Commission on Health Care Facilities in the 21st Century
Transcript of Commission on Health Care Facilities in the 21st Century
Presentation TopicsPresentation Topics
Numbers and trendsNumbers and trendsProfile of the uninsuredProfile of the uninsuredAccess barriersAccess barriersPublic coverage programsPublic coverage programsCoverage expansion proposalsCoverage expansion proposalsUncompensated care financingUncompensated care financing
MedicaidMedicareEmployerIndividualUninsured
New York United States
Sources of Health InsuranceAll Ages, 2003-2004
14.7% 15.8%
3.4% 4.8%
53.1% 53.7%
17.2% 13.9%
11.7% 11.8%
Source: Kaiser Commission on Medicaid and the Uninsured
Sources of Health Insurance Nonelderly, 2003-2004
New York United States
MedicaidUninsuredEmployerIndividualOther Public
17.0%18.0%
18.0% 13.0%
61.0% 61.0%
4.0% 5.0%1.0% 2.0%
Source: Kaiser Commission on Medicaid and the Uninsured
Sources of Health Insurance Sources of Health Insurance Nonelderly, 2002Nonelderly, 2002--20032003
New York City New York State
24%
25%
4%
47%
18%
18%
4%
61%
UninsuredUninsured
Public
Public
Directly Purchased
Employer-Sponsored Employer-
Sponsored
(16.7 million people)(7.2 million people)
Directly Purchased
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
Uninsured Trends Uninsured Trends -- NonelderlyNonelderly
15%
16%
17%
18%
19%
20%
21%
1995 1996 1997 1998 1999 2000 2001 2002 2003
United States New York State
Source: March 1996 - March 2004 Current Population Survey, Annual Social and Economic Supplement
Percent Change in the Rate of Coverage of the Nonelderly, 2000 to 2004
-2.4%
-0.7%
3.7%
-0.5%
-4.9%
0.3%
1.7%
2.7%
-6.0%
-5.0%
-4.0%
-3.0%
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
New York
United StatesUninsured
Medicaid
Employer
Individual
_______________________________________________________________________
Source: Kaiser Commission on Medicaid and the Uninsured
0%50%
100%150%200%250%
WorkingParents
PregnantWomen
Infants ChildrenAges 1-5
ChildrenAges 6-19
% o
f Fed
eral
Pov
erty
Lev
el New York United States
Medicaid Eligibility Levels by Annual Income and Federal Poverty Level, 2005
Source: Kaiser Commission on Medicaid and the Uninsured
Uninsured by Income Uninsured by Income All Ages, 2002All Ages, 2002--20032003
New York City New York State
27%
38%
16%
19%
35%
27%
21%
17%
>300% FPL >300% FPL
201-300% FPL
100-200% FPL100-200% FPL
<100% FPL<100% FPL
201-300% FPL
1.7 million uninsured 2.9 million uninsured
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
Uninsured by Age Uninsured by Age All Ages, 2002All Ages, 2002--20032003
New York City New York State
83%17%
Children
Adults83%17%
Children
Adults
1.7 million uninsured 2.9 million uninsured
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
Uninsured by Work StatusUninsured by Work StatusAll Ages, 2002All Ages, 2002--20032003
New York City New York State
75%25%
Workers and Their Dependents
Non-Workers and Their Dependents
78%22%
Workers and Their Dependents
Non-Workers and Their Dependents
1.7 million uninsured 2.9 million uninsured
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
Uninsured Workers by Firm SizeUninsured Workers by Firm SizeNY State, 2002NY State, 2002--20032003
54%
20%
14%
12%
<25 Workers 25-99 Workers 100-999 Workers 1000+ Workers
18%13% 11%
33%
Uninsured Rates Share of Uninsured Workers
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
Distribution by Race/EthnicityDistribution by Race/EthnicityNY State, Nonelderly, 2002NY State, Nonelderly, 2002--20032003
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
60%
16% 16%7%
41%
21%28%
10%
0%
10%
20%
30%
40%
50%
60%
70%
White (non-hispanic)
Black (non-hispanic)
Hispanic Other
Total Population Uninsured Population
Uninsured Rates by Citizenship Uninsured Rates by Citizenship Status, Nonelderly, 2002Status, Nonelderly, 2002--20032003
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
42.6%
51.7%
21.4%14.7%
41.3%45.2%
20.7%13.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
U.S. Citizen -Native
U.S. Citizen -Naturalized
Non-U.S. Citizen,Resident for
<6 years
Non-U.S. Citizen,Resident for
6+ years
United States NY State
Estimated Eligible but Not Insured Estimated Eligible but Not Insured by Public Insurance Programs by Public Insurance Programs
NY State, 2003NY State, 2003
370,000
880,000
1,330,000
80,000
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
Children Adults Total
Num
ber o
f Per
sons
Child Health Plus B Eligible but UninsuredChild Health Plus A/Medicaid Eligible but UninsuredMedicaid/Family Health Plus Eligible but Uninsured
450,000
880,000
1,330,000
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
Profile of the NY StateProfile of the NY State’’s Uninsureds Uninsured
TEND TO BE:TEND TO BE:LowLow--incomeincomeAdultsAdultsIn a working familyIn a working familyMembers of racial/ethnic minoritiesMembers of racial/ethnic minoritiesNonNon--US citizensUS citizensSometimes eligible for public coverageSometimes eligible for public coverage……but not but not enrolledenrolled
Barriers to Care by Insurance Status, Barriers to Care by Insurance Status, US Adults Ages 18+, 2003US Adults Ages 18+, 2003
13%
9%
15%
9%
37%
35%
47%
42%
Did Not Fill a Prescriptionbecause of Cost
Needed Care but Did NotGet It
Postponed Seeking Carebecause of Cost
No Regular Source of Care
UninsuredInsured
Source: March 2003 and March 2004 Current Population Survey, Annual Social and Economic Supplement
Barriers to Care by Insurance Status Barriers to Care by Insurance Status Adults Ages 18+, 2005Adults Ages 18+, 2005
New York State New York City
9%
7%
25%
48%
42%
51%
No RegularSource of
Care
Could notSeek Carebecause of
Cost
No checkupin past year
Insured Uninsured
12%
9%
21%
62%
44%
53%
No RegularSource of
Care
Could notSeek Carebecause of
Cost
No checkupin past year
Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data, 2005.
NYS Public Coverage ProgramsNYS Public Coverage Programs
MedicaidMedicaid4.583M enrollees (2004)4.583M enrollees (2004)
2.03M children (covered under Child Health Plus Part A)2.03M children (covered under Child Health Plus Part A)2.03M adults2.03M adults500K elderly500K elderly603K blind and disabled603K blind and disabled
Child Health PlusChild Health PlusChildren < 19 yearsChildren < 19 years--old, with eligibility based on family incomeold, with eligibility based on family income400,000 400,000 CHPlusCHPlus Part B enrolleesPart B enrollees
NYS Public Coverage ProgramsNYS Public Coverage Programs
Family Health PlusFamily Health PlusLowLow--income adults < 65 years old, with income/resources income adults < 65 years old, with income/resources too high to qualify for Medicaid. too high to qualify for Medicaid. 510,000 enrollees (July 2006)510,000 enrollees (July 2006)
Healthy NYHealthy NYEstablished in January 2001 to make insurance more affordable for 3 key populations:
Small business employers and their employeesSole proprietorsWorking individuals who cannot obtain insurance through their employer
107,000 enrollees (December 2005)107,000 enrollees (December 2005)
Coverage Expansion ProposalsCoverage Expansion Proposals
““Fair ShareFair Share”” –– employer mandateemployer mandate•• A A ““pay or playpay or play”” approachapproach•• Would require businesses with 100+ employees to Would require businesses with 100+ employees to
contribute $3/hour to their workerscontribute $3/hour to their workers’’ health benefitshealth benefits•• Manufacturing and agricultural companies are exemptManufacturing and agricultural companies are exempt
Massachusetts modelMassachusetts modelMandates individual purchase of insuranceMandates individual purchase of insuranceEmployers with 11+ employees must provide Employers with 11+ employees must provide insurance or pay up to $295 annually/employee insurance or pay up to $295 annually/employee
Uncompensated Care FinancingUncompensated Care Financing
NYS hospitals report providing $1.6B/year of NYS hospitals report providing $1.6B/year of uncompensated care uncompensated care
NY State provides $847M/year in HCRA NY State provides $847M/year in HCRA funding to subsidize care for the uninsuredfunding to subsidize care for the uninsured
$765M : $765M : General Hospital Indigent Care Pool General Hospital Indigent Care Pool $82M : High Need Indigent Care$82M : High Need Indigent Care
Uncompensated Care FinancingUncompensated Care Financing
Comprehensive Diagnostic and Treatment Centers also Comprehensive Diagnostic and Treatment Centers also provide a significant amount of care to the indigentprovide a significant amount of care to the indigent
Separate pool reimburses Separate pool reimburses D&TCsD&TCs
Additional State support for uninsured/indigentAdditional State support for uninsured/indigentGME poolGME poolIGTIGT’’ss to public hospitalsto public hospitalsADAPADAPOther public health programsOther public health programs