Considerations for Moving Forward
Health Foundation of Greater Cincinnati
August 17, 2007
Cindy Mann
Executive Director
Georgetown University Health Policy Institute
Center for Children and Families
Trends & Current Status
The Uninsured in America
Number of Total Uninsured in Millions
44.8
43.4
43.5
2003
2004
42
39.8
38.8
1999
38.4
2000
2001
2002
2005
Source: U.S. Census Bureau, Current Population Survey, 2000 to 2006 Annual Social and Economic Supplements, (released June
28, 2007)
Trends in the Uninsured Rate of
Low-Income Children, 1997- 2005
Uninsured rate of low-income children under 19
22.3%
21.5%
20.1%
20.0%
18.0%
15.8%
1997
1998
1999
2000
2001
2002
15.9%
2003
15.2%
14.9%
2004
2005
Source: CCF analysis of National Health Interview Survey.
Note: “Low-income” is defined as having income below 200% of the federal poverty line, which in 2005 was $32,180 for a family of 3.
Why the Big Difference?
• ESI declining for adults and children
• Children much more likely to be eligible for
public programs (Medicaid/SCHIP) which
fill in the gaps
Premiums for Employer-Sponsored Coverage
Are Growing Faster than Workers Earnings
16%
14%
12.9%
12%
13.9%
11.2%
10.9%
9.2%
10%
8.2%
8%
6%
7.7%
4.4%
5.3%
4%
3.8%
2%
3.6%
3.9%
3.8%
4.0%
2.6%
3.0%
2.1%
2.7%
0%
1998
1999
2000
2001
2002
Health Insurance Premiums
2003
2004
2005
2006
Workers Earnings
Note: The annual growth for premiums is statistically significant from the prior year at p<0.05 for every year except 2003.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006, (September 2006).
Changes in Health Insurance Coverage,
2000-2004
Adults
Children
(6.3 million more
uninsured adults)
(300,000 fewer
uninsured children)
5.2%
2.7%
1.2%
-0.7%
-4.6%
-4.6%
Employer
Medicaid/SCHIP
Source: Urban Institute, 2005, for Kaiser Commission on Medicaid and the Uninsured
Uninsured
State Uninsurance Rates of
Nonelderly Adults (2005)
29.7%
U.S. Average, 19.7%
Kentucky, 17.8%
Ohio, 14.3%
10.4%
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).
State Uninsurance Rates of Children
(2005)
20%
U.S. Average, 11%
Ohio, 8.1%
Kentucky, 7.8%
4.8%
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).
Where Do We Go From Here?
Sources of Coverage for Nonelderly
Americans, 2004-2005
Uninsured
17%
Other Public
2%
Medicaid/SCHIP
14%
Employer
62%
Individual
5%
256 Million Nonelderly Americans
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).
Sources of Coverage for Nonelderly
Kentuckians & Ohioans, 2004-2005
Other
Public
2%
Uninsured
15%
Other
Public
4%
Medicaid/
SCHIP
15%
Individual
4%
3.6 Million Nonelderly
Kentuckians
Uninsured
13%
Medicaid/
SCHIP
13%
Employer
62%
Individual
4%
Employer
68%
9.9 Million Nonelderly
Ohioans
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).
Characteristics of the Nonelderly
Uninsured, 2005
Age
Income
Children
under
19
20%
Adults
35-64
40%
200399%
FPL
23%
Work Status
Parttime
worker
11%
400% +
FPL
10%
No
worker
19%
< 100%
FPL
37%
Adults
19-34
40%
100199%
FPL
30%
44.4 Million Nonelderly Americans
Source: Urban Institute, 2005, for Kaiser Commission on Medicaid and the Uninsured
1 or
more fulltime
worker
70%
Health Care Is An Important Priority for
Americans
The most important issue to voters in deciding who they
would like to see elected president (July 2007):
1.
2.
3.
4.
5.
6.
7.
Iraq (20%)
Terrorism/national security (17%)
Economy/jobs (17%)
Health care (16%)
Immigration (10%)
Education (8%)
Environment (7%)
Source: CBS News/New York Times Poll, July 9-17, 2007.
Payment Sources for Uncompensated
Care, 2004
Private Dollars
15%
Federal Dollars
58%
State Dollars
27%
Total = $40.7 Billion
Source: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, (October 2006).
There Is Not A Consensus on Solutions
The public’s most preferred policy option to
help the uninsured:
Offer tax incentives to businesses to
help provide insurance
23%
Expand Medicaid, SCHIP, and other
state programs
17%
Offer tax incentives to the uninsured
to help them purchase insurance
17%
Create a national, single-payer health
plan
Require businesses to offer insurance
Expand Medicare to cover uninsured
people 55 and over
15%
13%
12%
Source: Kaiser/Harvard Health Care Agenda for the New Congress Survey (conducted November 4-28, 2004).
A Big Divide?
• “We need universal health care coverage in this country,
not stale ideas and savings account schemes.”
- AFL-CIO President John Sweeney (February 1, 2006)
• “I emphasize private insurance, the best health care plan
-- the best health care policy is one that emphasizes
private health. In other words, the opposite of that would
be government control of health care.”
- President George W. Bush (June 27, 2007)
More Action at the State Level
•
•
•
•
Children’s coverage
Universal coverage
In between?
Insurance reforms, tax changes
States are Moving Forward
On Children’s Coverage
NH
VT
WA
MT
ME
ND
MN
OR
MA
NY
ID
SD
WI
MI
WY
CT
PA
NJ
IA
OH
NE
NV
IL IL
UT
CA
CO
MO
KS
IN
DE
WV
VA
MD
KY
NC
TN
OK
NM
AZ
RI
SC
AR
MS
TX
AK
DC
AL
GA
LA
FL
HI
Implemented or Recently Adopted
Legislation to Improve Children’s Coverage
(26 states and DC)
Considering Significant Proposal to
Improve Children’s Coverage (2 states)
Source: As of August 2, 2007 based on CCF review of state initiatives.
Americans Support Covering Children
July 23, 2007
Source: Poll conducted by Lake Research Partners and American Viewpoint, national survey of 1,002 American voters from June 26
- July 1, 2007 for the Center for Children and Families
But Their Parents Are Often Left Behind
Medicaid/SCHIP Eligibility Levels for Children and
Parents With Earnings in the Median State
Income Eligibility Levels Expressed as a Percent of the Federal Poverty Level
200%
65%
Children
Source: CBPP survey for KCMU, January 2007.
Note: In 2007, 65% of the FOL is equal to $11,161 for a family of 3.
Parents
“Universal” Coverage
• Enacted: Massachusetts, Vermont
• Partial: Maine
• Under active debate: California, Illinois,
Maine, Pennsylvania, Washington
• Commissions, studies going on in several
states
Solutions Are At Hand
Decline in the Rate of Uninsured Children, 1997/1998 to 2004/2005
40.20%
23.90%
11.30%
U.S.
Kentucky
Ohio
Source: RWJF, Protecting America’s Future: A State-by-State Look at SCHIP & Uninsured Kids, (August 2007).
Elements For Success
• It doesn’t happen overnight
• Advocacy/organizing capacity is essential
– Look for opportunities for common ground
• For several reasons, public program coverage is
key
• Solutions are at hand, but they aren’t free
• Much can be done at the state level but the
federal government will need to step to the plate