1. One Illness Away National Congress on the Un- and Under Insured December 11, 2007 Washington, DC The crisis of the underinsured

2. “One Illness Away” How Did We Get Here?

3. “One Illness Away” The Crisis of the Underinsured A large portion of the American population is unable to access health care services because they simply cannot afford them

4. The Sad History of Health Care Cost Containment as Told in One Chart Medicare & Medicaid Wage & price controls Voluntary effort Managed care & threat of health reform Annual Change in Private Health Spending Per Capita

5. The cost of providing coverage has increased 80% in our state in the last five years.

6. A recent study demonstrated that New Jersey paid the highest premiums for single plans and the third highest for family plans.

7. As a result, businesses providing coverage for their workers has dropped so dramatically that now, one in every five New Jersey small business owners simply cannot afford health insurance and those who can are increasingly shifting costs to their workers.

8. “One Illness Away” We are home to more than 1.3 million uninsured, 240,000 of them children

9. One out of every seven children in our state received NO medical care last year as a result of being uninsured.

10. “One Illness Away” Where “Here” Is Medical Innovation = more people are living with chronic illness and ongoing treatment costs

11. “One Illness Away” For most underinsured Americans, there is no health care “system,” but rather a blotchy and frayed patchwork of unreliable and inconsistent programs, providers, and facilities.

12. The underinsured routinely experience delays in getting care for a variety of medical problems.

13. The underinsured receive less preventive care and poorer treatment for both minor and serious chronic and acute illnesses.

14. The bottom line: In many cases, the underinsured live shorter lives than comparable insured populations.

15. “One Illness Away” Where “Here” Is Increased patient cost-sharing is exacerbating, not helping, the problem.

16. “One Illness Away” Where “Here” Is Insurers and employers typically do not anticipate co- payment problems when they design or select a health plan

17. “One Illness Away” Where “Here” Is New kinds of insurance benefits are often abysmal for the seriously ill

18. “One Illness Away” Where “Here” Is Patients required to pay more out-of-pocket are less likely to be compliant

19. “One Illness Away” Where “Here” Is Underinsured patients use a variety of strategies to stretch their medications

20. “One Illness Away” Where “Here” Is Not seeking treatment until their condition becomes more severe

21. “One Illness Away” What We Are Doing H EALTH W ELL F OUNDATION ©

22. “One Illness Away” How do copayment foundations help? Screen applications to determine if patients qualify for assistance based on their  Income  Insurance situation  Disease being treated Award patients a grant for full or partial assistance, typically to cover one year’s treatment Process requests for reimbursement based on a patient’s award and actual expenses

23. “One Illness Away” What We Are Doing Independent, National Charity Independent, National Charity committed to help individuals unable to afford critical medications for serious, chronic conditions committed to help individuals unable to afford critical medications for serious, chronic conditions HealthWell has granted assistance to more than 40,000 patients HealthWell has granted assistance to more than 40,000 patients

24. “One Illness Away” What We Are Doing HealthWell fields more than 20,000 inquiries in a typical month HealthWell fields more than 20,000 inquiries in a typical month HealthWell provides more than $5 million each month in relief. HealthWell provides more than $5 million each month in relief.

25. “One Illness Away” What We Are Doing HealthWell beneficiaries  Have chronic and life- threatening diseases  Have some form of health care coverage  Still cannot afford the out-of-pocket costs of their treatment

26. What We Are Doing Assistance from HealthWell is based on disease state, not prescribed treatment Acute Porphyrias Acute Porphyrias Age-Related Macular Degeneration Age-Related Macular Degeneration Anemia associated with Chronic Renal Insufficiency or Chronic Renal Failure Anemia associated with Chronic Renal Insufficiency or Chronic Renal Failure Ankylosing Spondylitis Ankylosing Spondylitis Asthma, Moderate to Severe Asthma, Moderate to Severe Breast Cancer Breast Cancer Carcinoid Tumors and Symptoms Related to Carcinoid Tumors Carcinoid Tumors and Symptoms Related to Carcinoid Tumors Chemotherapy Induced Anemia and Neutropenia Chemotherapy Induced Anemia and Neutropenia Colorectal Carcinoma Colorectal Carcinoma Cutaneous T-Cell Lymphoma Cutaneous T-Cell Lymphoma Head and Neck Cancer Head and Neck Cancer Hodgkin’s Disease Hodgkin’s Disease Immunosuppressive Treatment for Solid Organ Transplant Recipients Immunosuppressive Treatment for Solid Organ Transplant Recipients Iron Overload as a Result of Blood Transfusions Iron Overload as a Result of Blood Transfusions Multiple Myeloma Multiple Myeloma Myelodysplastic Syndromes Myelodysplastic Syndromes Non-Hodgkin’s Lymphoma Non-Hodgkin’s Lymphoma Non-Small Cell Lung Cancer Non-Small Cell Lung Cancer Psoriasis Psoriasis Psoriatic Arthritis Psoriatic Arthritis Rheumatoid Arthritis Rheumatoid Arthritis Secondary Hyperparathyroidism Secondary Hyperparathyroidism Wilms’ Tumor Wilms’ Tumor

27. “One Illness Away” They are our friends and neighbors. Gordon “Keith” Parke Middleburg, Florida Macular Degeneration Age 50

28. “One Illness Away” They are our family members. Beatrice Szeles Orange, California Rheumatoid Arthritis Age 56

29. “One Illness Away” What We Can Do We must do more!

30. “One Illness Away” What Reform Might Look Like One State’s Proposal...

31. “One Illness Away”

32. We knew where to start. 1. Enroll all who are eligible for state sponsored coverage and manage the Federal dollars available to us for this purpose. 2. Make sure that those who have health care coverage are able to keep it. 3. Provide an affordable and adequate coverage alternative for every man, woman and child in our state.

33. “One Illness Away” Total Uninsured = 1,300,000 New Jersey Total Population = 8,500,000

34. “One Illness Away” New Jersey’s Uninsured 600,000 remaining uninsured 300,000 Eligible but not enrolled 400,000 undocumented

35. Comprehensive & Transformational Successful Health Care Reform Successful CommercialGradeCommercialGrade Universal & Portable Portable Affordable & Sustainable SustainableMandatedMandated

36. “One Illness Away” Reform Elements

37. “One Illness Away” Individuals will be responsible to provide proof of health insurance when they file their state income tax return.

38. “One Illness Away” If they do not provide proof of health insurance, they will be placed by the state into the new state health insurance plan.

39. “One Illness Away” If, for whatever reason, a New Jersey resident seeks care without insurance, their provider will place them into the new plan and provide billing information to the new plan.

40. “One Illness Away” Combine in one, self ‑ funded plan so the healthy and the sick balance each other out yielding a more affordable health insurance product.

41. “One Illness Away” This new health insurance plan... Statewide network of providers, Statewide network of providers, Available in an HMO and a PPO format. Available in an HMO and a PPO format. Commercial grade, with commercial reimbursements Commercial grade, with commercial reimbursements Modeled after the standard plan in New Jersey’s small employer market. Modeled after the standard plan in New Jersey’s small employer market.

42. Where an employee does not have employer ‑ based coverage his or her employer must provide them access to a flexible ‑ spending account under Section 125 of the IRS Code so the employee can purchase their coverage with before tax dollars.

43. “One Illness Away” Final Elements Offered to all New Jersey residents, Offered to all New Jersey residents, State subsidy provided based on individual or family affordability State subsidy provided based on individual or family affordability Charity care and related hospital subsidies redirected to premium assistance Charity care and related hospital subsidies redirected to premium assistance

44. “One Illness Away” Comparison to the Massachusetts Plan Individual Mandate Individual Mandate Expand Medicaid & SCHIP Expand Medicaid & SCHIP Section 125 Required Section 125 Required d Connector to Private market Connector to Private market Multiple Insured Plans Multiple Insured Plans Employer Mandate Employer Mandate Massachusetts New Jersey Individual Mandate Individual Mandate Expand Medicaid & SCHIP Expand Medicaid & SCHIP Section 125 Required Section 125 Required State-Run Public Plan State-Run Public Plan Single, Self-Insured Plans Single, Self-Insured Plans No Employer Mandate No Employer Mandate

45. We must be wary of ungenerously throwing upon posterity the burden which we ourselves ought to bear.

46. “One Illness Away” What We Can Do

47. “One Illness Away” How You Can Make a Difference, Too Encourage Transformational Health Reform Support HealthWell Foundation or other Co-Payment Relief Oranizations Spread the Word

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