1. Health Insurance in the District of Columbia State Planning Grant Overview Raymond T. Terry, Sr., PhD, Project Director Office of Policy, Planning and Research November 8, 2004 HRSA State Planning Grant ‘04 A Project of the District of Columbia Department of Health

2. 2 What is a State Planning Grant? Purpose Federally funded program to examine ways to expand health insurance coverage for uninsured residents in the District of Columbia

3. 3 State Planning Grant Objectives  Conduct quantitative and qualitative analyses to identify uninsured residents and reasons why they are uninsured, by utilizing several different health care and insurance data sources, such as the MEPS, CPS, BRFSS, US Census, etc. and focus groups;  Explore effective options to provide high quality affordable health insurance/coverage that will target actionable groups  Foster collaboration by convening an advisory panel of community partners and experts

4. 4 The State Planning Grant Project Team D.C. Dept of Health – Lead State Agency Urban Institute Health Care Coverage Advisory Panel AcademyHealth HRSA SHADAC ACHI AHRQ

5. 5 The Advisory Panel  Chosen to represent a broad range of District constituencies & expertise  Designed to facilitate discussions and foster collaboration among groups with competing interests in the public and private sectors  Expected to develop options for expanding coverage that balance these competing interests

6. 6 Advisory Panel Process The balanced composition of the Panel will allow competing interests to be considered The Panel will meet quarterly to discuss relevant issues, ongoing projects, and develop further project concepts Project staff will facilitate discussions and provide needed research and analysis Panel recommendations will be included in the final grant report to the Mayor and HRSA

7. 7 Components of District’s Project 7 Tasks I Research and Assessment Tool Development Task 1: Establish Health Care Coverage Panel Task 2: Review prior experience in District and other states Task 3: Conduct relevant quantitative analysis with existing and newly generated data Task 4: Conduct relevant qualitative analyses with existing and newly gathered data II Decision Process--a public private collaboration Task 5: Refine options, analyze alternatives Task 6: Prioritize feasible options III Prepare recommendations Task 7: Recommend course of action for the District

8. 8 Make-up of Uninsured Population by Income Adults 18-64, 2003 Source: Urban Institute estimates of the D.C. Health Care Access Survey, 2003

9. 9 Make-up of Uninsured Population by Employment Status Adults 18-64, 2003 Source: Urban Institute estimates of the D.C. Health Care Access Survey, 2003

10. 10 Uninsured Adults Who Are Working UninsuredUninsured & Employed Full time30%55% Part time10%18% Self-employed15%27% Employed54%100% Adults 18-64, 2003 Source: Urban Institute estimates of the D.C. Health Care Access Survey, 2003

11. 11 A large share of firms in DC offer insurance State% Firms Offering Insurance, 2001 U.S. Total58% District74% Maryland62% Virginia62% State rates in U.S. range from 43% to 82% Source:Source: Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey - Insurance Component. 2001.

12. 12 Still, many workers are not offered insurance Uninsured Workers 18-64, 2003 Source: Urban Institute estimates of the D.C. Health Care Access Survey, 2003

13. 13 Average Annual Cost of Employer-Sponsored Insurance, 2001 State Employee Share / Employer Share IndividualFamily DC$507 / $2,523$2,003 / $6,709 MD$524 / $2,364$2,178 / $5640 VA$580 / $2,122$1,947 / $5,401 US$498 / $2,391$1,741 / $ 5,768 Source: Kaiser Family Foundation, State Health Facts Online.

14. 14 Why are People Uninsured?  High Cost of Coverage – vast majority of uninsured are low-income workers and coverage is unaffordable or not offered;  Fragmentation of Systems of Coverage – e.g. Medicaid/Healthy Families, the Alliance  Complicated Life Circumstances – (homelessness, mental illness, family transitions between DC/MD/VA;  Immigration Status – national data indicate that most non-native uninsured are legal residents or who have lived in the US for 6+yrs.

15. 15 Consequences of Uninsurance  Poor access to care - Less likely to have usual source of care - Less likely to have medical visits  Inappropriate use of the ER  Poorer health outcomes  Greater financial burden when obtaining care

16. 16 Questions for the Project  What is being spent in the District on care for people who are uninsured?  What is being spent on uncompensated care for non-District residents?  How many uninsured residents are eligible for Medicaid or SCHIP?  How should Medical Homes be funded?  What does expanded insurance mean for patients, for safety-net providers?

17. 17 Focus Group Approach  Total of eight focus groups  Two with publicly insured individuals  Two with uninsured individuals  Two with insurance carrier representatives  Two with small business employers  Each with English and Spanish speaking participants

18. 18 Preliminary Findings from the Uninsured Focus Groups Some Reasons for not having insurance  Most had periods of insurance in past  Failed to renew coverage  Made attempts to renew, but had problems with complex system (too much documentation required)  No staff in eligibility office  Didn’t make attempt to apply  Didn’t know where to apply; needed more info  Couldn’t afford coverage offered by employer  Didn’t feel the need for insurance

19. 19 “Live” Options on the Table Being Considered  District government health plan Buy- In/High Risk Insurance Pool: “Equal Access Act”, proposed by the District’s insurance commissioner  Strengthen and expand current services - HIFA Waiver

20. 20 From Recommendations to Action  The District is learning from progress in 42 other state planning grant states;  The District is building state agency capacity;  Regional collaborative efforts in progress with MD and VA;  Additional new or expanded health coverage options will be identified;  Advisory Panel’s recommendations will have a major impact on health coverage policy in the District of Columbia

21. 21 Health Insurance in the District of Columbia State Planning Grant Overview For more information, please contact: Raymond T. Terry, Sr., PhD, Project Director Office of Policy, Planning and Research 825 North Capitol Street, NE 3 rd Fl. Washington, DC 20002 Rterry@dchealth.com (202) 442-9377