1 House Insurance Committee CSHB 636 by Zerwas March 1, 2011 Anne Dunkelberg, Assoc. Director, Center for Public Policy Priorities, 900 Lydia Street - Austin, Texas Phone (512) (X102) –

2 Our Principles: Quality affordable health insurance available for every Texan Sustainable health care system Long term services and supports are provided in the most integrated setting possible Maximum federal funding for Texas health care by preserving CHIP and Medicaid Improved small business’ access to affordable health insurance Common-sense protections for Texas health insurance consumers in state law Transparent, open systems that meet consumers’ needs

Cover Texas Now Goals for the 82 nd Texas Legislature: To get the best deal for Texans, we must take 3 steps in 2011: –Start building a strong Texas insurance exchange to help families and small businesses get affordable insurance in –Make sure the Texas Department of Insurance can enforce popular insurance reforms—like no pre-existing denials for kids, keeping kids on your policy until age 26, and making sure rate hikes are fair. –Give state agencies and the exchange the authority and tools to build consumer-friendly systems for enrolling in health coverage 3

ADAPT of Texas Advocacy, Inc. Alamo Breast Cancer Foundation Center for Public Policy Priorities Consumers Union – Southwest Regional Office Children's Defense Fund – Texas La Fe Policy Research and Education Center La Union del Pueblo Entero (LUPE) National MS Society – Lone Star Methodist Healthcare Ministries Texans Care for Children Texas AFL-CIO Texas Impact Texas Organizing Project TexPIRG

5 Under Reform Employer 159 million 56% Medicaid/CHIP 51 million 18% Nongroup & Other 26 million 9% Private Exchanges 24 million 9% Uninsured 23 million 8% Americans’ Insurance Coverage in 2019: If Nothing Changed compared to Health Reform Law Employer 162 million 58% Medicaid/CHIP 35 million 12% Uninsured 54 million 19% Nongroup & Other 30 million 11% Without Reform Source: The Congressional Budget Office Cost Estimate of H.R. 4872, Reconciliation Act of 2010, Mar. 20, 2010, Million U.S. Residents Under Age 65

6 >$88,400 for a family of four; >400% of FPL  Job-based coverage, or  Full-cost coverage in the exchange $66,200-$88,400; % of FPL  Job-based coverage, or  Subsidized exchange coverage: premiums capped at 9.5% of income $44,100-$66,200; % of FPL  Job-based coverage, or  Subsidized exchange coverage: premiums capped at 6.3 – 9.5% of income $29,300-$44,100; % of FPL CHIP Job-based coverage, or Subsidized exchange coverage: premiums capped at 3% - 6.3% of income <$29,300 for a family of four; < 133% FPL Medicaid Children Adults (non-disabled adults, not eligible for Medicare) Family Income Health Reform Coverage Options by Income Family income based on 2009 federal poverty income levels for a family of four

7 Texas Uninsured by Income Today… 88% of 6.4 million uninsured <400% FPL 758K 628K 693K Million Million 525K Annual income limits given for a family of four, 2009 federal poverty level U.S. Census, CPS 901K 6.4 million includes 1.6 million non- citizens; ~2/3 of these ( just over 1 million) likely undocumented

8 Which Texans would Gain Coverage If Reform were Fully Implemented Today? ≈ 2.5 million (adults and kids) would qualify for help with coverage in the exchange ≈ 700,000+ would qualify for exchange coverage at full cost ≈ 1.3 million U.S. citizen adults would newly qualify for Medicaid ≈ 500,000 to 600,000 kids qualify for Medicaid or CHIP right now CBO predicts ≈ 1.1 to 1.8 million would remain uninsured ≈ 2 Texans gain private exchange coverage for each 1 gaining through Medicaid Of the 6.4 Million Uninsured Texans today…

9 Texas Medicaid/CHIP Enrollment August 2010, HHSC data Total enrolled 8/1/2010: 3.4 million Medicaid; 523,000 CHIP

Texas Connector: Critical to Covering low- and moderate-income working Texas families U.S. Census data indicate 2 uninsured Texans stand to gain private coverage for every 1 added to Medicaid or CHIP. Every month, 25,000-40,000 children leave CHIP and another 100,000 to 150,000 leave Medicaid. –Texas HHSC has reported fewer than 30% of kids leaving these programs gain coverage later –National studies have shown that only a small minority of uninsured kids in families under 400% FPL have access to ESI –With connector and premium assistance, demand among low-income families will be high and systems MUST be interoperable to guarantee easy transtion to private coverage. 90% federal match for adapting Medicaid systems to interact with Exchanges thru end of 2015 (proposed and may be extended); then 75% thereafter. –Fiscal note should be revisited, as it indicates 31% state share Interoperability of Connector enrollment systems with Medicaid systems is critical, and integration should be explicitly directed in HB 636.

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