National Congress on the

Uninsured and Underinsured

December 10, 2007

Karen IgnagniPresident and CEO

America’s Health Insurance Plans

Outline

Our Objectives

What do Voters Say?

What We Have Proposed

Bipartisan Approach to Reform

Addressing the Larger Puzzle

Conclusion

Our Objectives

Getting Kids Covered

Getting Adults Covered

Blending Public/Private Solutions

Defining an Affirmative Role for Both Public and Private Sectors

Inserting Quality Into the Debate

Ensuring Costs Are Not Ignored

Source: Kaiser Family Foundation; Domestic Issues Only; October, 2007

What Are the Voters Saying? Topics They Want to Hear from the Candidates

0%

10%

20%

30%

40%

50%

Republicans Democrats Independents

Health care Economy Immigration Education

Source: Kaiser Family Foundation; October, 2007

What Are the Voters Saying? Priorities for Health Care Reform

15%

32%

40%

0%

10%

20%

30%

40%

50%

Reducing Costs Expanding Coverage Improving Quality

TrendsHow Rising Costs Affect Coverage

0

2

4

6

8

10

12

14

16

18

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Pe

rce

nt

Source for Premiums and Expenditures: Centers for Medicare and Medicaid Services, National Health Expenditures by Type of Service and Source of Funds. Source for uninsured: U.S. Census Bureau.

Uninsured Rate

National Health Expenditures

Private Health Insurance Premiums

TrendsIncome and Coverage

Source: Income, Poverty, and Health Insurance Coverage in the United States: 2006, Census Bureau.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

General Population Low Income (<$25,000)

Moderate Income($25,000 to $49,999)

Upper ModerateIncome ($50,000 to

$74,999)

Growth in Uninsured Rate from 2005 to 2006 (Percentage Points)

TrendsAge and Coverage

Source: Income, Poverty, and Health Insurance Coverage in the United States: 2006, Census Bureau.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

Uner 18 Yearsof Age

Between 18and 24 years

old

Between 25and 34 years

old

Between 35and 44 years

old

Between 45and 64 years

old

Age 65 andover

Growth in Uninsured Rate from 2005 to 2006 (Percentage Points)

Source: Kaiser Family Foundation

TrendsEmployer-Sponsored Coverage

0%

20%

40%

60%

80%

100%

3-9 10-24 25-49 50-199 200+ Cumulative

Firm Size

Percentage of Firms Offering Health Benefits

1996 2000 2007

TrendsRegion and Coverage

Source: Income, Poverty, and Health Insurance Coverage in the United States: 2006, Census Bureau.

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Midwest West Northeast South

Growth in Uninsured Rate from 2005 to 2006 (Percentage Points)

The Political Challenges

Federal vs. State

Children vs. Adults

Public vs. Private

To Mandate or Not

Basic vs. Comprehensive Coverage

Voter Enthusiasm vs. Constituent Reluctance

What Have We ProposedAHIP Access Proposal Improve SCHIP to Cover All Uninsured Children From

Low-income Families

Expand Medicaid to Cover All Uninsured Adults Living in Poverty

Establish a Child Health Care Tax Credit for Working Families

Create a New Tax-free Health Care Account That Can Be Used to Pay For Any Type of Coverage

Create a New Incentive Grant Program to Assist States in Expanding Access

What Have We ProposedAddressing Quality and Costs Create a New Entity for Comparative Effectiveness

Revise Device Approval Process

Establishing a Research Agenda to Address Gaps in Evidence

Coordinate and Step Up Diffusion of Research

Develop Consensus on Measurement and Reward High Performance

Create a New Medical Dispute Resolution System to Resolve Disputes Fast, Fairly and Effectively

What Are We Trying to Accomplish

Promoting a Public-Private, Federal-State Approach

Encouraging Customized Solutions to Meet the Unique Needs of Each State

Expanding Access in Phases

Meeting Test of Fiscal Responsibility

Being Politically Advisable

Source: Ayres, McHenry & Associates; November 2006

What Voters Say About the Proposal

Giving a federal tax credit to low and moderate income parents

Increasing funding for health insurance program for children

Providing grants from the federal government

Having the federal government match contributions

Giving federal tax deduction for purchase of private insurance

Expanding the federal government’s Medicaid program

Establishing a tax-free Health Account for all Americans

Ranked by Percent “Support”

83%

65%

63%

75%

54%

66%

59%

88%

89%

77%

68%

82%

65%

82%

83%

75%

67%

69%

67%

64%

69%

Rep Ind Dem

65%

69%

69%

69%

71%

77%

85%

The Challenges are Palpable to the Public

Crisis is Reaching a Tipping Point for All Stakeholders

Solutions Must Appeal to Red, Blue and Purple Electorate

Must Address Costs, Quality and Access Together to Enact Effective Reform

Public-Private Partnerships are Key for Building Workable Approach

Conclusion

Conclusion

Reacting To Policy Lack Of Agreement On

Policy Little Experience On Ops Little Experience On

Quality Little Focus On Chronic

Disease

Proposing Policy Reforms

Agreement On Universal Access

Collaborating On Ops Prioritizing Quality Disease Management

THEN NOW