non-Elderly Persons, Ages 0-64, California, 2007 Notes: Numbers may not add to 100% due to rounding. "Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured. Source: 2007 California Health Interview Survey

Health Insurance Coverage During Last 12 Months Among Children, Ages 0-18, California, Notes: Numbers may not add to 100% due to rounding. "Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured. * Data is significantly different from 2007 at the 95% confidence level. Sources: 2001, 2003, 2005 and 2007 California Health Interview Surveys

Health Insurance Coverage During Last 12 Months Among Adults, Ages 19-64, California, Notes: Numbers may not add to 100% due to rounding. "Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured. * Data is significantly different from 2007 at the 95% confidence level. Sources: 2001, 2003, 2005 and 2007 California Health Interview Surveys

Household Income as Percent of the Federal Poverty Level Among Non-Elderly Persons Uninsured All or Part Year, Ages 0-64, California, 2007 Notes: Numbers may not add to 100% due to rounding. The 2007 Federal Poverty Level was $10,210 for one person, $13,690 for a two-person family and $17,170 for a three- person family. Source: 2007 California Health Interview Survey

Family Work Status Among Non-Elderly Persons Uninsured All or Part of the Last 12 Months, Ages 0-64, California, 2007 Note: Numbers may not add to 100% due to rounding. Source: 2007 California Health Interview Survey

Citizenship and Immigration Status Among Non-Elderly Persons Uninsured All or Part Year, Ages 0-64, California, 2007 Note: Numbers may not add to 100% due to rounding. Source: 2007 California Health Interview Survey

Percent Uninsured All or Part Year by County, Ages 0-64, California, 2007 Note: Differences in rates between counties may not be statistically significant. Source: 2007 California Health Interview Survey

If Nothing Changes – Outlook for 2010 and Beyond  Implementation of new initiatives from ARRA  Quality (value based purchasing)  Electronic health records and e-prescribing  Chronic care management  Strategies to improve access and to address low-income uninsured  Budget and state fiscal pressures  Medicaid spending and enrollment trending up  Economy impacting state revenues  Mid-year budget actions  Healthy Families had enrollment frozen for six weeks this year.  2010 likely to be a difficult year

Eligibility for Medi-Cal and Healthy Families in California, October % FPG Eligible for AIM Eligible for Healthy Families IF < 2yrs & Mother in AIM Not Eligible 250% FPG Healthy Families Eligible Not Eligible 200% FPG Healthy Families Eligibility Authorized not Imple- mented 133% FPG Medi-Cal Eligible 100% FPG Medi-Cal Eligible 75% FPG Medi-Cal Eligible Pregnant Women Ages 0 – 1 Ages 1 – 5 Ages 6 – 18 Ages 19 – 64, with Children Ages 19-20, Medically Indigent/ Needy Disabled and Aged All Other Adults ChildrenAdults

Eligibility of Currently Uninsured Children and Adults for Public Insurance Programs, Ages 0-64, California, 2007 Note: Numbers may not add to 100% due to rounding. Note: Eligibility for Healthy Kids programs is determined by meeting the eligibility criteria, and disregards whether there is room in the program to accept new enrollees. Source: 2007 California Health Interview Survey

Changes Proposed in National Health Care Reform  The House and Senate bills would make two key changes:  Expand Medicaid eligibility to include qualified uninsured adults and children with household incomes up to 133% FPL (Senate) or 150% FPL (House).  Provide public subsidies to enable qualified uninsured adults and children with household incomes from 134%/150% - 400% FPL to purchase insurance  CHIP might be eliminated in favor of moving all eligible families into a health insurance exchange  “Public option” within the exchange(s) could be expansion of current CHIP program in every state  Other options:  A national public option, more like “Medicare for All” (House)  State-based non-profit, co-op plans (Senate)  OPM managed, national not-for-profit private plans (Senate)

Eligibility for Health Insurance Expansions Under Proposed National Health Care Reform, Ages 0-64, California, 2007 SOURCE: Lavarreda, SA and Brown, ER (2009). National Health Care Reform Will Help 4 Million Uninsured Adults and Children in California. Fact Sheet, UCLA Center for Health Policy Research, October.

Thank You – and I’m Here to Help! Shana Alex Lavarreda, PhD, MPP Director of Health Insurance Studies and Research Scientist (310)