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Uninsured in Maryland. Presented to Maternal and Child Health Leadership Team February 7, 2005. Purpose and Objectives. Define the problem of the uninsured in Maryland in a conceptual framework Define stakeholders of problem Link the problem to clinical practice

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uninsured in maryland

Uninsured in Maryland

Presented to Maternal and Child Health Leadership Team

February 7, 2005

purpose and objectives
Purpose and Objectives
  • Define the problem of the uninsured in Maryland in a conceptual framework
  • Define stakeholders of problem
  • Link the problem to clinical practice
  • Present Maryland’s current policies and legislation
  • Discuss alternatives to the problem
statement of problem
Statement of Problem
  • Definition of uninsured
  • Growing rates of uninsured
  • Demographics of Maryland vs. United States uninsured
  • Why insurance is important
definition of uninsured
Definition of Uninsured
  • No health insurance
  • No Medicaid/Medicare
  • No Maryland Children’s Health Program (MCHP)
  • No self insurance
growing rate of uninsured
Growing Rate of Uninsured
  • In Maryland 11.3%- 12.8% in one year
  • Higher cost of insurance
  • 7.8% increase in health insurance cost in one year
  • Average Maryland’s family expenditure on healthcare $4,146
demographics of uninsured
Demographics of Uninsured
  • Maryland is rich!
  • Hispanic population
  • Children
  • Women
stakeholder analysis
Stakeholder Analysis
  • Private insurance industry
  • State Health Departments
  • Pharmaceutical industry
  • Health care providers
  • The uninsured
  • Tax payers/everyone!
consequences
Consequences
  • Fewer preventive screening
  • High debt
  • Sicker when diagnosed
  • Fewer therapeutic services
  • Higher mortality and morbidity
  • Lower annual earnings because of poorer health
explanation for growth
Explanation for Growth
  • Shift into service industry
  • Growth in part time and contracting employees
  • High costs of insurance
  • States cutting back publicly financed programs
medicaid mchp
Medicaid/ MCHP
  • SCHIP Legislation
    • 1997 Title XXI of Social Security Act
    • Federal Block Grant
    • Children up to 200% of FPL
    • Outreach
  • Maryland standards
    • 200% FPL 0-19
    • 250% FPL Pregnant Women
    • 40% FPL Non working parent
uninsured children
Uninsured Children
  • 1 out of 10 uninsured
  • 1 out of 5 <200% FPL
  • US born children of foreign parents
  • Working poor
  • Misconceptions on eligibility
  • Enrollment process
community health centers chcs
Community Health Centers (CHCs)
  • Community based
  • Services without regard to ability to pay
  • 40% of patients are uninsured
  • Demographics of Patients
    • 40% children
    • 67% < 100% FPL
national solutions
National Solutions
  • HR 676 Single payer legislation
  • “Medicare for All” – Senator Kennedy
  • Health Care Access Resolution
  • Prevent erosion of Medicaid
state policy initiatives
State Policy Initiatives
  • Health care for all plan
    • Expansion of existing programs
  • Speaker Casper Taylor plan
    • Medicaid expansion
    • Tax incentives
  • Maryland leading in most MCH policy issues
barriers to policy change
Barriers to policy change
  • Money
  • Political will
  • Administratively infeasible
  • State/federal relationship
  • Powerful corporate lobby
  • Mobilization of uninsured
literature review
Literature Review
  • Kaiser Family Foundation
    • http://www.statehealthfacts.org
  • Maryland Health Care Commission
    • http://www.mhcc.state.md.us
  • A public-private partnership for health care for all Marylanders: cost and coverage impacts analysis
    • http://www.lewin.com
wrap up
Wrap up
  • Growing problem
  • Not having insurance leads to poor health
  • Not every child is insured
  • Stakeholders include everyone
  • There are solutions!
questions

Questions?

Michelle G. Clark

mclark@jhsph.edu

410-302-4650

references
References
  • Advocates for Children and Youth. (2004, September). Maryland children’s action network. Retrieved October 5, 2004, from Advocates for Children and Youth Web Site: http://www.acy.org
  • American College of Physicians (ACP) (2000). No health insurance? It's enough to make you sick - Scientific research linking the lack of health coverage to poor health. Retrieved November 17, 2004 from http://www.acponline.org/uninsured/lack-contents.htm
  • Deber, R. B. (2003). Health care reform: lessons from Canada. American Journal of Public Health, 93(1), 20-24.
  • Health Affairs. (2004). Health Affairs Main Page. Retrieved December 10, 2004, from http://healtaffairs.org
  • Hoffman, C, Scholbohm, A. (2000, May) Uninsured in America A chart book (2nd ed.). Washington, DC: The Kaiser Commission on Medicaid and the Uninsured.
references24
References
  • Kaiser Commission on Medicaid and the uninsured. (January 2003). The cost of not covering the uninsured. Retrieved November 14, 2004, from http://www.kff.org/uninsured/4088-index.cfm
  • Lehman, A. F. (1995). Measuring quality of life in a reformed health system. Health Affairs, 14(3), 90-101.
  • Light, D. W. (2003). Universal health care: lessons from the British experience. American Journal of Public Health, 93(1), 25-30.
  • Maryland Citizens Health Initiative (MHCI). (2004, September). Health care for all. Retrieved November 29, 2004, from http://www.healthcareforall.com
  • Maryland Health Care Commission (MHCC). (2004, January). Options for covering the uninsured a report to the general assembly. Retrieved September 29, 2004, from Maryland Health Care Commission Web Site: http://www.mhcc.state.md.us
  • Meyer, J. A., & Silow-Carroll, S. (2003, August 27). Building on the job-based health care system: what would it take? Health Affairs Web Exclusive, W3, 415-425. Retrieved November 14, 2004, from http://www.content.healthaffairs.org
references25
References
  • Miller, W., Vigdor, E. R., & Manning, G. M. (2004, March 31). Covering the uninsured: what is it worth? Health Affairs Web Exclusive, W4, 157-167. Retrieved November 10, 2004, from http://www.content.healthaffairs.org
  • Newhouse, J. P. (2004). Consumer-directed health plans and the RAND health insurance experiment. Health Affairs, 23(6), 107-113.
  • Nichols, L. M., Ginsburg, P. B., Berenson, R. A., Christianson, J., & Hurley, R. E. (2004). Are market forces strong enough to deliver efficient health care systems? Confidence is waning. Health Affairs, 23(2), 8-21.
  • Samuelson, R. (2004, September 22). Prognosis: Stalemate The Washington Post, p. A31.
  • Schroeder, S. A. (2001). Prospects for expanding health insurance coverage. New England Journal of Medicine, 344(11), 847-851.
  • Sheils, J. F., Haught, R. A. (2000 May 2). Analysis of the costs and impact of universal health care models for the state of Maryland. Retrieved December 17, 2004 from http://www.lewin.com
references26
References
  • The Henry J. Kaiser Family Foundation (KFF). (2004). Maryland: At-a-glance. Retrieved November 27, 2004, from http://www.statehealthfacts.org
  • The Lewin Group (2003 October 28). A public-private partnership for health care for all Marylanders: cost and coverage impacts analysis. Falls Church, VA. Retrieved November 29, 2004, from http://www.lewin.com/Lewin_Publications/
  • The Physicians' Working Group for Single Payer National Health Insurance (PWG) (2003). Proposal of the physicians' working group for single-payer national health insurance. Journal of American Medical Association, 290(6), 798-805.
  • Wicks, E. K., & Meyer, J. A. (2001). Prospects for a reduction in the number of uninsured Americans. Retrieved November 3, 2004, from Economic and Social Research Institute Web Site: http://www.esresearch.org/covering_america.php