Considerations for Moving Forward

1. Considerations for Moving Forward Health Foundation of Greater Cincinnati August 17, 2007 Cindy Mann Executive Director Georgetown University Health Policy Institute Center for Children and Families

2. Trends & Current Status

3. The Uninsured in America Number of Total Uninsured in Millions Source: U.S. Census Bureau, Current Population Survey, 2000 to 2006 Annual Social and Economic Supplements, (released June 28, 2007)

4. Trends in the Uninsured Rate of Low-Income Children, 1997- 2005 Source: CCF analysis of National Health Interview Survey. Note: “Low-income” is defined as having income below 200% of the federal poverty line, which in 2005 was $32,180 for a family of 3.

5. Why the Big Difference? • ESI declining for adults and children • Children much more likely to be eligible for public programs (Medicaid/SCHIP) which fill in the gaps

6. Premiums for Employer-Sponsored Coverage Are Growing Faster than Workers Earnings Note: The annual growth for premiums is statistically significant from the prior year at p<0.05 for every year except 2003. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006, (September 2006).

7. Changes in Health Insurance Coverage, 2000-2004 Adults Children (6.3 million more uninsured adults) (300,000 fewer uninsured children) Source: Urban Institute, 2005, for Kaiser Commission on Medicaid and the Uninsured

8. State Uninsurance Rates of Nonelderly Adults (2005) U.S. Average, 19.7% Kentucky, 17.8% Ohio, 14.3% Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).

9. State Uninsurance Rates of Children (2005) U.S. Average, 11% Ohio, 8.1% Kentucky, 7.8% Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).

10. Where Do We Go From Here?

11. Sources of Coverage for Nonelderly Americans, 2004-2005 256 Million Nonelderly Americans Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).

12. Sources of Coverage for Nonelderly Kentuckians & Ohioans, 2004-2005 3.6 Million Nonelderly Kentuckians 9.9 Million Nonelderly Ohioans Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2005 Data Update, (May 2007).

13. Characteristics of the Nonelderly Uninsured, 2005 Age Income Work Status 44.4 Million Nonelderly Americans Source: Urban Institute, 2005, for Kaiser Commission on Medicaid and the Uninsured

14. Health Care Is An Important Priority for Americans • Iraq (20%) • Terrorism/national security (17%) • Economy/jobs (17%) • Health care (16%) • Immigration (10%) • Education (8%) • Environment (7%) The most important issue to voters in deciding who they would like to see elected president (July 2007): Source: CBS News/New York Times Poll, July 9-17, 2007.

15. Payment Sources for Uncompensated Care, 2004 Total = $40.7 Billion Source: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, (October 2006).

16. There Is Not A Consensus on Solutions The public’s most preferred policy option to help the uninsured: Source: Kaiser/Harvard Health Care Agenda for the New Congress Survey (conducted November 4-28, 2004).

17. A Big Divide? • “We need universal health care coverage in this country, not stale ideas and savings account schemes.” - AFL-CIO President John Sweeney (February 1, 2006) • “I emphasize private insurance, the best health care plan -- the best health care policy is one that emphasizes private health. In other words, the opposite of that would be government control of health care.” - President George W. Bush (June 27, 2007)

18. More Action at the State Level • Children’s coverage • Universal coverage • In between? • Insurance reforms, tax changes

19. States are Moving Forward On Children’s Coverage IL NH VT ME WA MT ND MN MA OR NY ID SD WI MI RI CT WY PA NJ IA OH NE IN NV DE IL WV VA UT MD CO CA MO KS KY NC DC TN SC OK AR NM AZ GA AL MS TX LA AK FL HI Implemented or Recently Adopted Legislation to Improve Children’s Coverage (26 states and DC) Considering Significant Proposal to Improve Children’s Coverage (2 states) Source: As of August 2, 2007 based on CCF review of state initiatives.

20. Americans Support Covering Children 91% July 23, 2007 Source:Poll conducted by Lake Research Partners and American Viewpoint, national survey of 1,002 American voters from June 26 - July 1, 2007 for the Center for Children and Families

21. But Their Parents Are Often Left BehindMedicaid/SCHIP Eligibility Levels for Children and Parents With Earnings in the Median State Income Eligibility Levels Expressed as a Percent of the Federal Poverty Level Source: CBPP survey for KCMU, January 2007. Note: In 2007, 65% of the FOL is equal to $11,161 for a family of 3.

22. “Universal” Coverage • Enacted: Massachusetts, Vermont • Partial: Maine • Under active debate: California, Illinois, Maine, Pennsylvania, Washington • Commissions, studies going on in several states

23. Solutions Are At Hand Decline in the Rate of Uninsured Children, 1997/1998 to 2004/2005 Source: RWJF, Protecting America’s Future: A State-by-State Look at SCHIP & Uninsured Kids, (August 2007).

24. Elements For Success • It doesn’t happen overnight • Advocacy/organizing capacity is essential • Look for opportunities for common ground • For several reasons, public program coverage is key • Solutions are at hand, but they aren’t free • Much can be done at the state level but the federal government will need to step to the plate