National Congress on the Uninsured and Underinsured December 10, 2007 Karen Ignagni President and CEO America’s Health Insurance Plans

Outline  Our Objectives  What do Voters Say?  What We Have Proposed  Bipartisan Approach to Reform  Addressing the Larger Puzzle  Conclusion

Our Objectives  Getting Kids Covered  Getting Adults Covered  Blending Public/Private Solutions  Defining an Affirmative Role for Both Public and Private Sectors  Inserting Quality Into the Debate  Ensuring Costs Are Not Ignored

Source: Kaiser Family Foundation; Domestic Issues Only; October, 2007 What Are the Voters Saying? Topics They Want to Hear from the Candidates

Source: Kaiser Family Foundation; October, 2007 What Are the Voters Saying? Priorities for Health Care Reform

Trends How Rising Costs Affect Coverage Source for Premiums and Expenditures: Centers for Medicare and Medicaid Services, National Health Expenditures by Type of Service and Source of Funds. Source for uninsured: U.S. Census Bureau. Uninsured Rate National Health Expenditures Private Health Insurance Premiums

Trends Income and Coverage Source: Income, Poverty, and Health Insurance Coverage in the United States: 2006, Census Bureau.

Trends Age and Coverage Source: Income, Poverty, and Health Insurance Coverage in the United States: 2006, Census Bureau.

Source: Kaiser Family Foundation Trends Employer-Sponsored Coverage

Trends Region and Coverage Source: Income, Poverty, and Health Insurance Coverage in the United States: 2006, Census Bureau.

The Political Challenges  Federal vs. State  Children vs. Adults  Public vs. Private  To Mandate or Not  Basic vs. Comprehensive Coverage  Voter Enthusiasm vs. Constituent Reluctance

What Have We Proposed AHIP Access Proposal  Improve SCHIP to Cover All Uninsured Children From Low-income Families  Expand Medicaid to Cover All Uninsured Adults Living in Poverty  Establish a Child Health Care Tax Credit for Working Families  Create a New Tax-free Health Care Account That Can Be Used to Pay For Any Type of Coverage  Create a New Incentive Grant Program to Assist States in Expanding Access

What Have We Proposed Addressing Quality and Costs  Create a New Entity for Comparative Effectiveness  Revise Device Approval Process  Establishing a Research Agenda to Address Gaps in Evidence  Coordinate and Step Up Diffusion of Research  Develop Consensus on Measurement and Reward High Performance  Create a New Medical Dispute Resolution System to Resolve Disputes Fast, Fairly and Effectively

What Are We Trying to Accomplish  Promoting a Public-Private, Federal-State Approach  Encouraging Customized Solutions to Meet the Unique Needs of Each State  Expanding Access in Phases  Meeting Test of Fiscal Responsibility  Being Politically Advisable

Source: Ayres, McHenry & Associates; November 2006 What Voters Say About the Proposal Giving a federal tax credit to low and moderate income parents Increasing funding for health insurance program for children Providing grants from the federal government Having the federal government match contributions Giving federal tax deduction for purchase of private insurance Expanding the federal government’s Medicaid program Establishing a tax-free Health Account for all Americans Ranked by Percent “Support” 83% 65% 63% 75% 54% 66% 59% 88% 89% 77% 68% 82% 65% 82% 83% 75% 67% 69% 67% 64% 69% RepIndDem 65% 69% 71% 77% 85%

 The Challenges are Palpable to the Public  Crisis is Reaching a Tipping Point for All Stakeholders  Solutions Must Appeal to Red, Blue and Purple Electorate  Must Address Costs, Quality and Access Together to Enact Effective Reform  Public-Private Partnerships are Key for Building Workable Approach Conclusion

 Reacting To Policy  Lack Of Agreement On Policy  Little Experience On Ops  Little Experience On Quality  Little Focus On Chronic Disease  Proposing Policy Reforms  Agreement On Universal Access  Collaborating On Ops  Prioritizing Quality  Disease Management THENNOW