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Universal Coverage. American Cancer Society/BALCONY Access to Healthcare Forum November 8, 2007. Universal Coverage Initiatives. Picture of Uninsured in New York Executive Budget Achievements Charge to Commissioner and Superintendent Public Hearings/Stakeholder Meetings Modeling

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Presentation Transcript
Universal coverage

Universal Coverage

American Cancer Society/BALCONY

Access to Healthcare Forum

November 8, 2007


Universal coverage initiatives
Universal Coverage Initiatives

  • Picture of Uninsured in New York

  • Executive Budget Achievements

  • Charge to Commissioner and Superintendent

  • Public Hearings/Stakeholder Meetings

  • Modeling

  • Next Steps


Percent with and without coverage new york 2005
Percent with and without CoverageNew York 2005

2.5 million

uninsured

16.5 million

insured

19 Million New Yorkers


Distribution of insurance coverage new york 2005
Distribution of Insurance CoverageNew York 2005

Uninsured 2.6 million

Directly Purchased

.4 million

Employer Sponsored

9.3 million

Public

7.2 million

19 Million New Yorkers


Distribution of public coverage
Distribution of Public Coverage

Child Health Plus

400,000

Family Health

Plus

500,000

Medicare

2.7 million

Medicaid

3.6 million


Percent uninsured by family income
Percent Uninsured by Family Income

Over 300% FPL

22%

Less than

100% FPL

36%

201-300%FPL

15%

27%

100-200% FPL

2.5 Million Uninsured


Age distribution of the uninsured
Age Distribution of the Uninsured

<19

50+

16%

16%

19-29

40-49

17%

31%

20%

30-39


2007 executive budget and session
2007 Executive Budget and Session

  • Child Health Plus Expansion

  • Streamlining/simplifications

  • Universal coverage consultant

  • FHP Buy-in

  • Managed Care Reform


Fhp buy in provisions
FHP Buy in Provisions

  • Allows any employer or Taft-Hartley fund to buy in to FHP, for all employees or members regardless of income eligibility.

  • Permits State subsidies for employees who are government program eligible if employer:

    • does not currently offer insurance; or

    • offers insurance, but their ability to continue to provide coverage is in jeopardy


Fhp buy in provisions1
FHP Buy in Provisions

  • Requires employer to pay at least 70% of the premium

  • Requires that coverage be community rated.

  • Premiums set by DOH

  • State funding for the employer share subsidies is subject to appropriation

  • Sunsets home care demonstration program


Managed care reform
Managed Care Reform

  • Payment for pre-authorized services

  • External review

  • PPO quality

  • Cooling off period

  • Claims submission deadlines


Charge to doh and sid
Charge to DOH and SID

  • Building block approach

  • Initiatives to get closer to universal coverage

  • Importance of restructuring delivery system to improve value

    • Reduce costs

    • Improve quality

  • Learn from experience of other states


  • Public hearings
    Public Hearings

    • Eight public hearings scheduled

      • Glens Falls September 5, 2007

      • Buffalo October 3, 2007

      • Conference Call October 10, 2007

      • NYC October 30, 2007

        November 2, 2007

      • Syracuse November 13, 2007

      • Rochester November 26, 2007

      • LI December 5, 2007


    Public hearings stakeholder meetings
    Public Hearings/StakeholderMeetings

    • Series of questions

    • Point of hearing is to solicit input

    • No preconceived notions of what the outcome should be

    • Experience


    Modeling of proposals
    Modeling of Proposals

    • Budget

    • RFP - July 9, 2007

    • Responses due September 14, 2007

    • Consultant under contract by year end

    • Modeling first quarter 2008

    • Recommendations for Governor May 2008


    2008 2009 executive budget
    2008/2009 Executive Budget

    • Potential additional building blocks

    • Government programs

      • Expansions?

      • Streamlining/simplification?

      • Consolidation of programs

      • Cost containment

      • Reimbursement reform


    2008 2009 executive budget1
    2008/2009 Executive Budget

    • Insurance Reforms

      • Markets?

        • Individual and small group

      • Insurer Surpluses, Medical loss ratios, Reserves

      • Medical malpractice?

      • Benefits?


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