The Michigan Healthcare Marketplace

1. The Michigan Healthcare Marketplace

2. 1 Health Management Associates What Do We Know and What Do We Need to Learn? Who is insured/covered in Michigan? How are they insured? Who is without insurance/coverage? Why are they uninsured? What characteristics of the Michigan insurance market impact the rate of insurance? How does insurance regulation impact today�s market and impact options for the future?

3. 2 Health Management Associates Sources of Information Data that will be reviewed by the Data Workgroup: Household survey Employer survey Focus Group reports Data collected through town hall meetings National Sources with State data: Current Population Survey (CPS) (2004 data just out) Medical Expenditure Panel Survey (MEPS) Snapshots of America�s Families (Urban Institute) Models workgroup will use State Office of Financial and Insurance Services (OFIS) data on the Michigan insurance marketplace CPS is not statistically significant for any one year on insurance questions due to small sample size. Urban sample is between 2500 and 3000 for 1997, 1999, and 2002. CPS is not statistically significant for any one year on insurance questions due to small sample size. Urban sample is between 2500 and 3000 for 1997, 1999, and 2002.

4. 3 Health Management Associates Overview of Coverage in Michigan in 2003 � Primary Source of Coverage

5. 4 Health Management Associates Managed Care In Michigan in 2004 Group Coverage Individual Medicare Comp. Medicaid/SCHIP Other HMO Total 1,730,917 11,761 20,998 889,065 10,206 2,705,763

6. 5 Health Management Associates How adequate are existing Insurance products in Michigan? HRSA Requires that Michigan answer questions about the adequacy of current insurance products: For persons of different income levels? For persons with pre-existing conditions? We must also indicate how adequacy is defined.

7. 6 Health Management Associates Affordability of Premiums  Group Coverage

8. 7 Health Management Associates Employer-Based Coverage

9. 8 Health Management Associates Individual Coverage Michigan has guaranteed coverage through Blue Cross Blue Shield of Michigan (BCBSM). Michigan has a lower percentage covered through individuals plans than the national average (4% vs 5%), but has 6% more persons covered through groups. Premiums for individual policies are age and community rated. Individual policies for family coverage may cost from $248 to $993 per month.* Individual policies when a family converts from group coverage to individual coverage may cost from $206 to $854 per month.*

10. 9 Health Management Associates Medicaid Coverage in Michigan

11. 10 Health Management Associates Medicaid Coverage in Michigan Optional groups covered in Michigan: Pregnant women & children < age 1 to 185% of the federal poverty level (FPL) Other children to 150% of FPL on Medicaid; to 200% of FPL through MI Child. Low-income women diagnosed with breast or cervical cancer. Aged & disabled individual with income < 100% FPL. �Medically Needy� families, aged, disabled. 55,000 �Childless adults� to 35% FPL through the Adult Benefits Waiver (ABW) Disabled individuals through Ticket to Work initiative. But Michigan only covers parents to about 35% of FPL. Many states at 100% to 150% - no waiver required.

12. 11 Health Management Associates Adequacy of Options for Low-Income Individuals Income status of Michigan insured Less than 100% FPL � 4% (238,000) 100-199% FPL - 12% (702,000) 200% FPL or more � 84% (5,086,000) Income status of Michigan uninsured Less than 100% FPL � 37% (412,000) 100-199% FPL - 26% (292,000) 200% FPL or more � 37% (409,000)

13. 12 Health Management Associates Pre-existing Conditions HIPAA has reduced this issue from the time when HRSA first developed the SPG program. No limit when transferring from one employer to another with a �certificate of credible coverage�. HMO group products in Michigan may not include a pre-existing condition waiting period. Individually purchased HMO coverage may be subject to a six month waiting period.

14. 13 Health Management Associates Variation in Benefits & Prevalence of Self-Insured Employers HRSA asks what variations exist in benefits for Non-group, small group, large group and self-insured. Specific data is difficult to obtain. Since BCBSM and HMOs cover a large portion, could use their data. Most states have not addressed this issue in their reports to HRSA. One state plans to survey all insurers. Mandated benefits will be included in the report, but do not apply to self-insured. OFIS has no data on prevalence of self-insurance. Ideally comes from employer survey.

15. 14 Health Management Associates Employer-Based Coverage In Michigan: Health Insurance Offered

16. 15 Health Management Associates Characteristics of Non-elderly Uninsured in Michigan: 2002 & 2003 Children represent 16% in MI, 20% in US. Employment Status: Families with at least one full-time worker are 63% of the uninsured in MI and 69% for the US. Families with no worker are 22% of uninsured in Michigan and 19% for the US. Families with only part-time workers are 15% of the uninsured in MI and 12% for the US.

17. 16 Health Management Associates The State as a Purchaser