HB 2201/SB 31

1. Healthy Kids Plan HB 2201/SB 31

2. The Problem • 117,000 Oregon children have no health insurance • About half (60,000) qualify for programs, but are not enrolled • Not all Oregon children have access to: • Doctors/healthcare providers • Medicine • Eyeglasses • Basic health care services

3. Geographical Distribution of Oregon’s Uninsured Kids

4. Over Half Of Oregon’s Uninsured Kids Are In Middle Class, Working Families* Many families earning between $40,000 and $80,000 a year make too much for their kids to qualify for state programs – BUT make too little to afford health insurance • No employer-sponsored coverage may be available • Premiums may be too expensive • Parent may be covered but dependent coverage is not available. *Recent statewide survey of Oregon families

5. Enrollment Barriers for Kids Already Eligible But Not Enrolled* • Difficulties some families face with the Oregon Health Plan (OHP) application process • Missing the OHP re-certification window - needing to re-do paperwork every 6 months. • Confusion about children’s eligibility if parents no longer eligible for OHP *Recent statewide survey of Oregon families

6. Why is health insurance so important? Uninsured kids are* : • Half as likely to get preventive care or see a doctor than if they were insured • More likely to use expensive emergency room for care • More likely to be hospitalized *From a recent statewide survey of Oregon families and several national studies

7. Healthy Kids Can Keep Kids Learning* • Kids in poor health miss school more often • If illnesses such as asthma are not treated, kids perform poorly in school • Kids will be more successful in the future if they are in school and healthy *from recent national studies

8. Keeping Kids Healthy Also Saves Money • When uninsured kids are hospitalized, their parents struggle to pay medical bills, and can only afford an average of 35% of the cost.* • Over 40% of the hospital costs for the uninsured are passed on as higher costs to people with health insurance.* *Families USA, June 2005

9. Healthy Kids Plan Design

10. Public Input Policy and Program Framework • The Medicaid Advisory Committee • Senate Children’s Health Access Committee Program Design and Implementation • Stakeholder Meetings

11. Key Components • Offer coverage to all uninsured Oregon children up to age 19 • Comprehensive health care that includes dental, vision, mental health with physical health • Build on existing programs • Keep it simple for families • One “Healthy Kids” card • Simpler enrollment and keeping kids enrolled

12. Meet Children’s Health Care Needs In Three Ways • Expand opportunities to families not eligible for the Oregon Health Plan to buy affordable coverage with state subsidies tiered to income ~Meet working families half-way and put health care within their reach. • Improve and expand access to kids eligible for enrollment in the Oregon Health Plan ~Simplify enrollment and keep kids enrolled. • Continue to improve access to care, including the expansion of school-based health centers ~Access and insurance are linked.

13. OHP Plus Package Continues For Kids Up To 200% FPL • Comprehensive benefits continue – includes dental, vision, mental health care • No Co-Pays, No Premiums

14. Family Health Insurance Assistance Program (FHIAP) Will Continue • Providing premium assistance to low-income families with insurance options through their work • Making insurance premiums affordable for families through a private-public partnership

15. AND…an Option For Families Without Other Choices: Private Insurance Product For families with incomes at 200% FPL and above with no access to employer-sponsored insurance • Comprehensive coverage • Assistance to families to choose a plan • Subsidies based on income • All health plans may compete to participate

16. How Much Will Healthy Kids Cost Families? As Healthy Kids was designed we talked with Oregon families about what is affordable: • Families pay at the level they can afford, with assistance at lower incomes • Affordable monthly premiums and copays at higher incomes

17. Rural Families: No Discretionary Monthly Income Until 200%-250% Of Poverty Level * *Economic Policy Institute and US HHS - Rural Oregon (2004) 2 Parents + 1 Child

18. Urban Families:No Discretionary Monthly Income Until 250% Of Poverty Level * *Economic Policy Institute and US HHHS data -Portland Area (2004) 2 Parents + 1 Child

19. Affordable Health Care for All

20. Healthy Kids Affordable Options 350% Federal Poverty Level (FPL) & Above Families Buy-in Full Price State-Only subsidies Federal match for state subsidies for private product State-only subsidies Federal match for state subsidies for employer-sponsored insurance Full subsidy 300% FPL 200% FPL No Copays/No Premiums Private Insurance Product Family Health Insurance Assistance Program FHIAP OHP Plus

21. Enrolling Kids and Keeping Kids Enrolled

22. Leverage Local Community PartnershipsTo Reach Families • Outreach to families with uninsured kids • Provide application assistance • Keep kids enrolled in a health plan

23. Simplify Enrollment and Keep Kids Enrolled • Shorter Application • 12-month Enrollment Period • 2 month Uninsurance Requirement • No asset test

24. Access to Health Care

25. Expand School-Based Health Centers Oregon has 44 SBHC in 17 counties Healthy Kids would support: • 6 new SBHC in 6 new counties • 7 new SBHC in counties already operating SBHC

26. Expand Dental Sealant Program: Seal the teeth of 50% of all 8-year-olds by 2010, compared to 30% of uninsured children who have dental sealants today • Nurse Advice Line: Ensure that families have access to nurse advice line so kids get best care in most appropriate setting

27. What About The Funding Of Healthy Kids? • Maximize use of federal dollars available to Oregon • Efficiently use current state programs’ tax dollars • Increase Tobacco tax dollars • Families pay their share based on income Saves all of us money by covering all uninsured children

28. In Summary:The Healthy Kids Plan • 117,000 of Oregon’s kids are uninsured, despite the efforts of their working parents and the state’s current health programs. • Access to health insurance is important to keep kids healthy and learning in school. • The Healthy Kids Plan will provide streamlined, affordable access to health care options for Oregon’s families. • An investment in the health of our children is an investment in Oregon’s future.

29. For More Information: The Governor’s Website http://governor.state.or.us/