What’s To Be Done About The Uninsured?

1. What’s To Be Done About The Uninsured? Charles N. Kahn III President Federation of American Hospitals January 25, 2002 Leonard Davis Institute of Health Economics, 2002 Health Policy Seminar Series

2. Policy Possibilities for the Uninsured • The Issue • Themes and Responses 1991-01 • Current Political Context • 2002 Political / Policy Bidding • Battlelines Or Compromises of the Future

3. Epidemic Continues Source: Kaiser Family Foundation, Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2001 Current Population Survey, December 2001

4. The Uninsured Will Continueto Climb 61 Million 55 Million Recession Inflation 1999 42.1 Million Source: The Changing Sources of Health Insurance, William S. Custer, Ph.D., Pat Ketsche, Ph.D., M.H.A.

5. Employers Cover Over 172 Million Americans, 9 out of 10 of Those With Private Insurance Source: Employee Benefit Research Institute, December 1998

6. Recovery Slow Source: Kaiser Family Foundation, Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2001 Current Population Survey, December 2001

7. Employers Responsible for Recent Decline in Uninsured Non-elderly Americans. From Custer and Ketsche, The Changing Sources of Health Insurance Coverage, HIAA, December 2000.

8. Poor Americans Are More Likely to Be Uninsured 400%+ Of FPL 0-199% Of FPL 200-399% Of FPL Source: HIAA

9. Low-Wage Workers Less Likely to Accept Coverage Source: Employment-Based Health Insurance Coverage, William S. Custer, Ph.D., Pat Ketsche, Ph.D., M.H.A.

10. Increasingly Worrisome Cost Growth Employer premiums Percentage Growth National Health Expenditures Consumer price index * 2001 estimated Source: For 1989 - 1991, HIAA Employer Survey; KPMG Employer Survey and Bureau of Labor Statistics, various years, Health Care Finance Administration; W.M. Mercer; CBO, July 2000

11. Cost Containment Success Likely Over Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 1999, 2000, 2001; KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1993, 1996

12. Policy Possibilities for the Uninsured • The Issue • Themes and Responses 1991-01 • Current Political Context • 2002 Political / Policy Bidding • Battlelines Or Compromises of the Future

13. Themes and Responses 1991-01 • 1992 Recession - Clinton Initiative • Kasenbaum/Kennedy - HIPAA • Hatch/Kennedy – SCHIP • Later-90’s - Parents • Strange Bedfellows - $28 Billion in FY02 Budget • 2001 Recession – Stimulus Package

14. GOP Tax Credit for Unemployed Democrats COBRA Subsidy Expand Medicaid Increase Medicaid Match Stimulus Package

15. Policy Possibilities for the Uninsured • The Issue • Themes and Responses 1991-01 • Current Political Context • 2002 Political / Policy Bidding • Battlelines Or Compromises of the Future

16. 2002 Political Landscape • September 11 • Unprecedented Views Of Gov’t And The President • Back To Politics As Usual • Election Prospects

18. 2002 Political Landscape • September 11 • Unprecedented Views Of Gov’t And The President • 2002, Back To Politics As Usual • Election Prospects

19. Patriotism Index(“Since September 11th, have you done any of the following…”) Source: American Viewpoint January 2002

20. Bush Job Approval *Strength of GWB performance is reflected in 10 consecutive post 9/11 Gallup polls with ratings between 84% -90% *13 previous ratings between May and early September were between 51%-54% Sources: WSJ, ABC News, NBC News, CNN, US Today, Gallup, American Viewpoint

21. Direction of Country Source: American Viewpoint January 2002

22. Trust In Government Source: National Election Studies / Washington Post Source: American Viewpoint January 2002

23. Role of Government • First time a majority has called for a greater role of government since Clinton elected. • Presents a significant challenge for Republicans as a plurality of GOPers say government should do more. Source: American Viewpoint January 2002

24. 2002 Political Landscape • September 11 • Unprecedented Views Of Gov’t And The President • 2002, Back To Politics As Usual • Election Prospects

27. 2002 Political Landscape • September 11 • Unprecedented Views Of Gov’t And The President • 2002, Back To Politics As Usual • Election Prospects

28. Primary Factors In Off Year Elections • Economy • Presidential Popularity • Seniors

30. Off-Year Elections

31. Is 2002 The Exception or The Expectation? • Redistricting stalemate • Only 24 hotly contested House seats • House Democrats Must Score Net Gain Of +6 Seats –Must Win 18 Of 24 Hot Races (75% success rate)

32. Generic House Ballot Source:, American Viewpoint, Gallup

33. United States Senate – 2002 Outlook 34 Races in 2002, Current Senate Composition: 50 DEM, 49 GOP, 1 IND

34. Policy Possibilities for the Uninsured • The Issue • Themes and Responses 1991-01 • Current Political Context • 2002 Political / Policy Bidding • Battlelines Or Compromises of the Future

35. Process State of the Union President's Budget Budget Resolutions Environment War – National Security Recession Deficit Spending Election Year FY 2003 Budget

36. Health Agenda: 2002 • Drugs (Reform Rhetoric) • Patient Protection • Bio-terrorism • Nurse Training Grants • Medicare Provider Payment • Regulation Reform • Medicaid Relief

37. Policy Possibilities for the Uninsured • The Issue • Themes and Responses 1991-01 • Current Political Context • 2002 Political / Policy Bidding • Battlelines Or Compromises of the Future

38. Battlelines Politics – Defining Issue Ideology - Reform Imperative Cost Compromise Common Definition Second Choices Coverage Without Reform Battlelines Vs Compromise