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Health Reform: Impact on Health Disparities & Social Justice Issues. Taetia Phillips-Dorsett October 19, 2012 5 th Annual CERC Health Disparities Institute. National Insurance Landscape.
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Health Reform: Impact on Health Disparities & Social Justice Issues Taetia Phillips-Dorsett October 19, 2012 5th Annual CERC Health Disparities Institute
National Insurance Landscape • The percentage of people in the U.S. without health insurance decreased to 15.7% in 2011 from 16.3% in 2010, the U.S. Census Bureau reports. • 260.2 million people were insured last year, up from 256.6 million in 2001. • Young adults ages 19 to 25 who gained coverage accounted for 40% of the decline in uninsured last year, according to Census Bureau statistics. The Patient Protection and Affordable Care Act extended dependent coverage to adults up to age 26 in September 2010. *2009 16.1% uninsured U.S. *2009 28.7% uninsured U.S.V.I *Source: 9-12-12 Modern HealthCare email alert
Health Coverage of USVI Residents Other Private Uninsured 27,670 32,970 24.1% 28.7% State Employees, Retirees, and Dependants Medicare 14,604 31,000 Medicaid 12.7% 27.0% 8,500 7.4% VI Insurance Landscape cont’d *Source: 2009 BER Insurance Survey (SHADAC Study)
VI Insurance Landscape cont’d *Source: 2009 BER Insurance Survey (SHADAC Study)
Public Coverage Programs • Medicare- 16,082 as of Jan 2012 • Medicaid- 9,085 as of FY2011 • Medicare/Medicaid Dual Eligibles-780 as of Jan 2012
VI Medicaid Program *Medicaid Rolls fluctuate annually between 8,500-10,000
VI Medicaid Program **Eligibility Criteria: $ 5,500 for the head of household plus $ 1,000 for every other person in the family AND Your savings is no more than: $1,500 for the head of household $ 100 for each extra family member Medically Needy vs. Categorically Needy Even if you make more than the limit of $5,500, if you have high medical bills, you can still get Medicaid. If you subtract your medical bills from your income and it brings your income below the limit, Medicaid will pay the rest of your medical bills. You have to bring your receipts to the office as proof. For example: $6,500 is your yearly income $1,000 in receipts for medical costs can be brought to the MAP office when you apply. This is termed your “spend-down” then MAP pays the rest.
The Affordable Care Act • Expands Access to Care • Ends Insurance Abuse • Makes Health Care More Affordable
During the Health Reform Process • Proposed $300 million in additional federal funding presents an opportunity to reduce our uninsured population from 28% over the reform period. • Proposed up to $30 million in additional funding to establish a Health Insurance Exchange • Provide coverage for childless adults up to 133% FPL beginning in 2014
During the Health Reform Process cont’d • Provide coverage extension to pregnant women and children up to 100% of the poverty level. (USVI Executive Branch Policy Decision) • Only 67% of mothers receive prenatal care during first trimester, as compared to 83% nationally. • In the VI 14% of babies are born preterm; the national average is 12%. • Importance of Text for Baby and Healthy Pregnancy, Healthy Babies Initiatives.
Factors Impacting Medicaid Expansion SERVICES OFFERED PROVIDER AVAILABILITY/ACCESS
“Just” Medical Care for the Insured, Underinsured and Uninsured ? • Insured-15,174 GVI CIGNA plan members (8,301 active & 6,873 retirees) • *41% members classified as having a chronic condition • *32.5% identified for active Disease Management Programs • *10,686 identified as having one or more gaps in care -Public Coverage Programs (Medicare/Medicaid) *Are most health services provided on- or off-island? *Are all covered services on par with Mainland Medicaid programs? *Impact of a high local match rate (45%) and a capped federal Medicaid allotment (~$14 million)
“Just” Medical Care for the Insured, Underinsured and Uninsured ? • Underinsured -Private Employer Sponsored Beneficiaries/ Individuals *What entity is tracking health experience for these groups? *Where can they seek additional coverage for services not covered by their policies? • Uninsured • -Documented Residents vs. Undocumented Residents • *What is the true impact of both populations on territory uncompensated health care rates? • *Are all populations aware of where primary/specialty care services are offered in the USVI? Sliding fee scales?