ITUP Teaser Slides Just the Facts: Coverage in the US & California 2/10/10 Prepared by Serina Reckling and Sara Watson

Per Capita Total Current Health Care Expenditures, U.S. and Selected Countries, 2007 ^OECD estimate. *Differences in methodology. Notes: Amounts in U.S.$ Purchasing Power Parity, see includes only countries over $2,500. OECD defines Total Current Expenditures on Health as the sum of expenditures on personal health care, preventive and public health services, and health administration and health insurance; it excludes investment. Source: Organisation for Economic Co-operation and Development. OECD Health Data 2009, from the SourceOECD Internet subscription database updated November Copyright OECD 2009, Data accessed on 11/13/2009.

Projected Percent Change in Medicaid Spending and Enrollment, FY NOTE: Enrollment percentage changes from June to June of each year. Spending growth percentage changes in state fiscal year. SOURCE: Enrollment Data for : Medicaid Enrollment in 50 States, KCMU. Spending Data from KCMU Analysis of CMS Form 64 Data for Historic Medicaid Growth Rates. FY 2009 and FY 2010 data based on KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2009.

Percent Reporting: Adults Children No Usual Source of Care Needed Care but Did Not Get It Due to Cost * Children Access to Care: Medicaid Comparable to Private Insurance; Uninsured, not so much * In the past 12 months NOTE: Respondents who said usual source of care was the emergency room were included among those not having a usual source of care SOURCE: KCMU analysis of 2008 NHIS data

Decrease in Employer Sponsored Insurance (million) 2.8% National Unemployment Rate Increase since 2008 (from 7.2% in Dec-08 to 10.0% in Nov-09) = Medicaid /CHIP Enrollment Increase (million) Uninsured Increase (million) & 6.9 Note: Totals may not sum due to rounding and other coverage. Source: Based on John Holahan and Bowen Garrett, Rising Unemployment, Medicaid, and the Uninsured, prepared for the Kaiser Commission on Medicaid and the Uninsured, January 2009.Rising Unemployment, Medicaid, and the Uninsured Impact of the Rise in Unemployment on Health Coverage, 2008 to 2009

Health Insurance Coverage of the Nonelderly Population, Million SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

Nonelderly’s Health Insurance Coverage by Family Poverty Level, M 46.0 M 41.5 M M Number Under 100% 100% - 199% 200% - 299% 300% + NOTES: Data may not total 100% due to rounding. The Federal Poverty Level for a family of four in 2008 was $22,025 (according to the U.S. Census Bureau’s poverty threshold). Family size and total family income are grouped by insurance eligibility. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

8 out of 10 of the uninsured are in working families & don’t have access to employer-sponsored health insurance In 2005, ¾ of uninsured workers were adults not offered employer-sponsored coverage Since 2002, the number of firms offering employer-sponsored health insurance has decreased from 69% to 60% Source: The Kaiser Family Foundation. Five Basic Facts on the Uninsured. September 2009.

Characteristics of the Uninsured, 2008 Family Income Family Work Status Total = 45.7 million uninsured 1 or More Full- Time Workers 66% No Workers 19% Part-Time Workers 14% Age % % % % The federal poverty level was $22,025 for a family of four in Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

Nearly 70% of the uninsured with mental health disorders do not have access to the services they need Source: The National Council for Community Behavioral Health Care. Unmet Healthcare Needs of Indigent, Uninsured Americans. July 2009.

In 2007, 5 million uninsured children were eligible for public coverage but were not enrolled 55% of low-income parents do not know how to enroll their child 45% do not think their child is eligible for coverage 50% think the enrollment process is difficult Source: Kenney, Genevieve. Uninsured and Eligible for Public Coverage: Underlying Causes and Policy Solutions. National Institute for Health Care Management. November 2009.

Source: The Kaiser Family Foundation. Five Basic Facts on the Uninsured. September 2009.

Cumulative Changes in Health Insurance Premiums, Inflation, and Workers’ Earnings, Note: Due to a change in methods, the cumulative changes in the average family premium are somewhat different from those reported in previous versions of the Kaiser/HRET Survey of Employer-Sponsored Health Benefits. See the Survey Design and Methods Section for more information, available at 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).

Average Health Insurance Premiums and Worker Contributions for Family Coverage, Note: The average worker contribution and the average employer contribution may not add to the average total premium due to rounding. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, $5, % Worker Contribution Increase 131% Premium Increase $13,375

Uninsured Rates Among Part-Time Students and Non-Students Ages 19–23 Are About Twice That of Full-Time Students * Other includes Medicare, Medicaid, and Military. ** Includes part-time students and non-students. Source: Analysis of the March 2008 Current Population Survey by S. Glied and B. Mahato of Columbia University for The Commonwealth Fund. Not full-time students** = 12.4 millionFull-time students = 7.8 million Own-employer 7% Employer- dependent 48% Individual or college plans 19% Other* 8% Uninsured 18% Other* 14% Employer- dependent 15% Own- employer 26% Individual or college plans 7% Uninsured 37%

Nineteenth Birthdays Are Critical Turning Points in Coverage for Young Adults ( Percent Uninsured) Children, Age 18 and Under Young Adults, Ages 19–29 Total 11% 29% <100% FPL %–199% FPL1640 >200% FPL716 Source: Analysis of the March 2008 Current Population Survey by S. Glied and B. Mahato of Columbia University for The Commonwealth Fund.

More Than Half of Young Adults Are Overweight or Obese, Two of Five Report Binge Drinking or Smoke Cigarettes, and 15 Percent Have a Chronic Health Condition Percent of young adults with the following health problems: 1 Data from 2005–2006; ages 18–29. 2 Binge drinking defined as ‘drinking five or more drinks on the same occasion on at least one day in the past 30 days’; data from 2006; ages 18–25. 3 Data from 2006; ages 18–25. 4 Data from 2003–2004; women ages 20–29. 5 Any chronic condition includes physician-diagnosed arthritis, asthma, cancer, diabetes, heart disease, or hypertension; data from 2004–2006; ages 18–29. 6 Mental disorders include major depression, generalized anxiety disorder, and panic disorder; data from 1999–2004; ages 20–29. 7 Data from 2004–2006; ages 18–29. Source: National Center for Health Statistics, “Health, United States, 2008” (Hyattsville, Md.: NCHS, 2009)

Adults ages 19–64 with individual coverage or who tried to buy it in past three years who: Total Health problem No health problem <200% FPL* 200%+ FPL* Found it very difficult or impossible to find coverage they needed 47%60%35%52%40% Found it very difficult or impossible to find affordable coverage Were turned down, charged a higher price, or excluded because of a preexisting condition Never bought a plan The Individual Insurance Market Is Not an Affordable Option for Many People * FPL = federal poverty level. Source: Commonwealth Fund Biennial Health Insurance Survey (2007).

StateNumber of Uninsured California 6.6 million Texas5.6 million Florida3.7 million Arizona1.2 million California has the 8th highest percent of uninsured residents in the nation: 20.5% State Comparison of the Uninsured, 3-Year Average, 2006 to 2008* Source: California Healthcare Foundation, 2009 California’s Uninsured

Uninsured Workers, by Employer Size and Type California Residents, Ages 18 to 64, 2008 Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2009 Supplement. Medically Indigent Adults (MIAs)

Employer-based Coverage and Uninsured Population Trends California vs. U.S Source: California Healthcare Foundation, 2009

Likelihood of Workers Being Uninsured by Employer Size and Type U.S. vs California 2008 Source: California Healthcare Foundation, 2009

California vs. US Uninsured (2009) National ComparisonCAUS Number of Uninsured (in millions) Adults (ages 18 to 64) Children (up to age 18) Sources of Coverage Uninsured20.6%17.4% Employer-based55.6%61.1% Public Programs (Medi-Cal, Healthy Families, Medicare, and Tricare/CHAMPVA)19.9%19.4% Individually Purchased7.7%6.3% Source: California Healthcare Foundation

Uninsured Californians, 2008 Age Ethnicity Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2009 Supplement.

COST/(SAVINGS) ELEMENT FY SENATE VERSION (H.R. 3590) Patient Protection and Affordable Care Act Total FundsGeneral Funds Eligibility expansion (MIAs and Parents)$ 6,815,000$ 1,338,000 Healthy Families Shift (to Medi-Cal)648,000324,000 Coverage of eligible but unenrolled (Medi-Cal and Healthy Families) 1,400,000700,000 Exchange coverage subsidies$11,130,000 Administrative Costs (Ongoing)16,0008,000 Direct Costs (Savings)(636,000)(425,000) Bright Line (Savings)(954,000)(477,000) State Program (Savings)(1,435,000)(608,000) County Program (Savings)($1,440,000 Federal Reform Dividend for CA$16,984,000($580,000) Outpatient rate increase (80% of Medicare)4,318,0001,974,000 Primary care rate increase (80% of Medicare)537,000255,000 (Dollars in Thousands ) HEALTH CARE REFORM COST AND SAVINGS ESTIMATE FULL IMPLEMENTATION: CALIFORNIA