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Uninsured in Maryland

Uninsured in Maryland. Presented to Maternal and Child Health Leadership Team February 7, 2005. Purpose and Objectives. Define the problem of the uninsured in Maryland in a conceptual framework Define stakeholders of problem Link the problem to clinical practice

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Uninsured in Maryland

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  1. Uninsured in Maryland Presented to Maternal and Child Health Leadership Team February 7, 2005

  2. Purpose and Objectives • Define the problem of the uninsured in Maryland in a conceptual framework • Define stakeholders of problem • Link the problem to clinical practice • Present Maryland’s current policies and legislation • Discuss alternatives to the problem

  3. Statement of Problem • Definition of uninsured • Growing rates of uninsured • Demographics of Maryland vs. United States uninsured • Why insurance is important

  4. Definition of Uninsured • No health insurance • No Medicaid/Medicare • No Maryland Children’s Health Program (MCHP) • No self insurance

  5. Growing Rate of Uninsured • In Maryland 11.3%- 12.8% in one year • Higher cost of insurance • 7.8% increase in health insurance cost in one year • Average Maryland’s family expenditure on healthcare $4,146

  6. Demographics of Uninsured • Maryland is rich! • Hispanic population • Children • Women

  7. Characteristics of MD Children Uninsured

  8. Uninsured by Poverty Level

  9. Number of Uninsured

  10. Stakeholder Analysis • Private insurance industry • State Health Departments • Pharmaceutical industry • Health care providers • The uninsured • Tax payers/everyone!

  11. Consequences • Fewer preventive screening • High debt • Sicker when diagnosed • Fewer therapeutic services • Higher mortality and morbidity • Lower annual earnings because of poorer health

  12. Explanation for Growth • Shift into service industry • Growth in part time and contracting employees • High costs of insurance • States cutting back publicly financed programs

  13. Medicaid/ MCHP • SCHIP Legislation • 1997 Title XXI of Social Security Act • Federal Block Grant • Children up to 200% of FPL • Outreach • Maryland standards • 200% FPL 0-19 • 250% FPL Pregnant Women • 40% FPL Non working parent

  14. Uninsured Children • 1 out of 10 uninsured • 1 out of 5 <200% FPL • US born children of foreign parents • Working poor • Misconceptions on eligibility • Enrollment process

  15. Exercise: Link to Clinical Practice/MCHP

  16. Community Health Centers (CHCs) • Community based • Services without regard to ability to pay • 40% of patients are uninsured • Demographics of Patients • 40% children • 67% < 100% FPL

  17. National Solutions • HR 676 Single payer legislation • “Medicare for All” – Senator Kennedy • Health Care Access Resolution • Prevent erosion of Medicaid

  18. State Policy Initiatives • Health care for all plan • Expansion of existing programs • Speaker Casper Taylor plan • Medicaid expansion • Tax incentives • Maryland leading in most MCH policy issues

  19. Barriers to policy change • Money • Political will • Administratively infeasible • State/federal relationship • Powerful corporate lobby • Mobilization of uninsured

  20. Literature Review • Kaiser Family Foundation • http://www.statehealthfacts.org • Maryland Health Care Commission • http://www.mhcc.state.md.us • A public-private partnership for health care for all Marylanders: cost and coverage impacts analysis • http://www.lewin.com

  21. Wrap up • Growing problem • Not having insurance leads to poor health • Not every child is insured • Stakeholders include everyone • There are solutions!

  22. Questions? Michelle G. Clark mclark@jhsph.edu 410-302-4650

  23. References • Advocates for Children and Youth. (2004, September). Maryland children’s action network. Retrieved October 5, 2004, from Advocates for Children and Youth Web Site: http://www.acy.org • American College of Physicians (ACP) (2000). No health insurance? It's enough to make you sick - Scientific research linking the lack of health coverage to poor health. Retrieved November 17, 2004 from http://www.acponline.org/uninsured/lack-contents.htm • Deber, R. B. (2003). Health care reform: lessons from Canada. American Journal of Public Health, 93(1), 20-24. • Health Affairs. (2004). Health Affairs Main Page. Retrieved December 10, 2004, from http://healtaffairs.org • Hoffman, C, Scholbohm, A. (2000, May) Uninsured in America A chart book (2nd ed.). Washington, DC: The Kaiser Commission on Medicaid and the Uninsured.

  24. References • Kaiser Commission on Medicaid and the uninsured. (January 2003). The cost of not covering the uninsured. Retrieved November 14, 2004, from http://www.kff.org/uninsured/4088-index.cfm • Lehman, A. F. (1995). Measuring quality of life in a reformed health system. Health Affairs, 14(3), 90-101. • Light, D. W. (2003). Universal health care: lessons from the British experience. American Journal of Public Health, 93(1), 25-30. • Maryland Citizens Health Initiative (MHCI). (2004, September). Health care for all. Retrieved November 29, 2004, from http://www.healthcareforall.com • Maryland Health Care Commission (MHCC). (2004, January). Options for covering the uninsured a report to the general assembly. Retrieved September 29, 2004, from Maryland Health Care Commission Web Site: http://www.mhcc.state.md.us • Meyer, J. A., & Silow-Carroll, S. (2003, August 27). Building on the job-based health care system: what would it take? Health Affairs Web Exclusive, W3, 415-425. Retrieved November 14, 2004, from http://www.content.healthaffairs.org

  25. References • Miller, W., Vigdor, E. R., & Manning, G. M. (2004, March 31). Covering the uninsured: what is it worth? Health Affairs Web Exclusive, W4, 157-167. Retrieved November 10, 2004, from http://www.content.healthaffairs.org • Newhouse, J. P. (2004). Consumer-directed health plans and the RAND health insurance experiment. Health Affairs, 23(6), 107-113. • Nichols, L. M., Ginsburg, P. B., Berenson, R. A., Christianson, J., & Hurley, R. E. (2004). Are market forces strong enough to deliver efficient health care systems? Confidence is waning. Health Affairs, 23(2), 8-21. • Samuelson, R. (2004, September 22). Prognosis: Stalemate The Washington Post, p. A31. • Schroeder, S. A. (2001). Prospects for expanding health insurance coverage. New England Journal of Medicine, 344(11), 847-851. • Sheils, J. F., Haught, R. A. (2000 May 2). Analysis of the costs and impact of universal health care models for the state of Maryland. Retrieved December 17, 2004 from http://www.lewin.com

  26. References • The Henry J. Kaiser Family Foundation (KFF). (2004). Maryland: At-a-glance. Retrieved November 27, 2004, from http://www.statehealthfacts.org • The Lewin Group (2003 October 28). A public-private partnership for health care for all Marylanders: cost and coverage impacts analysis. Falls Church, VA. Retrieved November 29, 2004, from http://www.lewin.com/Lewin_Publications/ • The Physicians' Working Group for Single Payer National Health Insurance (PWG) (2003). Proposal of the physicians' working group for single-payer national health insurance. Journal of American Medical Association, 290(6), 798-805. • Wicks, E. K., & Meyer, J. A. (2001). Prospects for a reduction in the number of uninsured Americans. Retrieved November 3, 2004, from Economic and Social Research Institute Web Site: http://www.esresearch.org/covering_america.php

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