Private Sector Strategies to Cover the Uninsured Illinois Health Forum Chicago, Illinois December 7, 2005 Enrique Martinez-Vidal Deputy Director RWJF’s State Coverage Initiatives program

Purchasing Pools  Mixed results: improves plan choice in small firms and has increased coverage, but enrollment has generally been low  Have not generated significant administrative savings or price discounts to date  Adverse selection problems  States continue to express interest in this option

Efforts to Make Insurance More Affordable  Limited benefits –At least 13 states have passed minimum benefit legislation –Low enrollment  Consumer directed health care –Options for state and local employees –Legislation to allow qualifying High Deductible Health Plans to be sold in the state  Prevention strategies – healthy behaviors

Mandating Health Insurance  Employer mandates –Several states have considered, only 1 with laws on the books Hawaii’s Prepaid Health Care Act – 30 years old this year California’s Health Insurance Act of repealed Maryland’s Fair Share Health Act - vetoed  Individual mandates –States have talked about, but none have enacted: Massachusetts

Comprehensive Models: Maine’s Dirigo Health  Voluntary program Maine’s health system  Cost Certificate of Need Moratorium Capital Investment Fund Voluntary expenditure limits Electronic claims Price disclosure  Quality Maine Quality Forum

Access: DirigoChoice  New Insurance product offered by Anthem DirigoChoice Small Employers, Individuals, Self-employed Medicaid Employer Premiums General Funds Individual Premiums Savings Offset Payment Premium Subsidy < 300% FPL

DirigoChoice… con’t Federal poverty level MaineCare Children ParentsChildless Adults Sliding Scale Discount 150%- 200% FPL 125%- 150% FPL DirigoChoice