commission on health care facilities in the 21st century

Commission on Health Care Facilities in the 21st Century

Uninsured in New York

August 2006

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%


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

_______________________________________________________________________


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


Uninsured by Income Uninsured by Income All Ages, 2002All Ages, 2002--20032003


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


Uninsured by Age Uninsured by Age All Ages, 2002All Ages, 2002--20032003


83%17%

Children

Adults83%17%

Children

Adults



Uninsured by Work StatusUninsured by Work StatusAll Ages, 2002All Ages, 2002--20032003


75%25%

Workers and Their Dependents

Non-Workers and Their Dependents

78%22%

Workers and Their Dependents

Non-Workers and Their Dependents



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


Distribution by Race/EthnicityDistribution by Race/EthnicityNY State, Nonelderly, 2002NY State, Nonelderly, 2002--20032003


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


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


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


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

commission on health care facilities in the 21st century

Documents