Universal Coverage and Access: Critical to Achieving Health Equity Getting to Universal Coverage and Access A Congressional Briefing Ron Pollack Families.

Universal Coverage and Access: Critical to

Achieving Health Equity

Getting to Universal Coverage and AccessA Congressional Briefing

Ron PollackFamilies USA

May 27, 2009

One in three non-elderly Americans uninsured in 2007-2008

33%

67%

86.7 million Americans under

the age of 65 went without

health insurance for some or all of

the two-year period 2007-2008

Source: Americans at Risk: One in Three Uninsured, Families USA, March 2009

Duration without insurance

Less than 6 months

25%

6-12 months

30%

More than a year45%

Source: Americans at Risk: One in Three Uninsured, Families USA, March 2009

Communities of color are hardest hit

25.8%

40.3%

55.1%

34.0%

0%

10%

20%

30%

40%

50%

60%

70%

WhiteAfrican AmericanHispanic, any raceAmerican Indian, Aleut or Eskimo, Asian or Pacific Islander, or multi-racial

Source: Americans at Risk: One in Three Uninsured, Families USA, March 2009

Percent of Non-Elderly Racial/Ethnic Group Uninsured

Health care must be made affordable

Create a Medicaid eligibility floor at 133% of poverty ($24,350 for a family of three in 2009)

Provide robust, sliding-scale premium subsidies for low-income people above the Medicaid floor

Cap out-of-pocket costs, to protect people from unaffordable cost-sharing

Growing support for these approaches

President Obama’s health reform framework

Senator Baucus’s health reform white paper

Senate Finance Committee’s coverage options paper

Broad acceptance among diverse stakeholders

Why set a Medicaid eligibility floor?

Median Medicaid eligibility for parents: 67% of poverty ($12,270 for a family of three in 2009)

Only 16 states cover parents at or above the poverty level ($18,310 for a family of three in 2009)

In 43 states, adults without dependent children can be penniless and still not be eligible for Medicaid

For example…

AlabamaWorking Parents: 25% of poverty ($4,570 for a family of three)Adults w/out dependent kids:Never eligible, at any income

For example…OregonWorking Parents: 67% of poverty ($12,270 for a family of three)Adults w/out dependent kids:Never eligible, at any income

For example…

MichiganWorking Parents: 66% of poverty ($12,085 for a family of three)Adults w/out dependent kids:35% of poverty ($3,790 for a single adult)

Medicaid = high-quality health coverage

11%

55%

45%

11%7%

13%

18%

11%

26%

0%

10%

20%

30%

40%

50%

60%

No Usual Sourceof Care

No doctor'sappointment in

the last year

Unmet health careneeds due to

costs

Medicaid

PrivateCoverage

Uninsured

Source: Medicaid As A Platform For Broader Health Reform: Supporting High-Need and Low-Income Populations, Kaiser Commission on Medicaid and the Uninsured, May 2009

Medicaid is well-liked

95%91%

0%

20%

40%

60%

80%

100%

Medicaid/CHIP is a good program

Parent would enroll child in

Medicaid/CHIP if eligible

Source: Kaiser Survey of Children’s Health Coverage, 2007.

Do not favor23%

Somewhat favor26%Strongly

favor51%

Public support for expanding Medicaid

Source: Kaiser Health Tracking Poll, April 2009

Do you favor expanding state government health insurance programs for low-income people?

Medicaid covers critical services

Early and periodic screening, diagnosis and treatment (EPSDT) for children

Language access services

Transportation services

Dental and mental health services

Case management for chronic diseases

Home and community based care

No denials because of preexisting conditions

No lifetime caps on benefits

Cost-sharing protections in Medicaid

Many other groups and services are limited to nominal copayments ($3.00 - $5.00)

No premiums: Anyone with income < 150% of poverty ($27,465 for a family of three)

Premiums for those with higher incomes must not be more than 5% of monthly or quarterly income

• Lowest-income children• Foster children• Institutionalized and hospice patients• Women in the breast or cervical cancer programs

• Pregnancy-related services• Preventive services• Emergency services• Family planning services

Protected from ANY cost sharing:

Who will benefit from Medicaid expansions?

Uninsured people under age 65 with income below the poverty level

Over half of the uninsured with income below poverty are people of color.

Source: Expanding Health Coverage for Low-Income Adults: Filling the Gaps in Medicaid Eligibility, Kaiser Commission on Medicaid and the Uninsured, May 2009.

African American

20%

Hispanic30%Other

7%

White43%

What about everyone else?

Medicaid

Covered through the Exchange, some with subsidies

Medicaid eligibility floor

There are low-income people here, too!

How will the subsidies be used?Regulated private health insurance marketplace

Public Plan Option

EXCHANGE

Private Plan

Private Plan

Choice!

Subsidy

Low-income people in the Exchange need:

Affordable premium subsidies on an income-based sliding scale

Limits on out-of-pocket costs based on income

Robust benefit packages; low-income people cannot afford to pay out-of-pocket for non-covered services

Yes, this will cost money.

Upfront investment

Substantial gains in coverage and access

Reductions in racial and ethnic health disparities

For more information, please contact:

Families USAFamilies USAwww.familiesusa.org

202.628.3030202.628.3030

Rea PaRea PañaresñaresDirector of Minority Health InitiativesDirector of Minority Health Initiatives

rpanares@familiesusa.org

Sarina Fogel GersonSarina Fogel GersonSenior Government Affairs AssociateSenior Government Affairs Associate

sfogel@familiesusa.org