1. Figure 0 The Role of Public Programs in Health Reform Diane Rowland and Robin Rudowitz Henry J. Kaiser Family Foundation for Congressional Health Care Reform Education Project Washington, DC September 19, 2008

2. Figure 1 Health Insurance Coverage of the Total Population, 2007 SOURCE: KCMU and Urban Institute analysis of March 2008 CPS. Total = 298.2 million

3. Figure 2 Public Health Coverage Programs Medicare (44 million) –Universal coverage for 37 million elderly (ages 65 +) and 7 million disabled (under 65) based on entitlement for Social Security with no regard to income or medical history –Federally financed and administered Medicaid (59 million) –Means-tested program that provides health and long-term care for low-income children and their parents, elderly, and disabled –Financed jointly by federal government and states and administered by states SCHIP (6.1 million) –Builds on Medicaid to provide insurance coverage to low-income uninsured children who are not eligible for Medicaid –Financed jointly by federal government and states with capped funding from federal government and administered by states Veterans Health Administration and Military Health System –VHA provides coverage for and delivers health care to over 5 million veterans and their families at its network of outpatient providers and hospitals –Department of Defense purchases and provides health care to over 8 million active duty personnel and retirees and their dependents at military treatment facilities as well as the TRICARE programs network of civilian providers

4. Figure 3 Only nationwide health insurance program in US Most Medicare beneficiaries (77%) in traditional Medicare program (Parts A & B) Low administrative costs (2%) High provider participation including almost all hospitals and over 90% of physicians Financed by payroll tax, general revenues, and beneficiary premiums 14% of the federal budget and 19 % of national health expenditures Key Features of Medicare 13% 7% Part A Part B Part A and B Part D 30% 5% 21% 4% 20% 8% 11% Total Benefit Payments, 2008 = $444 billion SOURCE: CBO Medicare Baseline, March 2008.

5. Figure 4 The A, B, C and Ds of Medicare Part A – Hospital Insurance Program (44.5 million) –Inpatient hospital, skilled nursing facility, home health, and hospice care –Funded by a payroll tax paid by employers and employees Part B – Supplemental Medical Insurance (41.5 million) –Physician visits, outpatient hospital, preventive services, home health –Funded by general revenues, premiums (some income-related) Part C – Medicare Advantage plans (10.1 million) –Private plans, such as HMOs, Private Fee-for-Service, and MSAs –Integrates financing from Parts A and B Part D – Medicare Prescription Drug Benefit (25.4 million) –Offered through private stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans –Funded by premiums, general revenues and state payments for dual eligibles

6. Figure 5 Medicares Benefit Package is Less Generous Than Typical Large Employer Plans or FEHBP Plan NOTE: The FEHBP (Federal Employees Health Benefits Program) standard option is offered through Blue Cross Blue Shield. Employer plans include dental benefits. SOURCE: Hewitt Associates analysis for the Kaiser Family Foundation, 2008. Total Average Medical Spending, 2007 = $14,270 $10,610 $12,160 $11,780

7. Figure 6 Most Medicare Beneficiaries Have Supplemental Coverage, 2006 Medicare Advantage Employer- sponsored Medicaid Self-purchased only None – Medicare fee-for-service only Other public/private NOTES: Percents rounded to the nearest whole number. SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Access to Care File, 2006. Total Number of Beneficiaries = 39.8 Million

8. Figure 7 Medicare Per Capita Expenditures, 2004 AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA TX IL FL AL $0-$3,000 (19 states including DC) $12,000 + (7 states) $3,001-$6,000 (15 states) $6,001-$12,000 (9 states) SOURCE: KCMU and Urban Institute estimates based on data from MSIS 2005.

9. Figure 8 Contribution of Health Care Costs and Enrollment Trends to Growth in Medicare Spending Medicare outlays net of beneficiary premiums as share of Gross Domestic Product (GDP): SOURCE: CBO, 2007. Historical trends in health care cost growth Enrollment trends Current Medicare spending

10. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 9 Key Features of Medicaid States administer program with federal funds and guidelines –Operates as 50 distinct state programs with variation in eligibility, benefits, and provider payment –Provides 44% of federal funds to states –Federal matching rates range from 50% to 76% Provides health insurance coverage for 29 million children and 15 million adults in low-income families and 8 million low-income persons with disabilities Provides supplemental health care coverage for 8.8 million aged and disabled Medicare beneficiaries Provides long-term care assistance to 1 million nursing home residents (41% of long-term care services) Accounts for 16% of national spending on health services and supplies and 7% of federal budget SCHIP supplements Medicaid covering an additional 6 million low-income children with enhanced match rate but capped federal financing

11. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 10 Medicaid Enrollees and Expenditures by Enrollment Group, 2005 Children 18% Elderly 28% Disabled 42% Adults 12% Children 50% Elderly 10% Disabled 14% Adults 26% Total = 59 millionTotal = $275 billion SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on 2005 MSIS data.

12. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 11 Medicaid Payments Per Enrollee by Acute and Long-Term Care, 2005 $1,617 $2,102 $13,524 $11,839 SOURCE: KCMU and Uninsured and Urban Institute estimates based on 2005 MSIS data.

13. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 12 Medicaid Expenditures by Service, 2006 Total = $304.0 billion SOURCE: KCMU and Urban Institute estimates based on data from CMS (Form 64) Inpatient Hospital Ambulatory Care Drugs Other Acute Payments to MCOs Nursing Facilities Mental Health Home Care Payments to Medicare DSH Payments Acute Care 59% Long-Term Care 36% 14% 11% 6% 7% 18% 3% 16% 5% 15% 6%

14. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 13 Medicaid Per Capita Expenditures for Nonelderly, 2005 AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA TX IL FL AL $2,000-$3,500 (17 states) $5,500 + (6 states including DC) $3,501-$4,500 (20 states) $4,501-$5,500 (7 states) U.S. Average = $3,621 SOURCE: KCMU and Urban Institute estimates based on data from MSIS 2005.

15. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 14 Poor Near-Poor (<100% Poverty) (100-199% Poverty) Poor Near-Poor Poor Near-Poor Children Parents Adults without Children Medicaid also includes SCHIP and other state programs, Medicare and military-related coverage. SOURCE: KCMU and Urban Institute analysis of March 2008 CPS. Health Insurance Coverage of Low-Income Adults and Children, 2007

16. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 15 Access Problems by Insurance Status Percent Reporting: Adults Children No Usual Source of Care Needed Care but Did Not Get It SOURCE: KCMU analysis of 2007 NHIS data and Summary of Health Statistics for U.S. Children: NHIS, 2006. Children

17. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 16 Childrens Eligibility for Medicaid/SCHIP by Income, January 2008 AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA *The Federal Poverty Level (FPL) for a family of four in 2008 is $21,200 per year. **IL and NY use state funds to cover children above 200% FPL. TX IL FL AL 185-199% FPL (9 states) 251-350% FPL (11 states including DC) 200% FPL (23 states) 201-250% FPL (8 states) U.S. Median Eligibility = 200% FPL SOURCE: Survey by the Center on Budget and Policy Priorities for KCMU, 2008.

18. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 17 Medicaid Eligibility for Working Parents by Income, January 2008 AZ AR MS LA WA MN ND WY ID UT CO OR NV CA MT IA WI MI NE SD ME MOKS OH IN NY IL KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA *The Federal Poverty Level (FPL) for a family of four in 2008 is $21,200 per year. SOURCE: Survey by the Center on Budget and Policy Priorities for KCMU, 2008. TX IL FL AL 50- 99% FPL (21 states) 20-49% FPL (13 states) 100-150% FPL (8 states) US Median Eligibility = 63% FPL 151-275% FPL (9 states including DC)

19. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 18 The Low-Income Challenge for Health Reform Total = 45.0 million uninsured *200% of the Federal Poverty Level (FPL) for a family of four in 2008 is $42,400 per year. SOURCE: KCMU/Urban Institute analysis of March 2008 CPS. Other Adults <200% FPL 200-299% FPL 9% 4% 3% 11% 4% 3% 300% FPL +