What Can States Do About the Uninsured?

1
What Can States Do About the Uninsured?

• Kenneth E. Thorpe, Ph.D.
• Robert W. Woodruff Professor and Chair
• Department of Health Policy and Management
• Rollins School of Public Health
• Emory University

2
Issues

1. Who are the uninsured?
2. Who pays for care received by the uninsured?
3. Access to care among the uninsured
4. Options for covering the uninsured

3
Who are the Uninsured?
4
Uninsured by Age 45 Million in 2003 Most are
Young Adults
5
Most Uninsured Children Are Eligible for Medicaid
or SCHIP Today
6
Most Uninsured Adults Work During the Year in
Small Firms
7
Who Pays for the Health Care Received by the
Uninsured?

• Estimated Uncompensated Care in 2005 44
  Billion
• SOURCES OF FUNDING
• Federal Government
• Medicaid DSH 8.5 Billion
• Medicare DSH 8.0 Billion
• State and Local
• Tax Levy Support 10 Billion
• RESIDUAL UNSPONSORED 17.5 Billion

8
Policy Options

• Reduce Cost of Private Insurance
• Stop-loss for small firms using purchasing pools
• Pool State employees, Medicaid, and SCHIP to
  negotiate payments
• Health insurance tax credit
• Allow no-mandate insurance policies for small
  employers

9
Options for Covering the Uninsured

• Medicaid/SCHIP Options
• Enroll currently eligible children
• Expand Medicaid to parents and childless adults
• HIFA and 1115 Waivers

10
Options for Covering the Uninsured

• Mandated/Comprehensive Returns
• Pay or play approach (California)
• Mandate health plans include young adults to age
  25/26 on parents policy
• Require all college students to have coverage
• Require vendors to have health insurance as
  conditions of receiving State contract