1. Fall Speaker Series Breaking Down Barriers & Building Access to Healthcare Wednesday, October 26, 2011 11:30 a.m. La Colombe D'Or Le Grand Salon de la Comtesse 3416 Yoakum Blvd., Houston, TX 77006

2. 2 Health Reform: The Big Picture Or, Why ACA is worth Keeping, In Spite of Flaws First-ever system for making comprehensive care available to all (lawfully present) Americans at an affordable price Competition in health insurance marketplace will no longer be based on avoiding risk Lays a foundation for controlling costs and improving quality of care

3. 3 Affordable Care Act Timeline 20142013201220112010 2010: Early insurance market reforms begin. 2010-2014: Start building new systems needed to support covering large numbers of uninsured. 2014: Big expansion of coverage starts.

4. Build on current system: Vast majority of Americans still get coverage through their employer. Medicaid expansion: US citizens to 133% FPL ($14,404 individual; $29,327 for 4). (Increases primary care Medicaid fees to MediCARE level in 2013.) Reform Private Health Insurance: standard minimum benefits, can’t charge more based on health status, limits on premium increases as people age, no denial of coverage, no excluding pre-existing conditions, no annual or lifetime maximums. New Health Insurance Exchanges where private insurers’ options can be compared and purchased. Open to people without job-based coverage and small employers, and all members of Congress will get coverage thru exchange. Sliding scale premium assistance in the exchange up to 400% of FPL ($88,200 for family of 4). Sliding scale deductibles/co-pays and out-of-pocket caps in the exchange to increase affordability & reduce medical bankruptcy. Individual mandate to have coverage (with major exemptions). Some requirements for employers to contribute if their employees get sliding-scale help in exchange, with exemption for all employers with 50 or fewer workers. 2014: Health Reform Building Blocks

5. 5 5 Texas Medicaid/CHIP: Who is Helped Today September 2011, HHSC data Total enrolled 9/1/2011: 3.6 million Medicaid; 550,000 CHIP

6. 6 How Could 2010 Uninsured Texans Gain Coverage If Reform were Fully Implemented Today? ≈ 2.6 million (< 65) may get help with coverage in the exchange ≈ 610,000+ would qualify for exchange coverage at full cost ≈ 1.4 million U.S. citizen adults would newly qualify for Medicaid ≈ 600,000 kids qualify for Medicaid or CHIP right now ≈ BUT: 1.1 to 1.8 million would remain uninsured (CBO) ≈ 3 uninsured Texans gain private exchange coverage for each 2 gaining through Medicaid/CHIP Of the 6.2 Million Uninsured Texans in 2010…

7. 7 Under Reform - 2019 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 - 2019 Source: The Congressional Budget Office Cost Estimate of H.R. 4872, Reconciliation Act of 2010, Mar. 20, 2010, http://www.cbo.gov/doc.cfm?index=11379.http://www.cbo.gov/doc.cfm?index=11379 282 Million U.S. Residents Under Age 65

8. 8 Texas Uninsured by Income 2010… 89% of 6.2 million uninsured have incomes <400% FPL 656K 501K 626K 614K 1.912 Million 421K Annual income limits given for a family of four, 2011 federal poverty level U.S. Census, March 2011 CPS 921K 6.2 million includes 1.7 million non-US citizens; ~2/3 of these (about 1.1 million) likely undocumented 525K

9. San Jose Clients by Income Level

10. 10 Uninsured Texans by Age Group, 2010 Source: U.S. Census, March 2011 CPS 6.2 million uninsured Texans 101,000 4% of Texas Seniors uninsured – twice the US average

11. San Jose Clients by Age Dental Care: 10% are 65 + (no dental in Medicare). 80% are ages 19 + (no dental in adult Medicaid, either)

12. Texas Uninsured Rates by Citizenship Status, 2010: though non-citizens are much more likely to be uninsured…. Texas average: 24.6% 4.1 million people 392,128 people 1.7 million people (including legal immigrants) Source: CPPP Analysis of CPS Annual Social & Econ. Supplement http://www.census.gov/hhes/www/cpstc/cps_table_creator.html

13. Most Uninsured Texans are U.S. Citizens Source: CPPP Analysis of CPS Annual Social & Econ. Supplement http://www.census.gov/hhes/www/cpstc/cps_table_creator.html

14. Fall Speaker Series Breaking Down Barriers & Building Access to Healthcare Wednesday, October 26, 2011 11:30 a.m. La Colombe D'Or Le Grand Salon de la Comtesse 3416 Yoakum Blvd., Houston, TX 77006