Universal Coverage and Access: Critical to Achieving Health Equity Getting to Universal Coverage and Access A Congressional Briefing Ron Pollack Families USA May 27, 2009

One in three non-elderly Americans uninsured in million Americans under the age of 65 went without health insurance for some or all of the two-year period Source: Americans at Risk: One in Three Uninsured, Families USA, March 2009

Duration without insurance Source: Americans at Risk: One in Three Uninsured, Families USA, March 2009

Communities of color are hardest hit Source: Americans at Risk: One in Three Uninsured, Families USA, March 2009 Percent of Non-Elderly Racial/Ethnic Group Uninsured

Health care must be made affordable Create a Medicaid eligibility floor at 133% of poverty ($24,350 for a family of three in 2009) Provide robust, sliding-scale premium subsidies for low-income people above the Medicaid floor Cap out-of-pocket costs, to protect people from unaffordable cost-sharing

Growing support for these approaches President Obamas health reform framework Senator Baucuss health reform white paper Senate Finance Committees coverage options paper Broad acceptance among diverse stakeholders

Why set a Medicaid eligibility floor? Median Medicaid eligibility for parents: 67% of poverty ($12,270 for a family of three in 2009) Only 16 states cover parents at or above the poverty level ($18,310 for a family of three in 2009) In 43 states, adults without dependent children can be penniless and still not be eligible for Medicaid

For example… Alabama Working Parents: 25% of poverty ($4,570 for a family of three) Adults w/out dependent kids: Never eligible, at any income

For example… Oregon Working Parents: 67% of poverty ($12,270 for a family of three) Adults w/out dependent kids: Never eligible, at any income

For example… Michigan Working Parents: 66% of poverty ($12,085 for a family of three) Adults w/out dependent kids: 35% of poverty ($3,790 for a single adult)

Medicaid = high-quality health coverage Source: Medicaid As A Platform For Broader Health Reform: Supporting High-Need and Low-Income Populations, Kaiser Commission on Medicaid and the Uninsured, May 2009

Medicaid is well-liked Medicaid/CHIP is a good program Parent would enroll child in Medicaid/CHIP if eligible Source: Kaiser Survey of Childrens Health Coverage, 2007.

Public support for expanding Medicaid Source: Kaiser Health Tracking Poll, April 2009 Do you favor expanding state government health insurance programs for low-income people?

Medicaid covers critical services Early and periodic screening, diagnosis and treatment (EPSDT) for children Language access services Transportation services Dental and mental health services Case management for chronic diseases Home and community based care No denials because of preexisting conditions No lifetime caps on benefits

Cost-sharing protections in Medicaid Many other groups and services are limited to nominal copayments ($ $5.00) No premiums: Anyone with income < 150% of poverty ($27,465 for a family of three) Premiums for those with higher incomes must not be more than 5% of monthly or quarterly income Lowest-income children Foster children Institutionalized and hospice patients Women in the breast or cervical cancer programs Pregnancy-related services Preventive services Emergency services Family planning services Protected from ANY cost sharing:

Who will benefit from Medicaid expansions? Uninsured people under age 65 with income below the poverty level Over half of the uninsured with income below poverty are people of color. Source: Expanding Health Coverage for Low-Income Adults: Filling the Gaps in Medicaid Eligibility, Kaiser Commission on Medicaid and the Uninsured, May 2009.

What about everyone else? Medicaid Covered through the Exchange, some with subsidies Medicaid eligibility floor There are low- income people here, too!

How will the subsidies be used? Regulated private health insurance marketplace Public Plan Option EXCHANGEEXCHANGE Private Plan Choice! Subsidy

Low-income people in the Exchange need: Affordable premium subsidies on an income-based sliding scale Limits on out-of-pocket costs based on income Robust benefit packages; low-income people cannot afford to pay out-of-pocket for non-covered services

Yes, this will cost money.

Upfront investment Substantial gains in coverage and access Reductions in racial and ethnic health disparities

For more information, please contact: Families USA Rea Pañares Director of Minority Health Initiatives Sarina Fogel Gerson Senior Government Affairs Associate