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