HB 2201SB 31

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Healthy Kids Plan

• HB 2201/SB 31

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The Problem

• 117,000 Oregon children have no health insurance
• About half (60,000) qualify for programs, but are
  not enrolled
• Not all Oregon children have access to
• Doctors/healthcare providers
• Medicine
• Eyeglasses
• Basic health care services

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Geographical Distribution of Oregons Uninsured
Kids
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Over Half Of Oregons Uninsured Kids Are In
Middle Class, Working Families

• Many families earning between 40,000 and
  80,000 a year make too much for their kids to
  qualify for state programs BUT make too little
  to afford health insurance
• No employer-sponsored coverage may be available
• Premiums may be too expensive
• Parent may be covered but dependent coverage is
  not available.

Recent statewide survey of Oregon families
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Enrollment Barriers for Kids Already Eligible But
Not Enrolled

• Difficulties some families face with the Oregon
  Health Plan (OHP) application process
• Missing the OHP re-certification window - needing
  to re-do paperwork every 6 months.
• Confusion about childrens eligibility if parents
  no longer eligible for OHP
• Recent statewide survey of Oregon
  families

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Why is health insurance so important?

• Uninsured kids are
• Half as likely to get preventive care or see a
  doctor than if they were insured
• More likely to use expensive emergency room for
  care
• More likely to be hospitalized
• From a recent statewide survey of Oregon
  families and several national studies

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Healthy Kids Can Keep Kids Learning

• Kids in poor health miss school more often
• If illnesses such as asthma are not treated, kids
  perform poorly in school
• Kids will be more successful in the future if
  they are in school and healthy

from recent national studies
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Keeping Kids Healthy Also Saves Money

• When uninsured kids are hospitalized, their
  parents struggle to pay medical bills, and can
  only afford an average of 35 of the cost.
• Over 40 of the hospital costs for the uninsured
  are passed on as higher costs to people with
  health insurance.

Families USA, June 2005
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Healthy Kids Plan Design
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Public Input

• Policy and Program Framework
• The Medicaid Advisory Committee
• Senate Childrens Health Access Committee
• Program Design and Implementation
• Stakeholder Meetings

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Key Components

• Offer coverage to all uninsured Oregon children
  up to age 19
• Comprehensive health care that includes dental,
  vision, mental health with physical health
• Build on existing programs
• Keep it simple for families
• One Healthy Kids card
• Simpler enrollment and keeping kids enrolled

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Meet Childrens Health Care Needs In Three Ways

• Expand opportunities to families not eligible for
  the Oregon Health Plan to buy affordable coverage
  with state subsidies tiered to income
• Meet working families half-way and put health
  care within their reach.
• Improve and expand access to kids eligible for
  enrollment in the Oregon Health Plan
• Simplify enrollment and keep kids enrolled.
• Continue to improve access to care, including the
  expansion of school-based health centers
• Access and insurance are linked.

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OHP Plus Package Continues For Kids Up To 200 FPL

• Comprehensive benefits continue includes
  dental, vision, mental health care
• No Co-Pays, No Premiums

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Family Health Insurance Assistance Program
(FHIAP) Will Continue

• Providing premium assistance to low-income
  families with insurance options through their
  work
• Making insurance premiums affordable for families
  through a private-public partnership

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ANDan Option For Families Without Other Choices
Private Insurance Product

• For families with incomes at 200 FPL and
  above with no access to employer-sponsored
  insurance
• Comprehensive coverage
• Assistance to families to choose a plan
• Subsidies based on income
• All health plans may compete to participate

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How Much Will Healthy Kids Cost Families?

• As Healthy Kids was designed we talked with
  Oregon families about what is affordable
• Families pay at the level they can afford, with
  assistance at lower incomes
• Affordable monthly premiums and copays at higher
  incomes

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Rural Families No Discretionary Monthly Income
Until 200-250 Of Poverty Level
Economic Policy Institute and US HHS - Rural
Oregon (2004) 2 Parents 1 Child
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Urban FamiliesNo Discretionary Monthly Income
Until 250 Of Poverty Level
Economic Policy Institute and US HHHS data
-Portland Area (2004) 2 Parents 1 Child
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Affordable Health Care for All
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Healthy Kids Affordable Options
Families Buy-in Full Price State-Only
subsidies Federal match for state subsidies for
private product
350 Federal Poverty Level (FPL) Above
State-only subsidies Federal match for state
subsidies for employer-sponsored insurance Full
subsidy
300 FPL
200 FPL
No Copays/No Premiums
Private Insurance Product
Family Health Insurance Assistance Program FHIAP
OHP Plus
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Enrolling Kids and Keeping Kids Enrolled
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Leverage Local Community PartnershipsTo Reach
Families

• Outreach to families with uninsured kids
• Provide application assistance
• Keep kids enrolled in a health plan

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Simplify Enrollment and Keep Kids Enrolled

• Shorter Application
• 12-month Enrollment Period
• 2 month Uninsurance Requirement
• No asset test

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Access to Health Care
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Expand School-Based Health Centers

• Oregon has 44 SBHC in 17 counties
• Healthy Kids would support
• 6 new SBHC in 6 new counties
• 7 new SBHC in counties already operating SBHC

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• Expand Dental Sealant Program
• Seal the teeth of 50 of all 8-year-olds by
  2010, compared to 30 of uninsured children who
  have dental sealants today
• Nurse Advice Line
• Ensure that families have access to nurse
  advice line so kids get best care in most
  appropriate setting

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What About The Funding Of Healthy Kids?

• Maximize use of federal dollars available to
  Oregon
• Efficiently use current state programs tax
  dollars
• Increase Tobacco tax dollars
• Families pay their share based on income
• Saves all of us money by covering all
• uninsured children

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In SummaryThe Healthy Kids Plan

• 117,000 of Oregons kids are uninsured, despite
  the efforts of their working parents and the
  states current health programs.
• Access to health insurance is important to keep
  kids healthy and learning in school.
• The Healthy Kids Plan will provide streamlined,
  affordable access to health care options for
  Oregons families.
• An investment in the health of our children is an
  investment in Oregons future.

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For More Information

• The Governors Website
• http//governor.state.or.us/