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Premium Assistance: Evolution of Programs and New Challenges Jeremy Alberga Senior Manager

Premium Assistance: Evolution of Programs and New Challenges Jeremy Alberga Senior Manager SCI Workshop for State Officials June 28-29, 2004. Goals for Premium Assistance (PA) Programs. Leverage employer contributions Keep family members together Limit Crowd-Out

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Premium Assistance: Evolution of Programs and New Challenges Jeremy Alberga Senior Manager

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  1. Premium Assistance: Evolution of Programs and New Challenges Jeremy Alberga Senior Manager SCI Workshop for State Officials June 28-29, 2004

  2. Goals for Premium Assistance (PA) Programs • Leverage employer contributions • Keep family members together • Limit Crowd-Out • Ease transition from public to private coverage • Strengthen private insurance market • Platform for future program expansions • Eliminate “stigma” of public program

  3. What Problems Are You Trying to Solve? Different problem requires different solution… • Problem: Coverage offered by employer but not taken up by worker Solution: Subsidize employee premium -or- • Problem: Employer doesn’t offer coverage at all Solution: Create affordable product targeting employers and workers

  4. PA Strategy 1: Address Employee Take-up Note: The take-up rate is the percent of employees in a firm who enroll in a plan offered by the firm. All estimates are weighted by the number of employees in the firm. Source: RWJF Employer Health Insurance Survey, 1997

  5. Challenges to Date • Administrative complexities • Start-up costs • Identify potential enrollees • Coordination with employers • Wrap-around requirements • Assessing cost effectiveness • Availability of employer coverage • Low employer contribution for dependant coverage • Employer reluctance to participate

  6. PA Strategy 2: Address Employer Offer Rates (Offer Rates by Firm Size, 1996-2003) Source: Kaiser/HRET Employer Health Benefits 2003 Annual Survey

  7. Premium Assistance: The New Breed • Create a new product, targeting working uninsured • Target either employer or employees • Challenges • Coordinating with carriers, other stakeholders • Avoiding adverse selection • Finding new funding sources in difficult times • Controlling rapidly rising costs

  8. Ongoing Technical Assistance • Premium Assistance Toolkit (with CMS, NASHP) • First three sections written (program costs, design, benefits and cost-sharing) • 1-day PA mtg. at NASHP Annual Conference, Aug. 1-4 • Dissemination of lessons learned from 8 demonstration grantees (AR, HI, ME, NM, OR, RI, VA, WV) • State Reports: 101 individual state and multistate reports [keyword=“premium assistance”] http://statecoverage.net/reportsearch/index.cfm

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