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Healthy Kids Plan HB 2201/SB 31 The Problem 117,000 Oregon children have no health insurance About half (60,000) qualify for programs, but are not enrolled Not all Oregon children have access to: Doctors/healthcare providers Medicine Eyeglasses Basic health care services

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HB 2201/SB 31

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hb 2201 sb 31

Healthy Kids Plan

HB 2201/SB 31

the problem
The Problem
  • 117,000 Oregon children have no health insurance
  • About half (60,000) qualify for programs, but are not enrolled
  • Not all Oregon children have access to:
        • Doctors/healthcare providers
        • Medicine
        • Eyeglasses
        • Basic health care services
over half of oregon s uninsured kids are in middle class working families
Over Half Of Oregon’s Uninsured Kids Are In Middle Class, Working Families*

Many families earning between $40,000 and $80,000 a year make too much for their kids to qualify for state programs – BUT make too little to afford health insurance

  • No employer-sponsored coverage may be available
  • Premiums may be too expensive
  • Parent may be covered but dependent coverage is not available.

*Recent statewide survey of Oregon families

enrollment barriers for kids already eligible but not enrolled
Enrollment Barriers for Kids Already Eligible But Not Enrolled*
  • Difficulties some families face with the Oregon Health Plan (OHP) application process
  • Missing the OHP re-certification window - needing to re-do paperwork every 6 months.
  • Confusion about children’s eligibility if parents no longer eligible for OHP

*Recent statewide survey of Oregon families

why is health insurance so important
Why is health insurance so important?

Uninsured kids are* :

  • Half as likely to get preventive care or see a doctor than if they were insured
  • More likely to use expensive emergency room for care
  • More likely to be hospitalized

*From a recent statewide survey of Oregon families and several national studies

healthy kids can keep kids learning
Healthy Kids Can Keep Kids Learning*
  • Kids in poor health miss school more often
  • If illnesses such as asthma are not treated, kids perform poorly in school
  • Kids will be more successful in the future if they are in school and healthy

*from recent national studies

keeping kids healthy also saves money
Keeping Kids Healthy Also Saves Money
  • When uninsured kids are hospitalized, their parents struggle to pay medical bills, and can only afford an average of 35% of the cost.*
  • Over 40% of the hospital costs for the uninsured are passed on as higher costs to people with health insurance.*

*Families USA, June 2005

public input
Public Input

Policy and Program Framework

  • The Medicaid Advisory Committee
  • Senate Children’s Health Access Committee

Program Design and Implementation

  • Stakeholder Meetings
key components
Key Components
  • Offer coverage to all uninsured Oregon children up to age 19
  • Comprehensive health care that includes dental, vision, mental health with physical health
  • Build on existing programs
  • Keep it simple for families
    • One “Healthy Kids” card
    • Simpler enrollment and keeping kids enrolled
meet children s health care needs in three ways
Meet Children’s Health Care Needs In Three Ways
  • Expand opportunities to families not eligible for the Oregon Health Plan to buy affordable coverage with state subsidies tiered to income

~Meet working families half-way and put health care within their reach.

  • Improve and expand access to kids eligible for enrollment in the Oregon Health Plan

~Simplify enrollment and keep kids enrolled.

  • Continue to improve access to care, including the expansion of school-based health centers

~Access and insurance are linked.

ohp plus package continues for kids up to 200 fpl
OHP Plus Package Continues For Kids Up To 200% FPL
  • Comprehensive benefits continue – includes dental, vision, mental health care
  • No Co-Pays, No Premiums
family health insurance assistance program fhiap will continue
Family Health Insurance Assistance Program (FHIAP) Will Continue
  • Providing premium assistance to low-income families with insurance options through their work
  • Making insurance premiums affordable for families through a private-public partnership
and an option for families without other choices private insurance product
AND…an Option For Families Without Other Choices: Private Insurance Product

For families with incomes at 200% FPL and above with no access to employer-sponsored insurance

  • Comprehensive coverage
  • Assistance to families to choose a plan
  • Subsidies based on income
  • All health plans may compete to participate
how much will healthy kids cost families
How Much Will Healthy Kids Cost Families?

As Healthy Kids was designed we talked with Oregon families about what is affordable:

  • Families pay at the level they can afford, with assistance at lower incomes
  • Affordable monthly premiums and copays at higher incomes
rural families no discretionary monthly income until 200 250 of poverty level
Rural Families: No Discretionary Monthly Income Until 200%-250% Of Poverty Level *

*Economic Policy Institute and US HHS - Rural Oregon (2004) 2 Parents + 1 Child

urban families no discretionary monthly income until 250 of poverty level
Urban Families:No Discretionary Monthly Income Until 250% Of Poverty Level *

*Economic Policy Institute and US HHHS data -Portland Area (2004) 2 Parents + 1 Child

healthy kids affordable options
Healthy Kids Affordable Options

350% Federal Poverty Level (FPL) & Above

Families Buy-in Full Price

State-Only subsidies

Federal match for state subsidies for private product

State-only subsidies

Federal match for state subsidies for employer-sponsored insurance

Full subsidy

300% FPL

200% FPL

No Copays/No Premiums

Private Insurance


Family Health Insurance Assistance Program FHIAP

OHP Plus

leverage local community partnerships to reach families
Leverage Local Community PartnershipsTo Reach Families
  • Outreach to families with uninsured kids
  • Provide application assistance
  • Keep kids enrolled in a health plan
simplify enrollment and keep kids enrolled
Simplify Enrollment and Keep Kids Enrolled
  • Shorter Application
  • 12-month Enrollment Period
  • 2 month Uninsurance Requirement
  • No asset test
expand school based health centers
Expand School-Based Health Centers

Oregon has 44 SBHC in 17 counties

Healthy Kids would support:

  • 6 new SBHC in 6 new counties
  • 7 new SBHC in counties already operating SBHC
Expand Dental Sealant Program:

Seal the teeth of 50% of all 8-year-olds by 2010, compared to 30% of uninsured children who have dental sealants today

  • Nurse Advice Line:

Ensure that families have access to nurse advice line so kids get best care in most appropriate setting

what about the funding of healthy kids
What About The Funding Of Healthy Kids?
  • Maximize use of federal dollars available to Oregon
  • Efficiently use current state programs’ tax dollars
  • Increase Tobacco tax dollars
  • Families pay their share based on income

Saves all of us money by covering all

uninsured children

in summary the healthy kids plan
In Summary:The Healthy Kids Plan
  • 117,000 of Oregon’s kids are uninsured, despite the efforts of their working parents and the state’s current health programs.
  • Access to health insurance is important to keep kids healthy and learning in school.
  • The Healthy Kids Plan will provide streamlined, affordable access to health care options for Oregon’s families.
  • An investment in the health of our children is an investment in Oregon’s future.
for more information
For More Information:

The Governor’s Website