www.healthpolicy.ucla.edu
Shana Alex Lavarreda, PhD, MPP
Sacramento, CA2/10/2010
The Uninsured and National Health Care Reform
46 Million Adults and Children are Uninsured in the United States
Other Public3%
7,124,000
Individual5%
13,823,000 Medicaid15%
39,256,000
Uninsured17%
45,693,000Employment-
Based Insurance60%
156,860,000
Notes: Numbers may not add to 100% due to rounding.Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements). www.statehealthfacts.org
Health Insurance Coverage During Last 12 Months Among Non-Elderly Persons, Ages 0-64, California, 2007
Uninsured All or Part Year
19.5%6,400,000
Uninsured All Year
11.3%3,699,000
Uninsured Part
Year8.2%
2,701,000
Employment-Based
Coverage All Year55.6%
18,298,000
Privately
Purchased All Year
5.5%1,794,000 Medi-Cal or
Healthy Families All Year
15.3%5,015,000
Other All Year4.2%
1,378,000
Notes: Numbers may not add to 100% due to rounding."Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured.Source: 2007 California Health Interview Survey
Health Insurance Coverage During Last 12 Months Among Children, Ages 0-18, California, 2001-2007
14.8%*
11.3% 10.7% 10.2%
52.2%55.1%*
50.8% 50.3%*
30.9%29.2%
24.2%*
29.3%
0%
10%
20%
30%
40%
50%
60%
2001 2003 2005 2007
Percent Insured
Uninsured Allor Part Year
Employment-BasedCoverage AllYear
Medi-Cal orHealthyFamilies AllYear
Notes: Numbers may not add to 100% due to rounding."Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured.* Data is significantly different from 2007 at the 95% confidence level.Sources: 2001, 2003, 2005 and 2007 California Health Interview Surveys
Health Insurance Coverage During Last 12 Months Among Adults, Ages 19-64, California, 2001-2007
23.9%
57.0% 56.2%
25.4% 25.7%* 24.8%
55.1%*57.3%
8.5%8.6% 9.0% 8.7%
0%
10%
20%
30%
40%
50%
60%
70%
2001 2003 2005 2007
Percent Insured
Uninsured Allor Part Year
Employment-BasedCoverage AllYear
Medi-Cal orHealthyFamilies AllYear
Notes: Numbers may not add to 100% due to rounding."Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured.* Data is significantly different from 2007 at the 95% confidence level.Sources: 2001, 2003, 2005 and 2007 California Health Interview Surveys
Household Income as Percent of the Federal Poverty Level Among Non-Elderly Persons Uninsured All or Part Year, Ages 0-64,
California, 2007
600%+ FPL
7.5%
479,000
500-599% FPL
3.2%
204,000
400-499% FPL
5.2%
331,000
300-399% FPL
8.5%
546,000
200-299% FPL
16.1%
1,027,000
100-199% FPL
30.6%
1,956,000
<100% FPL
29.0%
1,857,000
Notes: Numbers may not add to 100% due to rounding.The 2007 Federal Poverty Level was $10,210 for one person, $13,690 for a two-person family and $17,170 for a three-person family.Source: 2007 California Health Interview Survey
Family Work Status Among Non-Elderly Persons Uninsured All or Part of the Last 12 Months, Ages 0-64, California, 2007
Non-Working Family
17.7%
1,136,000
At Least One Adult is
Self-Employed
14.3%
918,000
At Least One Adult
Works Part-Time
6.1%
392,000
At Least One Adult
Works Full-Time
61.8%
3,955,000
Note: Numbers may not add to 100% due to rounding.Source: 2007 California Health Interview Survey
Citizenship and Immigration Status Among Non-Elderly Persons Uninsured All or Part Year, Ages 0-64, California, 2007
U.S. Citizen
66.1%
4,230,000
Noncitizen Adult
w ith Green Card
13.8%
881,000 Noncitizen Child
w ith Green Card
0.8%
50,000
Noncitizen Adult
w ithout Green Card
16.6%
1,065,000
Noncitizen Child
w ithout Green Card
2.7%
174,000
Note: Numbers may not add to 100% due to rounding.Source: 2007 California Health Interview Survey
Percent Uninsured All or Part Year by County, Ages 0-64, California,
2007
Note: Differences in rates between counties may not be statistically significant.Source: 2007 California Health Interview Survey
If Nothing Changes – Outlook for 2010 and Beyond
Implementation of new initiatives from ARRA
Quality (value based purchasing)
Electronic health records and e-prescribing
Chronic care management
Strategies to improve access and to address low-income uninsured
Budget and state fiscal pressures
Medicaid spending and enrollment trending up
Economy impacting state revenues
Mid-year budget actions
Healthy Families had enrollment frozen for six weeks this year.
2010 likely to be a difficult year
Eligibility for Medi-Cal and Healthy Families in California, October 2009
300% FPG
Eligible
for AIM
Eligible for Healthy
Families IF < 2yrs &
Mother in AIM
Not Eligible
250% FPG
Healthy Families Eligible
Not Eligible
200% FPG Healthy Families
Eligibility Authorized
not Imple-mented
133% FPG
Medi-Cal
Eligible
100% FPG Medi-Cal Eligible
75% FPG
Medi-Cal Eligible
Medi-Cal Eligible
Medi-Cal
Eligible
Pregnant Women
Ages 0 – 1
Ages 1 – 5
Ages6 – 18
Ages 19 – 64,with
Children
Ages 19-20,
Medically Indigent/
Needy
Disabled and
Aged
All Other Adults
Children Adults
Eligibility of Currently Uninsured Children and Adults for Public Insurance Programs, Ages 0-64, California, 2007
Medi-Cal Eligible6.6%, 272,000
Medi-Cal Eligible30.0%
205,000
Healthy Families Eligible
Healthy Families Eligible26.4%180,000
Healthy Kids Eligible
Healthy Kids Eligible22.7%155,000
Not Eligible for Public Programs
93.4%3,862,000
Not Eligible for Public Programs
20.9%143,000
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Children, Ages 0-18 Adults, Ages 19-64
Total Children Uninsured at Time of Interview = 665,000 Total Adults Uninsured at Time of Interview = 4,134,000
Note: Numbers may not add to 100% due to rounding.Note: Eligibility for Healthy Kids programs is determined by meeting the eligibility criteria, and disregards whether there is room in the program to accept new enrollees.Source: 2007 California Health Interview Survey
Changes Proposed in National Health Care Reform
The House and Senate bills would make two key changes:
Expand Medicaid eligibility to include qualified uninsured adults and children with household incomes up to 133% FPL (Senate) or 150% FPL (House).
Provide public subsidies to enable qualified uninsured adults and children with household incomes from 134%/150% - 400% FPL to purchase insurance
CHIP might be eliminated in favor of moving all eligible families into a health insurance exchange
“Public option” within the exchange(s) could be expansion of current CHIP program in every state
Other options:
A national public option, more like “Medicare for All” (House)
State-based non-profit, co-op plans (Senate)
OPM managed, national not-for-profit private plans (Senate)
Eligibility for Health Insurance Expansions Under Proposed National Health Care Reform, Ages 0-64,
California, 2007
Total Uninsured All or Part Year = 6.4 Million
Ineligible
Due to Citizenship
Status
1,422,000
22%
Ineligible
Due to Income
958,000
15%
Eligible for
Medicaid
Expansion
up to 133% FPL
1,689,000
26%
Eligible for Insurance
Purchase Subsidies
134 - 400% FPL
2,331,000
37%
SOURCE: Lavarreda, SA and Brown, ER (2009). National Health Care Reform Will Help 4 Million Uninsured Adults and Children in California. Fact Sheet, UCLA Center for Health Policy Research, October.
www.healthpolicy.ucla.edu
Thank You – and I’m Here to Help!
Shana Alex Lavarreda, PhD, MPP
Director of Health Insurance Studies and Research Scientist
[email protected], (310) 794-2261
www.chis.ucla.edu
www.statehealthfacts.org
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