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Prescription for Pennsylvania

Prescription for Pennsylvania. Ann S. Torregrossa, Esq. Deputy Director & Director of Policy GOHCR. The State of Insurance Coverage in Pennsy lvania. The survey found 9% of our population is uninsured--over 900,000 Pennsylvanians.

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Prescription for Pennsylvania

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  1. Prescription for Pennsylvania Ann S. Torregrossa, Esq. Deputy Director & Director of Policy GOHCR

  2. The State of Insurance Coverage in Pennsylvania • The survey found 9% of our population is uninsured--over 900,000 Pennsylvanians. • Our uninsured are more than the total population of Alaska, Delaware, North Dakota, South Dakota, Vermont, Wyoming or D.C. • 71% of uninsured adults are employed. • 27.3% of uninsured adults have been without health care coverage for 5 years or more. • 76% have household incomes below 300% FPL and will need help paying for coverage. • 62% of uninsured working adults work in the service industry and 21% in retail. • 56% of very small employers do not provide health care coverage.

  3. Pennsylvania’s Employees and Pennsylvania’s Businesses Cannot Keep Up with Health Care Inflation % Increase in Family Health Insurance Premiums vs. Inflation and Increase in Median Wages in PA Between 2000 and 2006

  4. Every day that passes without meaningful change increases the cost to our health care system.

  5. Affordability: The Cost of Failure is Simply too Great If current trends continue, the cost of uncompensated care for the uninsured could increase by as much as $1 billion over the next 5 years. Represented in Billions of Dollars

  6. Prescription for Pennsylvania Prescription for Pennsylvania is a set of integrated practical strategies for improving the health care of all Pennsylvanians, making the health care system more efficient and containing its cost. Right State | Right Plan|Right Now

  7. Rx for PA

  8. Cover All Kids • Advisory panel told us to expand coverage for kids immediately and not wait for entire plan • Our CHIP Program is separate from Medicaid • Kids not eligible for Medicaid up to 200% FPL have no premium. • Kids with household incomes between 200%-235% had a premium and all state subsidy. • Did a state plan amendment to increase CHIP limits to 300% FPL, and because we got a federal match it did not cost the state much more money than original program and lowered premiums for families. • Approved by CMS in February and has resulted in enrollment of more kids already eligible than expansion population.

  9. Cover All Pennsylvanians • Two ways to qualify for CAP: • Low-wage employers (the average wage of all employees must be less than the average wage in Pennsylvania) who have not offered insurance in 6 months, can enroll in Cap if they enroll at least 75% of all employees who work over a specified number of hours per week and pay 65% of the discounted premium for the enrolled employees. • Uninsured self-employed and other uninsured individuals are eligible to enroll individually in CAP if they meet go bare period. • CAP will replace our state funded adultBasic Program that has 54,000 enrollees and a waiting list of 85,000. Those on the adultBasic waiting list will be given the opportunity to immediately enroll in CAP.

  10. Projected Premiums for CAP • Small employer projected premium is $130/month. • Maximum small employee projected premium is $70/month, but varies depending on family income (see below). • Individual and employee premiums: • 0-100% FPL - $0/month • 101%-200% FPL - $40/month • 201%-300% FPL - $60/month • Individuals and the self-employed with incomes greater than 300% FPL may apply to CAP and will pay monthly premiums at the full Commonwealth projected price of $280.

  11. Proposed CAP Benefit Package • CAP is a cost effective, health care package that includes: • Inpatient hospital acute care • Health assessments • Routine diagnostic tests • Prescription and over the counter drugs • Behavioral health. • CAP will be provided through managed care plans doing business in Pennsylvania. The Blue Cross Blue Shield plans will be required to submit proposals. • Have proposed to fund it with a Fair Share Assessment, which the Governor feels is the fairest way and will help keep businesses from dropping coverage.

  12. Prescription for PA Prescription for Pennsylvania is a set of integrated practical strategies for improving the health care of all Pennsylvanians, making the health care system more efficient and containing its cost. Right State | Right Plan|Right Now

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