Insure New Mexico! NGO NM November 2, 2005

1. Insure New Mexico! NGO NM November 2, 2005

2. Objectives for Today’s Discussion • What We Learned about New Mexico’s Uninsured • Overview of Insure New Mexico! Council’s 2004 Recommendations Supported by Governor Richardson and passed by the Legislature • Insure New Mexico! Health Insurance Options for Small Employers including Nonprofits • Status of Small Employer Insurance Program (SEIP) • SEIP Interest Survey • Insure New Mexico! Council’s Remaining Initiatives 1

3. Insure New Mexico! CouncilWhat We Learned about NM’s Uninsured • 414,000 New Mexicans do not have health insurance equating to 22.1% of the State’s population being uninsured (Census Current Population Survey, 2003). • 88% of New Mexico’s employers employ less than 20 employees. • 41% of these small employers do not offer health insurance. (HPC Employer Survey, 2005) • Nonprofit agencies report interest in a health insurance purchasing collaborative as a way to create cost savings and provide health insurance coverage to more individuals. 2

4. Insure New Mexico! CouncilWhat We Learned about NM’s Uninsured (2) • Two-thirds of small employers in the State express interest in a health insurance purchasing alliance (HPC Employer Survey, 2005). • Half of the state’s small employers currently not offering health insurance coverage want a comprehensive plan (HPC Employer Survey, 2005). • ¾ of uninsured New Mexicans say they need comprehensive health insurance. (HRSA Household Survey, 2004) • 81% of small employers cite cost as the reason for not providing coverage. (HPC Employer Survey, 2005) 3

5. What We LearnedNGO NM Nonprofit Survey Nonprofit agencies completed a survey sponsored by NGO NM that asked them about health insurance issues, barriers to coverage, and what agencies pay for coverage. • The primary differences between insured and uninsured nonprofits were that agencies providing insurance tend to be larger, with more resources, and often provide a broader array of benefits than smaller agencies. • Nonprofits are most concerned about the cost of insurance to the agency as well as co-payment costs for employees. • Agencies are interested in pooling, to create cost savings. • Comprehensive insurance is strongly preferred over catastrophic options, although some of the smaller agencies that do not provide coverage indicate interest in catastrophic options. 4

6. What We Learned Strategies to Strengthen Employer Coverage • Provide tax credits or premium assistance to low-wage workers to make health insurance coverage more affordable. • Reduce and stabilize premiums for small employers through reinsurance or stop-loss coverage. • Create larger purchasing pools for small employers to get better premiums and benefits, as well as more choices. • Cover young adults under their parents’ policies up to age 25, whether or not they are full-time college students. • Limit waiting periods for new employees. • Continue coverage for employees for 2 months after termination of employment. • Enhance Medicaid options. 5

7. Reminder . . . • 2003 – Health Care Coverage and Access Task Force • 2004 – Insure New Mexico! Council • Charges: • reduce number of uninsured • increase number of employers offering insurance • 34 Recommendations, 6 passed legislature • 2005 – Working on Remaining Recommendations and Limited New Ones • Report due to Governor in December 2005 • Minutes on www.insurenewmexico.state.nm.us. 6

8. Insure New Mexico!Legislation Signed by Governor 2005 Legislation • Expand the Functions and Reduce Rates of the Health Insurance Alliance • Allowing Individual Health Care Coverage of Unmarried Dependents until their Twenty-Fifth Birthday • Require Insurers to Offer Insurance Coverage for Certain Part-Time Employees • Small Employer Insurance Program (GSD) FY06 Budget • Implement the State Coverage Insurance (SCI) Program ($4 million general fund) • Medicaid Outreach to Enroll Native American and Hispanic Children ($1 million general fund) 7

9. INSURE NEW MEXICO! • OPTIONS FOR SMALL EMPLOYERS • Health Insurance Alliance (HIA) • Information clearinghouse and technical assistance • Reduced cost product for small employers • Non-profit representation on board of directors • Commercial insurance carriers • Tax incentives to cover losses • Small Employer Insurance program (SEIP) • Small employer (under 50) insurance pool • Administered by General Services Department • Commercial insurance carriers • 12 month “crowd-out” • Not subsidized 8

10. INSURE NEW MEXICO! • State Coverage Insurance (SCI) • Public/Private partnership- state- employers- counties • 19-64 year-old adults at <200% FPL • Commercial insurance carriers • 12 month “crowd-out” • New Mexico Medical Insurance Pool (NMMIP) • Covers high risk and uninsurable • Administered by Blue Cross • Tax incentives to cover losses • Regular Commercial Insurance 9

11. SEIP Benefit Package* Is Similar to a Basic Commercial Plan BENEFITS INCLUDE: • Hospital—inpatient/outpatient • Emergency and urgent care • Primary care/Specialty care • Preventive and Women’s health services • Pharmacy • Behavioral health • Durable medical equipment and supplies • OT/PT/ST • Lab/diagnostics/X-ray * $100,000 annual limit 10

12. Insure New Mexico! SEIP INTEREST SURVEY • One page questionnaire to determine interest and gather feedback regarding the Small Employer Insurance Program (SEIP) • Please complete form and deposit in the marked box on your way out to lunch today. Thank you! 11

13. Insure New Mexico! Work Still to Come… 12

14. Insure New Mexico! Council – Remaining Initiatives A. Increase Insurance Options • Require insurers tooffer domestic partner health insurance benefits to employers of any size who want to provide this coverage. NOTE: HSAs considered and not considered important to charge of increasing the number of uninsured, and no legislation needed for market to do them within current law. 13

15. Insure New Mexico! Council – Remaining Initiatives B. Tax Incentives for Small Employers[2006] • Tax credit for businesses that provide health insurance for part-time employees working at least 20 hours a week. This credit is estimated to benefit 7,000 part-time employees (a total of 10,000 individuals, with families). • Graduated tax credit for small businesses (25 employees or less OR less than 10 employees) that offer health insurance for their employees. Small businesses currently offering health insurance would receive a five percent tax credit, while small businesses not currently offering health insurance would receive a 10 percent tax credit declining to five percent in the second year. This tax credit is designed to entice small businesses to begin and continue to offer health insurance for employees. This tax credit is estimated to benefit 5,000 employees (a total of 7,500 individuals, with families). • Tax Credit for small businesses offering insurance for families with small children or for low-income employees. 14

16. Insure New Mexico! Council – Remaining Initiatives C. Medicaid [2006] • Increase Medicaid coverage for adults up to 100% of the federal poverty level (FPL) by developing a limited benefit plan for such adults with appropriate cost-sharing, beginning with adults with children up to 50% FPL (currently ~ 33% FPL). (< 5,500 lives @ ~$6.7 million GF) • Increase coverage for: • Prenatal care up to 235% FPL (now 185%) (< 1,200 women ~$3.9 million GF). • Children up to 300% FPL (now 235%)(< 7,800 children to age 19 @ ~$3.8 million GF). • Increase aggressive outreach to families with children (increase enrollment @ ~ $15.3 million GF annualized). • Expand SCI ($4 million GF for ~ 7,000 lives). 15

17. Insure New Mexico! Council – Remaining Initiatives D. Use New Mexico Clout [2006] • Give preference in doing business with the state or enhance access to industrial revenue bonds for companies who offer health insurance to their employees. The Governor could call on New Mexico businesses to give preference to vendors, contractors and suppliers that offer health insurance for their employees. 16

18. Insure New Mexico! Council – Remaining Initiatives E. Increase Knowledge of Health Insurance Options [2006] • Educate the public regarding prevention and wellness and the link to reducing the cost of health insurance premiums. • Train brokers and increase HIA’s outreach capacity to small businesses. 17

19. Insure New Mexico! Council – NEW POSSIBILITIES • Market-Based Universal Coverage www.nmhealthchoices.org • Mandates on employers and individuals • State role in collecting funds and providing vouchers • Voucher amount depends on income and health status • Vouchers used to purchase private sector insurance • Mandates or Encouragement to Provide Wellness Benefits • “WalMart Mandates” for Large Employers 18

20. Insure New Mexico! Council – NEW POSSIBILITIES • Amend Small Employer Insurance Program (SEIP) to exempt nonprofits from the provision that small businesses are only eligible for coverage under SEIP if they have been uninsured for the preceding 12 months. 19