Health Care Challenges and Opportunities

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Health Care Challenges and Opportunities

• Diane Rowland, Sc.D.
• Executive Director
• The Kaiser Commission on Medicaid and the
  Uninsured
• for
• Health Action 2001
• Families USA
• Washington, DC
• January 25, 2001

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Health Insurance for Americas Families
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Health Insurance Coverageby Poverty Level, 1999
Figure 1
Medicaid
Uninsured
Other includes individually-purchased private
insurance and other public coverage. Note The
federal poverty level for a family of three in
1999 was 13,290. SOURCE Urban Institute and
Kaiser Commission on Medicaid and the Uninsured,
analysis of March 2000 Current Population Survey,
2000.
4
Characteristics of the Uninsured
Figure 2
Income
Work Status
Age
2 or More Full-Time Workers 16
Part-Time Workers 12
1 Full-Time Worker 55
No Workers 18
Total 42 million Uninsured
SOURCE Urban Institute and Kaiser Commission on
Medicaid and the Uninsured, analysis of March
2000 Current Population Survey, 2000.
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Health Insurance Offer Rates by Firm
Characteristics, 2000
Figure 3
Percent of firms offering health benefits
Small Firms
Lower Wage firms defined as firms in which more
than 35 of employees earn less than
20,000/year Higher Wage firms defined as those
in which fewer than 35 of employees earn less
than 20,000/year. SOURCE Kaiser/HRET Survey of
Employer-Sponsored Health Benefits, 2000.
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Average Annual Premium Costs for Covered Workers,
2000
Figure 4
6,348
2,424
SOURCE Kaiser/HRET Survey of Employer-Sponsored
Health Benefits, 2000.
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Access to Employer-Based Coverage forLow and
High Wage Workers, 1996
Figure 5
Note Annualized wage income at lt 7/hour would
be ? 12,740 and at gt15/hour would be gt
27,300. SOURCE Cooper P, and Schone B, 1997.
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Health Insurance Coverageof Adults and Children,
1999
Figure 6
CHILDREN
WOMEN
MEN
Note Adults age 19-64. Federal Poverty Level
was 13,290 for a family of three in
1999. SOURCE Urban Institute and Kaiser
Commission on Medicaid and the Uninsured,
analysis of March 2000 Current Population Survey,
2000.
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Figure 7
Medicaid/CHIP Income Eligibility Levels for
Children, 2000
NH
VT
WA
ME
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
DE
NV
IL
WV
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
OK
SC
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
Medicaid/CHIP Income Levels
lt 150 FPL (8 states)
151 - 199 FPL (7 states)
gt 200 FPL (36 states)
NOTE The Federal Poverty Level (FPL) is 14,150
for a family of three in 2000. SOURCE Center
on Budget and Policy Priorities, 2000.
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Health Coverage of Low-Income Children, 1998
Figure 8
Not Eligible 4
Eligible for CHIP 27
5.2 million uninsured
Total 31.3 million
NOTE Low-income refers to families with incomes
less than 200 of the Federal Poverty
Level. SOURCE Urban Institute simulations, 2000.
Based on the March 1997 Current Population
Survey, projected to 1998.
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Figure 9
Medicaid Income Eligibility Levels for Parents,
2000
NH
VT
WA
ME
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
DE
NV
IL
WV
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
OK
SC
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
Medicaid Income Eligibility Levels
(US Median 67 FPL)
lt 50 FPL (14 states)
50 - 99 FPL (19 states)
gt 100 FPL (18 states)
Connecticut, New Jersey, and New York have
enacted but have not yet implemented their
Medicaid expansion for parents. SOURCE Center
on Budget and Policy Priorities and Families USA,
2000.
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The Uninsured Population, 1999
Figure 10
Total 42 million
Low-income defined as lt 200 of poverty level,
or 26,580 for a family of three in 1999.
SOURCE Urban Institute and Kaiser Commission on
Medicaid and the Uninsured, analysis of March
2000 Current Population Survey, 2000.
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Impact of Being Uninsured
Figure 11
Percent reporting
Postponed Care Due to Cost
No Regular Source of Care
Did Not Fill Prescription Due to Cost
Did Not Get Medical Care for a Serious Condition
Contacted by a Collection Agency About Medical
Bills
Medical Bills Had Major Impact on Life
NOTE Among adults under age 65. SOURCE
NewsHour with Jim Lehrer/Kaiser Family Foundation
National Survey on the Uninsured, March 2000.
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Better Coverage for Elderly and Disabled
Medicare Beneficiaries
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The Non-Institutionalized Medicare Population by
Poverty Level, 1999
Figure 12
12
40 of beneficiaries
14
60
14
Total 36 Million
Note Reflects income from all household family
members. If income from household family members
other than spouse were excluded 17 would have
incomes below poverty. 1999 federal poverty was
8,240 for individuals 11,060 for couples.
Source Urban Institute estimates based on 2000
Current Population Survey.
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Health Insurance Coverage of Medicare
Beneficiaries, 1997
Figure 13
1
Note Columns may not sum to 100
Employer/retiree includes both beneficiaries who
have supplemental insurance from a former
employer or union and those who are still working
and whose current employer is their primary
source of insurance. Source Urban Institute
analysis of 1997 Medicare Current Beneficiary
Survey.
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Access to Care for Medicare Beneficiaries, 1997
Figure 14
Percent of beneficiaries reporting
No Usual Source of Care
Delayed Care Due to Cost
No Office Visit
Community residents only. Source Medicare
Current Beneficiary Survey, 1997.
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Figure 15
Simplifying Enrollment in Medicaid Buy-In
Programs
Number of States Reporting
SOURCE National Senior Citizens Law Center for
the Kaiser Commission on Medicaid and the
Uninsured, 1999.
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Sources of Prescription Drug Coverage for
Medicare Beneficiaries, 1996
Figure 16
Employer-sponsored 31
No drug coverage 31 (12 million)
Medicaid 11
Other 9
Medigap 10
Medicare HMO 8
Total 37 million Medicare beneficiaries
Source Poisal, J.A. and Chulis, G.S., Health
Affairs, March/April 2000. Note Data are based
on the noninstitutionalized population. Includes
people who changed coverage during the year and
those with Medicare and other coverage.
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Public Support for Expanding Medicare to Cover
Prescription Drugs
Figure 17
Percent who say they support the following
Expanding Medicare to pay directly for part of
prescription medicine costs for people age 65 and
over
Having the federal government help people age 65
and over to buy private health insurance plans
that would pay part of their prescription
medicine costs
SOURCE NewsHour with Jim Lehrer/Kaiser Family
Foundation/Harvard School of Public Health
National Survey on Prescription Drugs, September
2000 (conducted July-September 2000).
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Looking to the Future
Figure 18
Medicare beneficiaries as a of the population
2000
2025
Out-of-pocket spending on health care as a of
income
2000
2025
SOURCE Maxwell, S., M. Moon, and M. Segal.
Growth in Medicare and Out-of-Pocket Spending
Impact on Vulnerable Beneficiaries, 2001.
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Improved Protection for All Americans
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Managed Care Penetration, by Insurance Type
Figure 19
SOURCE Kaiser/HRET Survey of Employer-Sponsored
Health Benefits, 2000 Health Care Financing
Administration, July 2000 Health Care Financing
Administration, January 2001.
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Problems with Health Plans
Figure 20
Type of Problem
Did not report a problem with their
health plan 49
Reported a problem with their health plan 51
SOURCE Kaiser Family Foundation National Survey
of Consumer Experiences with Health Plans, June
2000.
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Increases in Health Insurance Premiums Compared
to Other Indicators, 1988-2000
Figure 21
SOURCE Kaiser/HRET Survey of Employer-Sponsored
Health Benefits 1999,2000 KPMG Survey of
Employer-Sponsored Health Benefits 1988, 1993,
1996.
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The Challenge of Building Support
Figure 22

• Health Insurance for Americas Families
• Strengthening public programs
• Extending coverage to the uninsured
• Better Coverage for Medicare Beneficiaries
• Assisting those with low incomes
• Covering prescription drugs
• Securing Medicares future
• Improved Protection for All Americans
• Implementing patients rights
• Assuring affordable quality care

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