www.healthpolicy.ucla.edu

Shana Alex Lavarreda, PhD, MPP

Sacramento, CA2/10/2010

The Uninsured and National Health Care Reform

46 Million Adults and Children are Uninsured in the United States

Other Public3%

7,124,000

Individual5%

13,823,000 Medicaid15%

39,256,000

Uninsured17%

45,693,000Employment-

Based Insurance60%

156,860,000

Notes: Numbers may not add to 100% due to rounding.Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements). www.statehealthfacts.org

Health Insurance Coverage During Last 12 Months Among Non-Elderly Persons, Ages 0-64, California, 2007

Uninsured All or Part Year

19.5%6,400,000

Uninsured All Year

11.3%3,699,000

Uninsured Part

Year8.2%

2,701,000

Employment-Based

Coverage All Year55.6%

18,298,000

Privately

Purchased All Year

5.5%1,794,000 Medi-Cal or

Healthy Families All Year

15.3%5,015,000

Other All Year4.2%

1,378,000

Notes: Numbers may not add to 100% due to rounding."Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured.Source: 2007 California Health Interview Survey

Health Insurance Coverage During Last 12 Months Among Children, Ages 0-18, California, 2001-2007

14.8%*

11.3% 10.7% 10.2%

52.2%55.1%*

50.8% 50.3%*

30.9%29.2%

24.2%*

29.3%

0%

10%

20%

30%

40%

50%

60%

2001 2003 2005 2007

Percent Insured

Uninsured Allor Part Year

Employment-BasedCoverage AllYear

Medi-Cal orHealthyFamilies AllYear

Notes: Numbers may not add to 100% due to rounding."Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured.* Data is significantly different from 2007 at the 95% confidence level.Sources: 2001, 2003, 2005 and 2007 California Health Interview Surveys

Health Insurance Coverage During Last 12 Months Among Adults, Ages 19-64, California, 2001-2007

23.9%

57.0% 56.2%

25.4% 25.7%* 24.8%

55.1%*57.3%

8.5%8.6% 9.0% 8.7%

0%

10%

20%

30%

40%

50%

60%

70%

2001 2003 2005 2007

Percent Insured

Uninsured Allor Part Year

Employment-BasedCoverage AllYear

Medi-Cal orHealthyFamilies AllYear

Notes: Numbers may not add to 100% due to rounding."Other All Year" includes other government-sponsored programs that are not Medi-Cal, as well as any combinations of insurance over the last 12 months during which the person was never uninsured.* Data is significantly different from 2007 at the 95% confidence level.Sources: 2001, 2003, 2005 and 2007 California Health Interview Surveys

Household Income as Percent of the Federal Poverty Level Among Non-Elderly Persons Uninsured All or Part Year, Ages 0-64,

California, 2007

600%+ FPL

7.5%

479,000

500-599% FPL

3.2%

204,000

400-499% FPL

5.2%

331,000

300-399% FPL

8.5%

546,000

200-299% FPL

16.1%

1,027,000

100-199% FPL

30.6%

1,956,000

<100% FPL

29.0%

1,857,000

Notes: Numbers may not add to 100% due to rounding.The 2007 Federal Poverty Level was $10,210 for one person, $13,690 for a two-person family and $17,170 for a three-person family.Source: 2007 California Health Interview Survey

Family Work Status Among Non-Elderly Persons Uninsured All or Part of the Last 12 Months, Ages 0-64, California, 2007

Non-Working Family

17.7%

1,136,000

At Least One Adult is

Self-Employed

14.3%

918,000

At Least One Adult

Works Part-Time

6.1%

392,000

At Least One Adult

Works Full-Time

61.8%

3,955,000

Note: Numbers may not add to 100% due to rounding.Source: 2007 California Health Interview Survey

Citizenship and Immigration Status Among Non-Elderly Persons Uninsured All or Part Year, Ages 0-64, California, 2007

U.S. Citizen

66.1%

4,230,000

Noncitizen Adult

w ith Green Card

13.8%

881,000 Noncitizen Child

w ith Green Card

0.8%

50,000

Noncitizen Adult

w ithout Green Card

16.6%

1,065,000

Noncitizen Child

w ithout Green Card

2.7%

174,000

Note: Numbers may not add to 100% due to rounding.Source: 2007 California Health Interview Survey

Percent Uninsured All or Part Year by County, Ages 0-64, California,

2007

Note: Differences in rates between counties may not be statistically significant.Source: 2007 California Health Interview Survey

If Nothing Changes – Outlook for 2010 and Beyond

Implementation of new initiatives from ARRA

Quality (value based purchasing)

Electronic health records and e-prescribing

Chronic care management

Strategies to improve access and to address low-income uninsured

Budget and state fiscal pressures

Medicaid spending and enrollment trending up

Economy impacting state revenues

Mid-year budget actions

Healthy Families had enrollment frozen for six weeks this year.

2010 likely to be a difficult year

Eligibility for Medi-Cal and Healthy Families in California, October 2009

 300% FPG

Eligible

for AIM

Eligible for Healthy

Families IF < 2yrs &

Mother in AIM

Not Eligible

 250% FPG

Healthy Families Eligible

Not Eligible

200% FPG Healthy Families

Eligibility Authorized

not Imple-mented

 133% FPG

Medi-Cal

Eligible

100% FPG Medi-Cal Eligible

 75% FPG

Medi-Cal Eligible

Medi-Cal Eligible

Medi-Cal

Eligible

 Pregnant Women

Ages 0 – 1

Ages 1 – 5

Ages6 – 18

Ages 19 – 64,with

Children

Ages 19-20,

Medically Indigent/

Needy

Disabled and

Aged

All Other Adults

  Children Adults

Eligibility of Currently Uninsured Children and Adults for Public Insurance Programs, Ages 0-64, California, 2007

Medi-Cal Eligible6.6%, 272,000

Medi-Cal Eligible30.0%

205,000

Healthy Families Eligible

Healthy Families Eligible26.4%180,000

Healthy Kids Eligible

Healthy Kids Eligible22.7%155,000

Not Eligible for Public Programs

93.4%3,862,000

Not Eligible for Public Programs

20.9%143,000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Children, Ages 0-18 Adults, Ages 19-64

Total Children Uninsured at Time of Interview = 665,000 Total Adults Uninsured at Time of Interview = 4,134,000

Note: Numbers may not add to 100% due to rounding.Note: Eligibility for Healthy Kids programs is determined by meeting the eligibility criteria, and disregards whether there is room in the program to accept new enrollees.Source: 2007 California Health Interview Survey

Changes Proposed in National Health Care Reform

The House and Senate bills would make two key changes:

Expand Medicaid eligibility to include qualified uninsured adults and children with household incomes up to 133% FPL (Senate) or 150% FPL (House).

Provide public subsidies to enable qualified uninsured adults and children with household incomes from 134%/150% - 400% FPL to purchase insurance

CHIP might be eliminated in favor of moving all eligible families into a health insurance exchange

“Public option” within the exchange(s) could be expansion of current CHIP program in every state

Other options:

A national public option, more like “Medicare for All” (House)

State-based non-profit, co-op plans (Senate)

OPM managed, national not-for-profit private plans (Senate)

Eligibility for Health Insurance Expansions Under Proposed National Health Care Reform, Ages 0-64,

California, 2007

Total Uninsured All or Part Year = 6.4 Million

Ineligible

Due to Citizenship

Status

1,422,000

22%

Ineligible

Due to Income

958,000

15%

Eligible for

Medicaid

Expansion

up to 133% FPL

1,689,000

26%

Eligible for Insurance

Purchase Subsidies

134 - 400% FPL

2,331,000

37%

SOURCE: Lavarreda, SA and Brown, ER (2009). National Health Care Reform Will Help 4 Million Uninsured Adults and Children in California. Fact Sheet, UCLA Center for Health Policy Research, October.

www.healthpolicy.ucla.edu

Thank You – and I’m Here to Help!

Shana Alex Lavarreda, PhD, MPP

Director of Health Insurance Studies and Research Scientist

shana@ucla.edu, (310) 794-2261

www.chis.ucla.edu

www.statehealthfacts.org