Health Care Coverage and Reform: The National Perspective

1. Health Care Coverage and Reform: The National Perspective Jennifer Tolbert Principal Policy Analyst Kaiser Commission on Medicaid and the Uninsured for State Coverage Initiatives 2007 National Meeting January 26, 2007

2. Number of Uninsured Children and Nonelderly Adults, 2000 - 2005 In Millions 45.5 46.1 44.8 44.7 43.3 40.9 39.6 Revised Method Because of revised Census Bureau methods used for the 2005 data, 2005 estimates should be compared only to 2004 data that have been re-estimated using the new methods and not to earlier years. Sums may not equal totals due to rounding.SOURCE: KCMU and Urban Institute estimates based on the March Current Population Surveys, 2001-2006.

3. Uninsured Rates Among the Nonelderly by State, 2004 - 2005 <13% Uninsured (8 states) National Average = 18% 13 to <18% Uninsured (24 states & DC) >18% Uninsured (18 states) SOURCE: KCMU and Urban Institute analysis of the March Current Population Survey, 2005 and 2006, two-year pooled data.

4. The Nonelderly Uninsured,by Age and Income Groups, 2005 Total = 46.1 Million Uninsured Note: Low-income includes those with family incomes less than 200% of the federal poverty level ($39,942 for a family of four in 2005). SOURCE: KCMU and Urban Institute analysis of March 2006 Current Population Survey.

5. Percentage of Children Without Health Insurance, By Poverty Level, 1997-2005 23% Children below 200% of poverty 21% 14% 6% 5% 5% Children above 200% of poverty * Survey method change in 2005 affects comparison with earlier years slightly. Children less than 18 years old. Source: L. Ku, “Medicaid: Improving Health, Saving Lives,” Center on Budget and Policy Priorities analysis of National Health Interview Survey data, August 2005.

6. Children’s Eligibility for Medicaid/SCHIP by Income, July 2006 NH VT WA ME MT ND MN MA OR NY ID SD WI RI MI CT WY PA NJ IA NE OH IN NV DE IL UT WV VA MD CO CA KS MO KY NC DC TN OK SC AR AZ NM AL GA MS TX LA AK FL HI > 200% FPL* (17 states) 200% FPL (24 states including DC) US Median Eligibility = 200% FPL < 200% FPL (10 states) * Federal Poverty Level (FPL) refers here to HHS Poverty Guidelines, $20,000 for a family of four in 2006. SOURCE: Center on Budget and Policy Priorities for KCMU, 2007

7. Simplifying Enrollment and Renewal:Strategies States are Using in Children’sHealth Coverage Programs, July 2006 Number of States: SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2006.

8. 3 Out of 4 Uninsured Children in 2004 were Eligible for Medicaid or SCHIP but not Enrolled Not Eligible, ≥300% FPL Not Eligible, <300% FPL Eligible for Medicaid or SCHIP Total = 8.0 million Uninsured Children SOURCE: Dubay, Holahan, and Cook, “The Uninsured and the Affordability of Health Insurance Coverage,” Health Affairs web exclusive w23, November 2006.

9. State Actions and Strategies for Covering Children States are looking to use a combination of: • Medicaid/SCHIP eligibility increases • Creating and facilitating affordable insurance for families • Public program buy-in allowing children at higher incomes to purchase coverage • Premium assistance for employer-sponsored insurance • New coverage products through private market • Increased funding for outreach, administrative simplification, and coordination

10. Next Steps for Children’s Coverage • Federal Action on SCHIP Reauthorization • Financing issues • Restructuring current eligibility and benefits • Medicaid Changes • Citizenship documentation • Restructuring benefits for children • Covering Uninsured but Eligible Children • Covering Uninsured Parents

11. Minimum Medicaid Eligibility Levels, 2005 Income eligibility levels as a percent of the Federal Poverty Level: Note: The federal poverty level was $9,750 for a single person and $16,090 for a family of three in 2005. SOURCE: Cohen Ross and Cox, 2005 and KCMU, Medicaid Resource Book, 2002.

12. Comprehensive Reform Aiming at Universal Coverage • Resurgence of interest in broad health reform at state level • Laws in Maine, Massachusetts, Vermont • Developing proposals in California, Connecticut, Illinois, Kansas, Minnesota, Pennsylvania, Washington • Combination approaches emphasizing shared benefits and burdens • Complicated financing using redirected current funds, new federal funds, new fees/taxes, and other sources • Role of Medicaid as financier is critical • Additional focus on wellness, prevention, and quality

13. Strategies for Comprehensive Reform

14. National Support for Reform Growing • National groups and coalitions proposing universal coverage • Divided We Fail coalition (AARP, Business Roundtable, SEIU) • Health Care Coverage Coalition for the Uninsured (“strange bedfellows”) • AHIP • Employers increasingly seeking relief • GM’s problems highlighted health care burden • Small businesses face affordability issues • Public Support • 85% support the federal government doing more to help provide health insurance for more Americans • Campaign issue in 2008

15. Prospects for Federal Action • Congressional health care proposals • “Healthy Americans Act” (Wyden) • “Medicare for All” (Kennedy, Dingell) • “Health Partnership Act” (Bingaman/Voinovich, Baldwin/Tierney/Price) • President Bush’s health care initiatives • Tax code reform to encourage purchase of health insurance • Small business purchasing pools • Divergent priorities may hinder federal action • Paygo rules and other health care demands pose additional challenges

16. The Future of Health Care Reform • Problems plaguing health care system will not go away • Growing uninsured • Declining rates of employer-sponsored coverage • Rising health care costs • Drumbeat at the grassroots level is growing louder • States must continue to advance proposals • Trend-setting states leading the way • Comprehensive reform not possible in all states • However, broad Federal initiatives are unlikely before 2008 election