Insuring the Uninsured in Pennsylvania By Maribeth LeBreton, MSN, APRN-BC

Uninsured Population Medicaid-nation’s safety net insurance In 2010, 49 million people under 65 were uninsured 75% -working families Change in economy Rising unemployment rates Lack of employer sponsored insurance If attempt to pay out of pocket, insurance rates high, unable to afford

Impact of Lack of Health Care Uninsured do without medical care Lack of timely health prevention Less likely to have outpatient care If ill, will wait until need hospitalization Less likely to obtain follow up care As young adult, without care, could develop chronic illness-costly later Chronic illness less likely to be treated on routine basis

ACA Medicaid Expansion Health care expenses continue to rise Patient Protection and Affordable Care Act, 2010 Full implementation 2014 Expand coverage to adults with income up to 138% FPL States to share cost with Federal government Each state designs and manages their patient population Each state has option not to implement

Impact for States Not Implementing Federal government not share cost 11.5 million adults with income below 100% FPL, will remain uninsured Will not benefit from reduced spending in uncompensated care Potentially large % of State residents will not have access to health care

Strengths of Medicaid Expansion Insure the uninsured, mostly adults Increase access to care Provide health prevention, maintenance Promote healthy communities States share cost with Federal Government

Weakness of Medicaid Expansion Fiscal implications not known Not enough health care providers to see all newly eligible for Medicaid Lack of clinic space to see all newly eligible for Medicaid State has the option not to implement

Opportunities Provided by the Medicaid Expansion Insure the uninsured Improve the health of the communities Increase health care workforce APRNs as healthcare providers Engage PA citizens in their health care

Threats to Medicaid Expansion State legislators choose not to implement Lack of sufficient # of health care providers Inability to sign up all of the uninsured Uninsured choose not to utilize preventive services Lack of fiscal benefit d/t lack of use of services Newly eligible Medicaid recipients continue to use rescue services

Implementation Benefits to PA Health care for all citizens Financial assistance from Federal Government Improve health of citizens Health prevention Diagnose chronic illness early Health maintenance Healthier communities =happier communities

Action Plan for PA Legislators Vote to implement Medicaid Expansion Adopt Consensus Model Standardize process-sign up, coverage, payment, assess fiscal aspect Establish outcome metrics Reassess program statewide

Action Plan for PA con’t. Health Care Providers Engage to serve population APRNs and physicians work collaborately Citizens /Communities of PA Inform uninsured of eligibility for Medicaid Develop simple process to sign up Educate so aware of access to care, health prevention and health maintenance

Action Plan for PA con’t. Providers/health systems Educate about new Medicaid eligibility Inform standardized process for newly eligible Increase access to care Funded by Federal and State Government Educate on fiscal impact

Questions and Comments

References Carrier, E., Yee, T. & Garfield, R.L. (October, 2011). The uninsured and their health care needs: How have they changed since the recession? KFF Publication No Henry J. Kaiser Foundation (May 30, 2013). State decisions on health insurance exchanges and the Medicaid expansion, as of May 30, Retrieved from reform/state-indicator/state-decisions-for-creating-health-insurances- exchanges-and-expanding-Medicaid/ Henry J. Kaiser Foundation KFF (April, 2013). Quick take: Key considerations in evaluating the ACA Medicaid expansion for states. Retrieved from Henry J. Kaiser Foundation (July, 2012). How will the Medicaid expansion for adults impact eligibility and coverage? (KFF Publication No. 8338).

References Con’t. Henry J. Kaiser Foundation (October, 2011). The uninsured, a primer: key facts about Americans without health insurance. (KFF Publication No ). Kenney, G.M., Zuckerman, S., Dubay, L., Huntress, M., Lynch, V., Haley, J. & Anderson, J. (August, 2012). Opting on to the Medicaid expansion under the ACA: Who are the uninsured adults who could gain health insurance coverage? Timely analysis of immediate health policy issues. Robert Wood Johnson Foundation Mason, D.J., Leavitt, J.K. & Chaffee, M.W. (2012). Policy and politics in nursing and health care. (6th ed.). St. Louis, MO: Saunders Elsevier The Patient Protection and Affordable Care Act, H.R Retrieved from