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ITUP Teaser Slideswww.itup.org

Just the Facts:Coverage in the US &

California2/10/10Prepared by Serina Reckling and Sara Watson

Per Capita Total Current Health Care Expenditures,

U.S. and Selected Countries, 2007

$2,851

$4,417

$3,180

$2,578

$4,463

$3,527

$2,569

$3,295

$3,319

$2,626

$3,463

$3,496

$2,677

$3,362

$3,715

$3,462

$3,581

$3,172

$6,956

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000

United States

United Kingdom

Switzerland̂

Sweden

Spain

Norway

Netherlands^

Italy

Ireland

Iceland*

Greece

Germany

France

Finland

Denmark

Canada

Belgium̂

Austria

Australia

^OECD estimate.

*Differences in methodology.

Notes: Amounts in U.S.$ Purchasing Power Parity, see www.oecd.org/std/ppp; includes only countries over $2,500. OECD defines Total Current Expenditures on Health as the sum of expenditures on personal health care, preventive and public health services, and health administration and health insurance; it excludes investment.

Source: Organisation for Economic Co-operation and Development. OECD Health Data 2009, from the SourceOECD Internet subscription database updated November 2009. Copyright OECD 2009, http://www.oecd.org/health/healthdata. Data accessed on 11/13/2009.

10.4%

12.7%

8.5%7.7%

6.4%

1.3%

2.9%

6.3%7.9%

6.3%7.5%

9.3%

5.6%4.3%

3.2%

0.2%-0.6%

3.0%

5.4%

6.6%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Medicaid Spending Growth Medicaid Enrollment Growth

Projected

Percent Change in Medicaid Spending and Enrollment, FY 2001-2009

NOTE: Enrollment percentage changes from June to June of each year. Spending growth percentage changes in state fiscal year. SOURCE: Enrollment Data for 1998-2006: Medicaid Enrollment in 50 States, KCMU. Spending Data from KCMU Analysis of CMS Form 64 Data for Historic Medicaid Growth Rates. FY 2009 and FY 2010 data based on KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, September 2009.

4%

11%

2%3% 4%1%

52%

30%

24%

14%10% 10%

Medicaid Private UninsuredPercent Reporting:

Adults Adults Children

No Usual Source of

Care

Needed Care but Did Not Get It Due to Cost *

Children

Access to Care: Medicaid Comparable to Private

Insurance; Uninsured, not so much

* In the past 12 monthsNOTE: Respondents who said usual source of care was the emergency room were included among those not having a usual source of careSOURCE: KCMU analysis of 2008 NHIS data

Decrease in Employer

Sponsored Insurance

(million)2.8%

National Unemployme

nt Rate Increase

since 2008(from 7.2% in

Dec-08 to 10.0% in Nov-09)

=

2.8 3.0

Medicaid /CHIP

Enrollment Increase(million)

Uninsured Increase(million)

&

6.9

Note: Totals may not sum due to rounding and other coverage.Source: Based on John Holahan and Bowen Garrett, Rising Unemployment, Medicaid, and the Uninsured, prepared for the Kaiser Commission on Medicaid and the Uninsured, January 2009.

Impact of the Rise in Unemployment on Health Coverage, 2008 to 2009

Private Non-group5%

Uninsured17%

Medicaid/ Other Public

18%Employer-sponsored Insurance

60%

Health Insurance Coverage ofthe Nonelderly Population, 2008

262.8 Million

SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

Nonelderly’s Health Insurance Coverage by Family Poverty Level,

2008

20%

89%

45%

29%

12%

5%

42%

71%

6%

18%

29%

35%

Private Medicaid/ Public Uninsured

50.2 M

46.0 M

41.5 M

125.1 M

Number

Under 100%

100% - 199%

200% - 299%

300% +

NOTES: Data may not total 100% due to rounding. The Federal Poverty Level for a family of four in 2008 was $22,025 (according to the U.S. Census Bureau’s poverty threshold). Family size and total family income are grouped by insurance eligibility. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

• 8 out of 10 of the uninsured are in working families & don’t have access to employer-sponsored health insurance

• In 2005, ¾ of uninsured workers were adults not offered employer-sponsored coverage

• Since 2002, the number of firms offering employer-sponsored health insurance has decreased from 69% to 60%

Source: The Kaiser Family Foundation. Five Basic Facts on the Uninsured. September 2009.

Characteristics of the Uninsured, 2008

400% FPLand Above

10%

200-399% FPL 23%

100-199% FPL29%

<100% FPL38%

Family IncomeFamily Work Status

Total = 45.7 million uninsured

1 or More Full-Time Workers

66%

No Workers

19%

Part-TimeWorkers

14%

Age

55-649%

30-5443%

19-2930%

0-1818%

The federal poverty level was $22,025 for a family of four in 2008. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

Nearly 70% of the uninsured with mental Nearly 70% of the uninsured with mental health disorders do not have access to the health disorders do not have access to the

services they needservices they need

Source: The National Council for Community Behavioral Health Care. Unmet Healthcare Needs of Indigent, Uninsured Americans. July 2009.

• In 2007, 5 million uninsured children were eligible for public coverage but were not enrolled

• 55% of low-income parents do not know how to enroll their child

• 45% do not think their child is eligible for coverage

• 50% think the enrollment process is difficult

Source: Kenney, Genevieve. Uninsured and Eligible for Public Coverage: Underlying Causes and Policy Solutions. National Institute for Health Care Management. November 2009.

Source: The Kaiser Family Foundation. Five Basic Facts on the Uninsured. September 2009.

Cumulative Changes in Health Insurance Premiums, Inflation, and Workers’ Earnings, 1999-2009

131%

38%

28%

0%

20%

40%

60%

80%

100%

120%

140%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Health Insurance Premiums

Workers' Earnings

Overall Inflation

Note: Due to a change in methods, the cumulative changes in the average family premium are somewhat different from those reported in previous versions of the Kaiser/HRET Survey of Employer-Sponsored Health Benefits. See the Survey Design and Methods Section for more information, available at http://www.kff.org/insurance/7936/index.cfm.

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2009; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2009 (April to April).

Average Health Insurance Premiums and Worker Contributions for Family Coverage, 1999-2009

$4,247

$9,860

$1,543$3,515

1999 2009

Employer Contribut ion

W orker Contribut ionNote: The average worker contribution and the average employer contribution may not add to the average total premium due to rounding.

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009.

$5,791 128% Worker

Contribution Increase

131% Premium Increase

$13,375

Uninsured Rates Among Part-Time Students and Non-Students

Ages 19–23 Are About Twice That of Full-Time Students

* Other includes Medicare, Medicaid, and Military.** Includes part-time students and non-students.Source: Analysis of the March 2008 Current Population Survey by S. Glied and B. Mahato of Columbia University for The Commonwealth Fund.

Not full-time students** = 12.4 million Full-time students = 7.8 million

Own-employer7%

Employer-dependent

48%

Individualor college

plans19%

Other*8%

Uninsured18%

Other*14%

Employer- dependent

15%

Own- employer

26%

Individual orcollege plans

7%

Uninsured37%

Nineteenth Birthdays Are Critical Turning Points in Coverage for Young Adults (Percent Uninsured)

Children,Age 18 and Under

Young Adults,Ages 19–29

Total 11% 29%

<100% FPL 19 51

100%–199% FPL 16 40

>200% FPL 7 16

Source: Analysis of the March 2008 Current Population Survey by S. Glied and B. Mahato of Columbia University for The Commonwealth Fund.

More Than Half of Young Adults Are Overweight or Obese,Two of Five Report Binge Drinking or Smoke Cigarettes,

and 15 Percent Have a Chronic Health Condition

Percent of young adults with the following health problems:

1 Data from 2005–2006; ages 18–29. 2 Binge drinking defined as ‘drinking five or more drinks on the same occasion on at least one day in the past 30 days’; data from 2006; ages 18–25. 3 Data from 2006; ages 18–25. 4 Data from 2003–2004; women ages 20–29.5 Any chronic condition includes physician-diagnosed arthritis, asthma, cancer, diabetes, heart disease, or hypertension; data from 2004–2006; ages 18–29. 6 Mental disorders include major depression, generalized anxiety disorder, and panic disorder; data from 1999–2004; ages 20–29. 7 Data from 2004–2006; ages 18–29.Source: National Center for Health Statistics, “Health, United States, 2008” (Hyattsville, Md.: NCHS, 2009).

1 2 3

4

5 6

7

Adults ages 19–64 with individual coverage or who tried to buy it in past three years who: Total

Health problem

No health problem

<200% FPL*

200%+ FPL*

Found it very difficult or impossible to find coverage they needed

47% 60% 35% 52% 40%

Found it very difficult or impossible to find affordable coverage

57 70 45 63 53

Were turned down, charged a higher price, or excluded because of a preexisting condition

36 47 26 39 34

Never bought a plan 73 79 66 85 62

The Individual Insurance MarketIs Not an Affordable Option for Many People

* FPL = federal poverty level.Source: Commonwealth Fund Biennial Health Insurance Survey (2007).

State Number of Uninsured

CaliforniaCalifornia 6.6 million6.6 million

Texas 5.6 million

Florida 3.7 million

Arizona 1.2 million

California has the 8th highest percent of uninsured residents in the nation: 20.5%

State Comparison of the Uninsured, 3-Year Average, 2006 to 2008*Source: California Healthcare Foundation, 2009

California’s Uninsured

Uninsured Workers, by Employer Size and TypeCalifornia Residents, Ages 18 to 64, 2008

Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2009 Supplement.

Medically Indigent Adults (MIAs)

0%

10%

20%

30%

40%

50%

60%

70%

80%

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

70.1%

64.6%

17.6%

13.7%

61.1%

55.6%

20.6%

17.4%

CA

CA

U.S.

U.S.Employer-based Coverage

Uninsured Population

Employer-based Coverage and Uninsured Population Trends

California vs. U.S.

1987-2008

Source: California Healthcare Foundation, 2009

Likelihood of Workers Being Uninsured by Employer Size and Type

U.S. vs California 2008

Source: California Healthcare Foundation, 2009

California vs. US Uninsured (2009)

National Comparison CA US

Number of Uninsured (in millions) 6.7 45.7

Adults (ages 18 to 64) 5.7 38.4

Children (up to age 18) 1.0 7.3

Sources of Coverage

Uninsured 20.6% 17.4%

Employer-based 55.6% 61.1%

Public Programs (Medi-Cal, Healthy Families, Medicare, and Tricare/CHAMPVA) 19.9% 19.4%

Individually Purchased 7.7% 6.3%

Source: California Healthcare Foundation

Uninsured Californians, 2008

Age Ethnicity

Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2009 Supplement.

COST/(SAVINGS) ELEMENTFY 2018-19

SENATE VERSION (H.R. 3590)Patient Protection and Affordable Care Act

Total Funds General Funds

Eligibility expansion (MIAs and Parents) $ 6,815,000 $ 1,338,000

Healthy Families Shift (to Medi-Cal) 648,000 324,000

Coverage of eligible but unenrolled (Medi-Cal and Healthy Families)

1,400,000 700,000

Exchange coverage subsidies $11,130,000

Administrative Costs (Ongoing) 16,000 8,000

Direct Costs (Savings) (636,000) (425,000)

Bright Line (Savings) (954,000) (477,000)

State Program (Savings) (1,435,000) (608,000)

County Program (Savings) ($1,440,000

Federal Reform Dividend for CA $16,984,000 ($580,000)

Outpatient rate increase (80% of Medicare) 4,318,000 1,974,000

Primary care rate increase (80% of Medicare) 537,000 255,000

(Dollars in Thousands)

HEALTH CARE REFORM COST AND SAVINGS ESTIMATEFULL IMPLEMENTATION: CALIFORNIA