1. Healthcare What are the issues?

2. Some interesting statistics- Uninsured by income level Some interesting statistics- Uninsured by income level (WA state office of financial management) (WA state office of financial management) Income as % of fpl 2002-% of pop. 2004-% of pop. 0-99%17.9%22.8% 100-199%15.916.1 200-299%10.612.2 (9.3 in ’06) 300-3993.53.4 State total8.49.8

3. Uninsured by age New York Times, March 2, 2010 Uninsured by age New York Times, March 2, 2010 Age200220042008 0-184.5%6.0%15.9% 19-6411.5%13.2%18.3 18-2417.7 25-4440.5 45-6424.5 65+.5%.4%1.4

4. Type of Insurance Coverage Kaiser Study Type of coverage 200220042008 Employer62.4% (70% in ’87) 61.3%55.8% Purchased10.6%12.3%5.7 Medicaid15.6%14%12.8 Medicare12.1%12.9%11.1 Other public2.1%1.9%2.7%

5. Definitions Important terms: Important terms: Single payer system Single payer system Socialized/nationalized system Socialized/nationalized system Universal healthcare Universal healthcare We have a variety of county, state, federal and private institutions providing healthcare funding and services. We have a variety of county, state, federal and private institutions providing healthcare funding and services.

6. Patient’s Bill of Rights Affordable Care Act, March 23, 2010 End limitations on care, e.g. pre-existing conditions, cancelling insurance plan, lifetime limits. End limitations on care, e.g. pre-existing conditions, cancelling insurance plan, lifetime limits. Remove insurance company barriers. Remove insurance company barriers. Review insurer premium increases. Review insurer premium increases. Medical care and efforts to improve care must equal 80/85% of premium dollars. Medical care and efforts to improve care must equal 80/85% of premium dollars. Maintain young adult coverage. Maintain young adult coverage. Provide affordable coverage to those with pre- existing conditions. Provide affordable coverage to those with pre- existing conditions.

7. Small Group Strategizing You are given a collection of healthcare services. You are given a collection of healthcare services. Your task is to define “Basic Health Care.” That is, which of these should everyone be guaranteed? Your task is to define “Basic Health Care.” That is, which of these should everyone be guaranteed? Which should definitely NOT be included? Which should definitely NOT be included? Which are you unsure of? Why? Which are you unsure of? Why? What criteria or principles are you using? What criteria or principles are you using? What information would help you decide to include or not include those in the “unsure” category? What information would help you decide to include or not include those in the “unsure” category?

8. Discussion What criteria did you use? What criteria did you use? What were some of the differences of opinion? What were some of the differences of opinion? What was the reason for the differences of opinion? What was the reason for the differences of opinion?

9. Some Healthcare Programs 1. Basic Health Plan Established in 1993 to insure more people and contain the costs of healthcare Established in 1993 to insure more people and contain the costs of healthcare State funded with individual contribution State funded with individual contribution Private providers Private providers Income guideline-200% of FPL Income guideline-200% of FPL

10. 2. Washington Association of Community and Migrant Health Services 103 clinics in the state; examples-45 th St. Clinic, Odessa Brown, Pike Market Medical Clinic, etc. 103 clinics in the state; examples-45 th St. Clinic, Odessa Brown, Pike Market Medical Clinic, etc. Provides care for underserved populations. Provides care for underserved populations. Accepts medicaid, private pay, private insurance Accepts medicaid, private pay, private insurance

11. 3. Indian Health Service, providing healthcare to members of the 557+ federally recognized tribes and descendants…approximately 1.8 million Alaskan Natives and American Indians in the U.S. (from IHS website) Includes direct services and contracted services Includes direct services and contracted services Is funded enough to serve about 60% of those eligible. Is funded enough to serve about 60% of those eligible.

12. 4. Medicaid-aka “coupons.” Federal and state funded Federal and state funded Pregnant women up to 185% of fpl Pregnant women up to 185% of fpl People receiving SSI for a disability People receiving SSI for a disability Other groups of people Other groups of people

13. 5. State Children’s Health Insurance Program (SCHIP)-Apple Health for Kids) 200% of fpl for kids under 19 200% of fpl for kids under 19 250% WITH $20 co-pay 250% WITH $20 co-pay 300% with a $30 co-pay 300% with a $30 co-pay Funded by both state and federal gov’t Funded by both state and federal gov’t

14. 6. Public Health-Seattle/King County Some direct service provision (immunizations, asthma prevention/tx services, etc). Some direct service provision (immunizations, asthma prevention/tx services, etc). Emphasis on prevention of accidental death, disease, community health issues (SIDS, asthma) and environmental health. Emphasis on prevention of accidental death, disease, community health issues (SIDS, asthma) and environmental health.

15. 7. Medicare Healthcare for older adults and some people with disabilities. Healthcare for older adults and some people with disabilities. Part A-Hospitalization, post hospitalization and hospice care. Part A-Hospitalization, post hospitalization and hospice care. Part B-Medical insurance with a monthly premium. Part B-Medical insurance with a monthly premium.

16. 8. Veteran’s Affairs system 9. Private system, largely paid for through employers but also individuals can purchase. 10. In 2014, a new “health insureance marketplace” will exist.

17. CONCLUSION? A patchwork quilt of a healthcare system-lots of possibilities, difficult to navigate.

18. An example of a socialized system: Cuba Healthcare system is one of three priorities of the revolution: Education, Healthcare and Literacy Healthcare system is one of three priorities of the revolution: Education, Healthcare and Literacy It is a socialized system, wherein the government both funds and provides healthcare services. It is a socialized system, wherein the government both funds and provides healthcare services. Education is free in Cuba, which means the country produces many healthcare personnel. Education is free in Cuba, which means the country produces many healthcare personnel.

19. Quiz review Define single payer, universal and socialized healthcare Define single payer, universal and socialized healthcare Healthcare services – Healthcare services – Basic Health Basic Health Medicare Medicare Medicaid Medicaid Washington Association of Community and Migrant Health Services Washington Association of Community and Migrant Health Services Public Health Public Health State Children’s Health Insurance Program State Children’s Health Insurance Program Children and Family Services Children and Family Services Institute of Family Development? Institute of Family Development? CCORS stand for? What is it? CCORS stand for? What is it? What does the Casey Family Foundation focus on? What does the Casey Family Foundation focus on?

20. Quiz review, continued Senior Services Senior Services Adult Protective Services Adult Protective Services SNAP SNAP AFH AFH COPES COPES GRAT GRAT Long Term Care Ombudsman Long Term Care Ombudsman What is an AFH? What is an AFH?