one illness away national congress on the un- and under insured december 11, 2007 washington, dc the...
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One Illness AwayOne Illness Away
National Congress on the Un- and Under Insured
December 11, 2007Washington, DC
The crisis of the underinsuredThe crisis of the underinsured
“One Illness Away”
How Did We Get Here?How Did We Get Here?
“One Illness Away”
The Crisis of the UnderinsuredThe Crisis of the UnderinsuredA large portion of
the American population is
unable to access health care
services because they simply cannot
afford them
The Sad History of Health Care Cost The Sad History of Health Care Cost Containment as Told in One ChartContainment as Told in One Chart
The Sad History of Health Care Cost The Sad History of Health Care Cost Containment as Told in One ChartContainment as Told in One Chart
Medicare & Medicare & MedicaidMedicaid
Wage & Wage & price price
controlscontrols
Voluntary Voluntary efforteffort Managed care & Managed care &
threat of health threat of health reformreform
Annual Change in Private Health Spending Per Capita
The cost of providing
coverage has increased 80% in our state in the last five years.
The cost of providing
coverage has increased 80% in our state in the last five years.
A recent study demonstrated
that New Jersey paid the highest
premiums for single plans and
the third highest for
family plans.
A recent study demonstrated
that New Jersey paid the highest
premiums for single plans and
the third highest for
family plans.
As a result, businesses providing coverage for
their workers has dropped so dramatically that now, one in every five New Jersey small
business owners simply cannot afford health insurance and those
who can are increasingly shifting costs to their
workers.
As a result, businesses providing coverage for
their workers has dropped so dramatically that now, one in every five New Jersey small
business owners simply cannot afford health insurance and those
who can are increasingly shifting costs to their
workers.
“One Illness Away”
We are home to more than 1.3 million We are home to more than 1.3 million uninsured, 240,000 of them childrenuninsured, 240,000 of them children
One out of every seven children in our
state receivedNO medical care last
year as a result of being uninsured.
One out of every seven children in our
state receivedNO medical care last
year as a result of being uninsured.
“One Illness Away”
Where “Here” IsWhere “Here” Is
Medical Innovation = Medical Innovation = more people are more people are living with chronic living with chronic illness and ongoing illness and ongoing treatment coststreatment costs
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For most underinsured For most underinsured Americans, there is no Americans, there is no health care “system,” health care “system,” but rather a blotchy but rather a blotchy
and frayed patchwork and frayed patchwork of unreliable and of unreliable and
inconsistent programs, inconsistent programs, providers, and providers, and
facilities. facilities.
The underinsured routinely experience delays in The underinsured routinely experience delays in getting care for a variety of medical problems.getting care for a variety of medical problems.
The The underinsuredunderinsured receive less receive less
preventive care preventive care and poorer and poorer
treatment for treatment for both minor and both minor and serious chronic serious chronic
and acute and acute illnesses.illnesses.
The bottom line: In many cases,
the underinsured live shorter lives than comparable
insured populations.
The bottom line: In many cases,
the underinsured live shorter lives than comparable
insured populations.
“One Illness Away”
Where “Here” IsWhere “Here” Is
Increased patient Increased patient cost-sharing is cost-sharing is
exacerbating, not exacerbating, not helping, the helping, the
problem.problem.
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Where “Here” IsWhere “Here” IsInsurers and Insurers and
employers typically employers typically do not anticipate co-do not anticipate co-payment problems payment problems
when they design or when they design or select a health planselect a health plan
“One Illness Away”
Where “Here” IsWhere “Here” Is
New kinds of New kinds of insurance benefits insurance benefits are often abysmal are often abysmal for the seriously illfor the seriously ill
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Where “Here” IsWhere “Here” Is
Patients required to pay Patients required to pay more out-of-pocket are more out-of-pocket are less likely to be compliantless likely to be compliant
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Where “Here” IsWhere “Here” IsUnderinsured Underinsured patients use a patients use a
variety of variety of strategies to strategies to stretch their stretch their medicationsmedications
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Where “Here” IsWhere “Here” Is
Not seeking Not seeking treatment until treatment until their condition their condition becomes more becomes more
severesevere
“One Illness Away”
What We Are DoingWhat We Are Doing
HEALTHWELLFOUNDATION©
“One Illness Away”
How do copayment foundations help?How do copayment foundations help?
Screen applications to determine if patients qualify for assistance based on their Income
Insurance situation
Disease being treated
Award patients a grant for full or partial assistance, typically to cover one year’s treatment
Process requests for reimbursement based on a patient’s award and actual expenses
“One Illness Away”
What We Are DoingWhat We Are Doing Independent, National Independent, National
CharityCharity committed to help committed to help
individuals unable to individuals unable to afford critical afford critical medications for serious, medications for serious, chronic conditionschronic conditions
HealthWell has granted HealthWell has granted assistance to more than assistance to more than 40,00040,000 patientspatients
“One Illness Away”
What We Are DoingWhat We Are Doing HealthWell fields HealthWell fields
more than 20,000 more than 20,000 inquiries in a inquiries in a typical monthtypical month
HealthWell HealthWell provides more than provides more than $5 million each $5 million each month in relief.month in relief.
“One Illness Away”
What We Are DoingWhat We Are Doing HealthWell beneficiaries
Have chronic and life-threatening diseases
Have some form of health care coverage
Still cannot afford the out-of-pocket costs of their treatment
What We Are DoingWhat We Are DoingAssistance from HealthWell is based on Assistance from HealthWell is based on disease state, not prescribed treatmentdisease state, not prescribed treatment
Acute PorphyriasAcute Porphyrias
Age-Related Macular DegenerationAge-Related Macular Degeneration
Anemia associated with Chronic Renal Anemia associated with Chronic Renal Insufficiency or Chronic Renal FailureInsufficiency or Chronic Renal Failure
Ankylosing SpondylitisAnkylosing Spondylitis
Asthma, Moderate to SevereAsthma, Moderate to Severe
Breast CancerBreast Cancer
Carcinoid Tumors and Symptoms Carcinoid Tumors and Symptoms Related to Carcinoid TumorsRelated to Carcinoid Tumors
Chemotherapy Induced Anemia and Chemotherapy Induced Anemia and NeutropeniaNeutropenia
Colorectal CarcinomaColorectal Carcinoma
Cutaneous T-Cell LymphomaCutaneous T-Cell Lymphoma
Head and Neck CancerHead and Neck Cancer
Hodgkin’s DiseaseHodgkin’s Disease
Immunosuppressive Treatment Immunosuppressive Treatment for Solid Organ Transplant for Solid Organ Transplant Recipients Recipients
Iron Overload as a Result of Iron Overload as a Result of Blood TransfusionsBlood Transfusions
Multiple MyelomaMultiple Myeloma Myelodysplastic SyndromesMyelodysplastic Syndromes Non-Hodgkin’s LymphomaNon-Hodgkin’s Lymphoma Non-Small Cell Lung CancerNon-Small Cell Lung Cancer PsoriasisPsoriasis Psoriatic ArthritisPsoriatic Arthritis Rheumatoid ArthritisRheumatoid Arthritis Secondary HyperparathyroidismSecondary Hyperparathyroidism Wilms’ TumorWilms’ Tumor
“One Illness Away”
They are our friends and neighbors.They are our friends and neighbors.
Gordon “Keith” Parke
Middleburg, Florida
Macular Degeneration
Age 50
“One Illness Away”
They are our family members.They are our family members.
Beatrice Szeles
Orange, California
Rheumatoid Arthritis
Age 56
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What We Can DoWhat We Can Do
We We must must
do do more!more!
“One Illness Away”
What Reform Might Look LikeWhat Reform Might Look LikeOne State’s Proposal . . . One State’s Proposal . . .
“One Illness Away”
“One Illness Away”
We knew where to start.We knew where to start.We knew where to start.We knew where to start.
1.1. Enroll all who are eligible for state Enroll all who are eligible for state sponsored coverage and manage the sponsored coverage and manage the Federal dollars available to us for Federal dollars available to us for this purpose.this purpose.
2.2. Make sure that those who have Make sure that those who have health care coverage are able to keep health care coverage are able to keep it. it.
3.3. Provide an affordable and adequate Provide an affordable and adequate coverage alternative for every man, coverage alternative for every man, woman and child in our state.woman and child in our state.
“One Illness Away”
Total Uninsured = 1,300,000Total Uninsured = 1,300,000
New Jersey Total Population = 8,500,000New Jersey Total Population = 8,500,000
“One Illness Away”
New Jersey’s UninsuredNew Jersey’s UninsuredNew Jersey’s UninsuredNew Jersey’s Uninsured
600,000 remaining uninsured
600,000 remaining uninsured
300,000 Eligible but not enrolled
300,000 Eligible but not enrolled
400,000 undocumented400,000 undocumented
Comprehensive & TransformationalComprehensive & TransformationalComprehensive & TransformationalComprehensive & Transformational
Successful Successful
Health Care ReformHealth Care Reform
Successful Successful
Health Care ReformHealth Care Reform
CommercialCommercial
GradeGrade
CommercialCommercial
GradeGradeUniversal &Universal &
PortablePortable
Universal &Universal &
PortablePortableAffordable & Affordable &
SustainableSustainable
Affordable & Affordable &
SustainableSustainable MandatedMandatedMandatedMandated
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Reform Reform ElementsElementsReform Reform
ElementsElements
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Individuals will Individuals will be responsible to be responsible to provide proof of provide proof of health insurance health insurance
when they file when they file their state income their state income
tax return.tax return.
“One Illness Away”
If they do not provide proof If they do not provide proof of health insurance, they will of health insurance, they will be placed by the state into the be placed by the state into the
new state health insurance new state health insurance plan.plan.
If they do not provide proof If they do not provide proof of health insurance, they will of health insurance, they will be placed by the state into the be placed by the state into the
new state health insurance new state health insurance plan.plan.
“One Illness Away”
If, for whatever reason, a New Jersey resident seeks care without insurance, their
provider will place them into the new plan and provide
billing information to the new plan.
If, for whatever reason, a New Jersey resident seeks care without insurance, their
provider will place them into the new plan and provide
billing information to the new plan.
“One Illness Away”
Combine in one, self‑funded plan so the healthy and the sick balance each other out yielding a more affordable health insurance product.
“One Illness Away”
This new health insurance plan. . . This new health insurance plan. . . This new health insurance plan. . . This new health insurance plan. . . Statewide network of providers, Statewide network of providers, Available in an HMO and a PPO Available in an HMO and a PPO
format. format. Commercial grade, with Commercial grade, with
commercial reimbursements commercial reimbursements Modeled after the standard plan in Modeled after the standard plan in
New Jersey’s small employer New Jersey’s small employer market.market.
Where an employee does not have employer‑based
coverage his or her employer must provide them access
to a flexible‑spending account under Section 125 of
the IRS Code so the employee can purchase their
coverage with before tax dollars.
Where an employee does not have employer‑based
coverage his or her employer must provide them access
to a flexible‑spending account under Section 125 of
the IRS Code so the employee can purchase their
coverage with before tax dollars.
“One Illness Away”
Final ElementsFinal ElementsFinal ElementsFinal ElementsOffered to all New Jersey Offered to all New Jersey
residents, residents, State subsidy provided based State subsidy provided based
on individual or family on individual or family affordabilityaffordability
Charity care and related Charity care and related hospital subsidies redirected to hospital subsidies redirected to premium assistancepremium assistance
“One Illness Away”
Comparison to the Massachusetts PlanComparison to the Massachusetts PlanComparison to the Massachusetts PlanComparison to the Massachusetts Plan
Individual MandateIndividual Mandate
Expand Medicaid & SCHIPExpand Medicaid & SCHIP
Section 125 Required Section 125 Required d
Connector to Private marketConnector to Private market
Multiple Insured PlansMultiple Insured Plans
Employer MandateEmployer Mandate
MassachusettsMassachusetts New JerseyNew Jersey
Individual MandateIndividual Mandate
Expand Medicaid & SCHIPExpand Medicaid & SCHIP
Section 125 RequiredSection 125 Required
State-Run Public PlanState-Run Public Plan
Single, Self-Insured PlansSingle, Self-Insured Plans
No Employer MandateNo Employer Mandate
We must be We must be wary of wary of
ungenerouslungenerously throwing y throwing
upon upon posterity the posterity the
burden burden which we which we ourselves ourselves ought to ought to
bear.bear.
“One Illness Away”
What We Can DoWhat We Can Do
“One Illness Away”
How You Can Make a Difference, TooHow You Can Make a Difference, Too
Encourage Transformational Health Reform
Support HealthWell Foundation or other Co-Payment Relief Oranizations
Spread the Word
HEALTHWELLHEALTHWELLFOUNDATION©
Web: Web: www.healthwellfoundation.org
Email: Email: [email protected]
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