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Health Insurance and Health Care in Wyoming

Health Insurance and Health Care in Wyoming. Rex E. Gantenbein, Ph.D., Center for Rural Health Research and Education Mary E. Burman, Ph.D., Fay W. Whitney School of Nursing. Consequences of being uninsured How does a lack of insurance affect people? Why aren’t more people covered?

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Health Insurance and Health Care in Wyoming

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  1. Health Insurance and Health Care in Wyoming Rex E. Gantenbein, Ph.D., Center for Rural Health Research and Education Mary E. Burman, Ph.D., Fay W. Whitney School of Nursing

  2. Consequences of being uninsured How does a lack of insurance affect people? Why aren’t more people covered? Aren’t there public programs for health care? Research findings Who are the uninsured in America, and in Wyoming? What are the reasons for being uninsured? What can be done? Special interest population: Young adults Overview

  3. Does lack of insurance affect access to health care? • Lack of coverage means decreased access to care and increased risk • The uninsured are more likely to postpone or forego treatment, even for serious conditions • Many uninsured cannot follow recommended treatments or fill prescriptions • Uninsured are less likely to have a regular source of care

  4. How do the uninsured pay for medical care? • Uninsured are often low-income, so medical bills can have a serious impact on family finances • Only about 35% of uninsured care costs are paid by uninsured • Most of remainder is “uncompensated care” • Estimated $41,000,000,000 in 2004 • 85% of this paid by government sources

  5. Is the problem getting worse? • Number of uninsured has grown in the last five years • Rates were stable (and even declined briefly) in mid-to-late 1990s • Increased employer coverage due to good economy • Medicare enrollment stabilized due to welfare reform • Stalling of economic growth has resulted in increases • Over five million more Americans became uninsured between 2000 and 2003

  6. Why aren’t more working people covered? • 27,000,000 workers were not covered in 2003 (increase of 1,000,000 over previous year) • Not all businesses offer health benefits to workers or their families • Not all workers qualify for coverage • Many employees cannot afford their share of the premiums

  7. Why aren’t more working people covered? • Small businesses are less likely to offer insurance to their employees • Fewer than 2/3 of businesses with fewer than 200 employees offer health insurance • Small businesses often require a higher share of premium cost from employees • Part-time workers are usually not eligible for benefits

  8. Why aren’t more working people covered? • Health coverage varies by industry and type of occupation • Uninsured rate among agriculture and construction is around 38% • Public administration (government) rate is around 6% • Over 80% of uninsured workers are in blue-collar jobs

  9. What is Medicaid’s role? • Medicaid covers three main groups of non-elderly, low-income people • Children (over half of beneficiaries) • Parents (if eligible under state guidelines) • People with disabilities • Most single or childless adults are not eligible for Medicaid, no matter how poor

  10. What can be done? • If we can understand the nature of the problem, we may be able to develop policy to address it • Who are the uninsured? • Why are they uninsured? • What solutions might help?

  11. 2002-2003 Wyoming Insurance Study (State Planning Grant) • Wyoming Department of Health received funding from Health Resources and Services Administration to undertake a Wyoming-specific study of uninsured • UW was subcontractor for research and strategic planning • Mission was to understand Wyoming’s uninsured population and develop a strategic plan to reduce their number

  12. Research Plan The Wyoming insurance study was designed to answer these questions: • Who are the uninsured in Wyoming and how do they compare to national demographics? • Why are they uninsured and how long have they been uninsured? • What might enable employers to offer insurance to more employees and their dependents? • What is the economic impact on individual communities and the State as a result of lack of coverage? • What options would result in the highest number of people being able to afford coverage?

  13. Research Activities • Data Collection & Analysis • Baseline data from national research • Statewide household and employer surveys (with comments) • Focus groups • Interviews with “key informants” • Group quarters interviews

  14. National baseline data

  15. Who are the uninsured? • Most Americans under 65 who have health insurance coverage receive it as an employer benefit • Americans over 65 are covered by Medicare • Some non-elderly, low-income people qualify for Medicaid, SCHIP or other state-subsidized programs

  16. Who are the uninsured? • 45,000,000 Americans were without health insurance coverage in 2003! • 18% of the nonelderly population (1% increase from 2002) • More than 80% of the uninsured came from working families • Most of these have one or more full-time workers in the household

  17. Who are the uninsured? • Among poor people, the uninsured rate is 36% (twice the average) • “Poor” is defined as under 100% of the federal poverty level -- $14,348 for a family of 3 in 2002) • The near-poor (100-200% of FPL) are also at risk (30% uninsured) • Often ineligible for Medicaid • These two income groups account for two-thirds of uninsured

  18. Who are the uninsured? • Majority of uninsured adults (59%) have gone without coverage for two years or longer • Adults are more likely to be uninsured than children • Most low-income children qualify for Medicaid or SCHIP (State Children’s Insurance Program) • Adults do not qualify for Medicaid unless they are pregnant, disabled, or have dependent children

  19. Table 5.5 Race and Incidence of Uninsured, 1987-2000 Minorities are more likely than whites to be uninsured. Hispanic Non-Hispanic American Indian Non-Hispanic Asian Non-Hispanic Black Total Non-Hispanic White Note: Under 65 population. Source: Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

  20. Rural uninsured • 17% of non-elderly rural population are uninsured • Remote rural areas (not adjacent to an urban county) have even higher risk (24%) • Rural residents tend to be uninsured for longer periods than urbanites

  21. Rural uninsured • Why are risks higher in rural areas? • More remote rural residents come from low-income families • Rural residents are less likely to be offered health benefits through employment • Rural/remote rural residents are just as likely as urban workers to enroll in programs if offered, however

  22. Results from Wyoming research

  23. Initial findings from household survey (late 2002) • 5,511 responses to survey (mail and phone) • 14.1% of Wyoming’s residents are uninsured: 70,217 people • 14.5% of adults: about 53,000 • 13.1% of children (18 and under): about 17,000

  24. Uninsured percentage by county County Mean = 12.08% The counties in gray have above mean % of uninsured, representing about 1/3 of Wyoming’s population.

  25. Uninsured individuals by age(from household survey)

  26. Uninsured by household income

  27. Uninsured individualsLength of time Since last insured

  28. Uninsured individuals takeup of employer coverage • 9.2% of households reported someone in the household is eligible for employer coverage but is not enrolled • 38.9% of those said reason is they cannot afford it

  29. Uninsured individuals takeup of employer coverage • 19.4% of uninsured report someone in the household is eligible for employer coverage but is not enrolled • 61.4% of these people say reason is they cannot afford it

  30. % of uninsured individuals by household per capita incomeAge 0 to 4 years

  31. % of uninsured individuals by household per capita income Age 19 to 24 years

  32. % of uninsured individuals by household per capita income Age 25 to 34 years

  33. % of uninsured individuals by household per capita income Age 35 to 44 years

  34. % of uninsured individuals by size of firm where employed(from household surveys)

  35. Focus Groups, Key Informant Interviews and Survey Comments • 13 focus groups (with physicians interviewed individually) • Uninsured persons, small employers and health care providers • Statewide with 82 different people • 16 Key informant interviews • Insurance industry leaders, safety net providers, business and health leaders, professional organization directors/officers. • Mail and telephone survey comments • 610 pages of transcribed data!

  36. Root Causes of Uninsurance: Health Care Costs and Low Wages Solutions: No Silver Bullet Themes Uninsured Persons/Families • Meeting Health Needs: Between and Rock and a Hard Place • Barriers to Purchase of Health Insurance: Money, money, money • Participation in Public Programs: Falling Through the Cracks • Employer-based Coverage • Decisions about Offering Insurance: Salary Vs. Benefits • Decisions about Type of Coverage: Playing Around with Deductible and Premiums • Response to Economic Downtown: Increased Employee Cost-Sharing

  37. Root Causes: Health Care Costs Back in 1981 . . . a single policy generally ran about $45, for a family about $95, which at the time seemed rather expensive. However, now we are in 2003 and a single policy has gone from $45 to $358 and family has gone from 95 to $828, so we’ve almost seen a 10-fold increase in cost increase in the cost, total cost of health insurance in roughly21, 22 years. (Ralph Hayes, Employees Group Insurance Program)

  38. Borger, Smith, Truffer, Keehan, Sisko, Poisal & Clemens, 2006.

  39. Root Causes: Low Wages [At 185% poverty], their actual income. . . ends up being around . . . $2000 to $2400 a month. Now you think of raising a family . . . on that and all the expenses of rent and insurance on your car and the whole bit. It really does not leave money for people to have insurance.(Key Informant)

  40. Wyoming Wages, 2004

  41. 2006 HHS Poverty Guidelines Size ofFamily Unit 48 ContiguousStates and D.C. Alaska Hawaii 1 $ 9,800 $12,250 $11,270 2 13,200 16,500 15,180 3 16,600 20,750 19,090 4 20,000 25,000 23,000 5 23,400 29,250 26,910 6 26,800 33,500 30,820 7 30,200 37,750 34,730 8 33,600 42,000 38,640 For each additional person, add 3,400 4,250 3,910 SOURCE:Federal Register, Vol. 71, No. 15, January 24, 2006, pp. 3848-3849 . According to US Census, official poverty rate is 12.5%

  42. Table 5.6 The Uninsured by Age, 1987-2000 Most of the uninsured are adults 18-54. Note: Under 65 population. Source: Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

  43. Impact of Being Uninsured: You live paycheck to paycheck. (Uninsured Person) Illness Behavior: I take 3 aspirin and if I’m still alive 3 days later… (Uninsured Person) I started taking medication for bipolar… But I weaned myself off of it because I know I’m not going to be able to get it… And I’m just winging it… Just do each day as it comes. (Uninsured Person) Meeting Health Needs: Between a Rock and a Hard Place

  44. Table 5.4 Income and Incidence of Uninsured, 1987-2000 Lower-income groups are more likely to be uninsured than higher-income groups. <100% of Federal Poverty Level 100-200% of Federal Poverty Level Total 200+% of Federal Poverty Level Note: Under 65 population. Source: Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

  45. Table 5.10 Impact on Non-Elderly Adults of Being Uninsured, 2000 The uninsured face financial and other barriers to health care. Note: Among adults under age 65. Source: NewsHour with Jim Lehrer/Kaiser Family Foundation, National Survey on the Uninsured, April 2000.

  46. Admission Rates forAvoidable Hospital Conditions by Uninsured vs. Privately Insured Adjusted Relative Rates

  47. Managing Care for the Uninsured It impacts me… limiting the number of laboratory tests and x-rays that I might order to just the bare essentials… choosing the medication based on what I have available for samples… rather than based on what I think is the best drug clinically. (Physician) If someone comes in with cardiac chest pain who may need a stress test or cardiac cath, there’s no way to pay for that. (Nurse Practitioner)

  48. Local Safety Nets • Hospitals • Community clinics • Private physician offices • Other agencies “Intact, but endangered” (IOM, 2000)

  49. Patients by Revenue Source: Physicians and Federally Qualified Health Centers

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