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
Sarina Fogel GersonSarina Fogel GersonSenior Government Affairs AssociateSenior Government Affairs Associate
