Expanding Health Insurance Coverage
James R. Tallon, Jr.
President, United Hospital Fund
Bipartisan Congressional Health Policy Conference
January 13, 2007
Three questions in expanding health insurance coverage:
1. Who pays?
2. Is it voluntary or mandatory?
3. How is the program designed?
• Public vs. private
• Federal vs. state roles
• Pooling risk
• Benefit package
• Cost control features
UHF-Commonwealth Fund Blueprint for Universal Coverage
Principles for Reform:
• Access and affordability for all
• Administrative simplicity
• Stability of coverage
• Shared responsibility
• Continuity with existing programs
• Choice
• Pooled risk
• Efficiency and quality
Blueprint Building Blocks
• Public Programs
– Simplification
– Eligibility Expansion
– Family Health Plus “Buy-In”
• Purchasing Entity
– Administer the Family Health Plus “buy-in”
– Make coverage available to individuals at group rates
• Mandates
– Two versions of employer assessment for those not providing coverage
– Individual mandate, with income protection
Comparing Massachusetts and New York Prior to Reform
• New York has a larger share of low-income people and a larger share of uninsured low-income people
• New York has a lower rate of employer-sponsored insurance
• New York has a larger eligible but uninsured population (41% vs. 23%)
Medicare and Other Public
UninsuredUninsured
Medicaid/FHP/ CHP
Medicare and Other Public
Directly Purchased
51%
19%
15%
43%
Current Distribution Post-Reform: Public Changes
Employer-Sponsored
8.3 m
Employer-Sponsored
9.7 m
Distribution of Health Insurance Coverage, Before and After Reform:
Combined Public Program Changes
Note: “Post-Reform” scenario includes the combined administrative simplification, expansion of Family Health Plus to 150% FPL, and subsidized buy-in to Family Health Plus (150-300% FPL). “Medicare and Other Public” category includes dual eligibles and persons covered by CHAMPUS.Data include persons of all ages. Numbers may not sum to 100% due to rounding.
19.1 million people
2%
13%
2%
24%
8%
13%
10%
.3 m
4.5 m
.5 m
3.6 m
2.5 m
2.8 m
1.5m
2.5 m
2.0 m
Medicaid/FHP/CHP
FHP Buy-In (through
InsuranceExchange)
Directly Purchased
Medicare and Other Public
UninsuredUninsured
Medicare and Other Public
Medicaid/FHP/ CHP
43%
24%
10%
45%
Post Reform: Public Changes Post-Reform: Public Changes, Individual Mandate, Modest Employer Assessment
Employer-Sponsored
8.7 m
Employer-Sponsored
8.3 m
Distribution of Health Insurance Coverage, Before and After Reform: Public Program Changes Alone Compared with
Public Program Changes, Individual Mandate, and Modest Employer Assessment
Note: “Public Changes” includes the combined administrative simplification, expansion of Family Health Plus to 150% FPL, and subsidized buy-in to Family Health Plus (150-300% FPL). “Medicare and Other Public” category includes dual eligibles and persons covered by CHAMPUS.Data include persons of all ages. Numbers may not sum to 100% due to rounding.
19.1 million people
2%
13%
2%
26%
12%
13%
2%
.3 m
5 .0m
1.5 m
4.5 m
2.5 m
2.0 m
2.2m
2.5 m
.4 m
Medicaid/FHP/CHP
InsuranceExchange
Directly Purchased
8%
FHP Buy-In (through
InsuranceExchange)
Directly Purchased
.3m
Overview of Results
• Public program changes achieve a one-third reduction in the uninsured
• Significant subsidies are needed to gain participation and protection of low-income persons
• Universal coverage requires mandatory features– Employer mandates alone are not enough– Individual mandates are necessary for universal
coverage
Spitzer Agenda
Restructure:
• Close and consolidate certain hospitals
• Shift spending from institutional nursing homes to community and home-based care
• Negotiate lower prices for prescription drugs
• Aggressively fight Medicaid fraud
Reinvest:
• Universal coverage for children (year one)
• Streamline enrollment in order to enroll eligible but uninsured adults (over 4 years)
• Better management of high-cost cases
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