Health Care Financing Challenges for 2009 and Beyond Michael Birnbaum Director of Policy, Medicaid Institute United Hospital Fund April 15, 2008 Funded.

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Presentation transcript:

Health Care Financing Challenges for 2009 and Beyond Michael Birnbaum Director of Policy, Medicaid Institute United Hospital Fund April 15, 2008 Funded by the New York State Department of Health

2006 National Health Expenditures = $2.1 trillion Government provides about half of all U.S. health care spending. 2006 National Health Expenditures = $2.1 trillion Source: Catlin et al. Health Affairs, 2008.

The federal budget has run a surplus four times since 1980. U.S. Total Budget Surplus or Deficit as a Share of Revenue 1984 1988 1992 1996 2004 2000 Note: Total revenue and expenditures include Social Security. Source: U.S. Congressional Budget Office.

Medicare and Medicaid represent one-fifth of federal outlays. $2,655 billion in federal outlays, 2006 Source: U.S. Congressional Budget Office.

The number of Medicare beneficiaries is projected to double between 2000 and 2030. Millions of beneficiaries Source: CMS, Office of the Actuary.

Medicaid plays a central role in the U.S. health care system. Medicaid covered 61 million low-income people at some point during 2006. 46 million people in low-income families 15 million elderly and disabled individuals 7 million Medicare beneficiaries Medicaid consists of two major entitlements under federal law. Coverage to individuals Federal funding to states

Outlays for 50 states and DC, 2006 Medicaid represents one-fifth of state outlays. Outlays for 50 states and DC, 2006 Source: NASBO 2006 Expenditure Report.

$34.6 billion in federal funds expended during SFY 2006 Medicaid accounts for more than half of all federal funds that New York State receives and spends each year. $34.6 billion in federal funds expended during SFY 2006 Source: National Association of State Budget Officers, 2006 State Expenditure Report.

Medicaid is a cornerstone of New York’s health insurance system. Medicaid provides insurance to 4.1 million low-income New Yorkers. 1.6 million children 1.5 million (non-elderly, non-disabled) adults Over 1 million elderly or disabled beneficiaries Medicaid funding sustains nearly one-third of New York’s health care economy. Medicaid has different rules from commercial insurance. No waiting periods or exclusions for pre-existing conditions People apply directly from the hospital to cover an admission Few benefit limits for medically necessary services Note: Medicaid enrollment is from April 2007. Source: United Hospital Fund analysis of NYS DoH enrollment reports.

Shares of Medicaid enrollment and spending by eligibility category Note: Shares may not sum to total. Source: United Hospital Fund and Urban Institute analysis of CMS Form 64 and Medicaid Statistical Information Systems (MSIS) data from FFY 2004.

Medicaid spending in New York $44.7 billion in 2006 Source: United Hospital Fund analysis of CMS Form 64.

Medicaid is downstream from our nation’s toughest health care challenges. Erosion of employer-based coverage Gaps in Medicare coverage No alternative for long-term care assistance Lack of system-wide cost containment Inadequate financing for the safety net