Fall Speaker Series Breaking Down Barriers & Building Access to Healthcare Wednesday, October 26, 2011 11:30 a.m. La Colombe D'Or Le Grand Salon de la.

Fall Speaker SeriesBreaking Down Barriers &

Building Access to HealthcareWednesday, October 26, 2011

11:30 a.m. La Colombe D'Or

Le Grand Salon de la Comtesse3416 Yoakum Blvd., Houston, TX 77006

2

Health Reform: The Big PictureOr, Why ACA is worth Keeping, In Spite

of Flaws

• First-ever system for making comprehensive care available to all (lawfully present) Americans at an affordable price

• Competition in health insurance marketplace will no longer be based on avoiding risk

• Lays a foundation for controlling costs and improving quality of care

3

Affordable Care Act Timeline

2014 2013 2012 2011 2010

• 2010: Early insurance market reforms begin.

• 2010-2014: Start building new systems needed to support covering large numbers of uninsured.

• 2014: Big expansion of coverage starts.

• Build on current system: Vast majority of Americans still get coverage through their employer.

• Medicaid expansion: US citizens to 133% FPL ($14,404 individual; $29,327 for 4). (Increases primary care Medicaid fees to MediCARE level in 2013.)

• Reform Private Health Insurance: standard minimum benefits, can’t charge more based on health status, limits on premium increases as people age, no denial of coverage, no excluding pre-existing conditions, no annual or lifetime maximums.

• New Health Insurance Exchanges where private insurers’ options can be compared and purchased. Open to people without job-based coverage and small employers, and all members of Congress will get coverage thru exchange.

• Sliding scale premium assistance in the exchange up to 400% of FPL ($88,200 for family of 4).

• Sliding scale deductibles/co-pays and out-of-pocket caps in the exchange to increase affordability & reduce medical bankruptcy.

• Individual mandate to have coverage (with major exemptions).

• Some requirements for employers to contribute if their employees get sliding-scale help in exchange, with exemption for all employers with 50 or fewer workers.

2014: Health Reform Building Blocks

55

Texas Medicaid/CHIP: Who is Helped Today

September 2011, HHSC data

Total enrolled 9/1/2011: 3.6 million Medicaid; 550,000 CHIP

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How Could 2010 Uninsured Texans Gain Coverage If Reform were Fully

Implemented Today?

≈ 2.6 million (< 65) may get help with coverage in the exchange

≈ 610,000+ would qualify for exchange coverage at full cost

≈ 1.4 million U.S. citizen adults would newly qualify for Medicaid

≈ 600,000 kids qualify for Medicaid or CHIP right now

≈ BUT: 1.1 to 1.8 million would remain uninsured (CBO)

2.6M

610K

1.4M

600K

1.1M

0 0.5 1 1.5 2 2.5 3

≈ 3 uninsured Texans gain private exchange coverage for each 2 gaining through Medicaid/CHIP

Of the 6.2 Million Uninsured Texans in 2010…

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Under Reform - 2019

Employer

159 million

56%

Medicaid/CHIP

51 million

18%Nongroup & Other

26 million 9%

Private Exchanges

24 million

9%

Uninsured

23 million

8%

Americans’ Insurance Coverage in 2019:If Nothing Changed compared to Health Reform Law

Employer

162 million

58%

Medicaid/CHIP35 million

12%Uninsured

54 million

19%

Nongroup & Other

30 million 11%

Without Reform - 2019

Source: The Congressional Budget Office Cost Estimate of H.R. 4872, Reconciliation Act of 2010, Mar. 20, 2010, http://www.cbo.gov/doc.cfm?index=11379 .

282 Million U.S. Residents Under Age 65

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Texas Uninsured by Income 2010… 89% of 6.2 million uninsured have incomes

<400% FPL

<100% FPL<$22,350/yr for family of four

100-125% FPL$22,350-$27,938

150-200% FPL$33,100-$44,100

200-250% FPL$44,100-$55,100

250-300% FPL$55,100-$66,200

300-400% FPL$66,200-$88,200

>400% FPL>$88,200

125-150% FPL $27,938-$33,525

656K

501K

626K614K

1.912 Million

421K

Annual income limits given for a family of four, 2011 federal poverty level U.S. Census, March 2011 CPS

921K

6.2 million includes 1.7 million non-US citizens;

~2/3 of these (about 1.1 million) likely

undocumented

525K

San Jose Clients by Income Level

A <101%55%B 101% -

125%14%

C 126% - 150%10%

D 151% - 200%12%

E 201% - 250%9%

A <101%

B 101% -125%

C 126% - 150%

D 151% - 200%

E 201% - 250%

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Uninsured Texans by Age Group, 2010

0-18

19-64

65+

4.84 millionRate: 31.8% of 19-64

are Uninsured

1.24 millionRate: 16.8% of 0-18

are uninsured

<2/3 are below 200%

FPL

63% are below 200% FPL

Source: U.S. Census, March 2011 CPS

6.2 million uninsuredTexans

101,0004% of Texas Seniors uninsured – twice the

US average

Children 0-18yrs

549, 15%Adults

19-64yrs2,916, 77%

Seniors 65+years303, 8%

Children 0-18yrs

Adults 19-64yrs

Seniors 65+years

San Jose Clients by Age

Dental Care:• 10% are 65 + (no dental in Medicare).• 80% are ages 19 + (no dental in adult Medicaid, either)

Texas Uninsured Rates by Citizenship Status, 2010:though non-citizens are much more likely to be uninsured….

Texas average: 24.6%

4.1 million people

392,128 people

1.7 million people (including legal immigrants)

Source: CPPP Analysis of CPS Annual Social & Econ. Supplementhttp://www.census.gov/hhes/www/cpstc/cps_table_creator.html

Most Uninsured Texans are U.S. Citizens

Uninsured by Citizenship Status, 2009-10 Average

Naturalized U.S. citizen

6%U.S.-born

citizen68%

Not a U.S. citizen26%

Source: CPPP Analysis of CPS Annual Social & Econ. Supplementhttp://www.census.gov/hhes/www/cpstc/cps_table_creator.html

Fall Speaker SeriesBreaking Down Barriers &

Building Access to HealthcareWednesday, October 26, 2011

11:30 a.m. La Colombe D'Or

Le Grand Salon de la Comtesse3416 Yoakum Blvd., Houston, TX 77006