1. Mary R. Grealy President Healthcare Leadership Council www.hlc.org December 11, 2007 Finding Health Insurance: The Ins, The Outs and Lessons for Policymakers National Congress on the Un and Underinsured

2. Healthcare Leadership Council Consortium of leaders from all health care sectors Shared vision of a health care system defined by accessibility, affordability, quality and innovation No greater priority than accessible health coverage for all Americans

3. Understanding the Uninsured Is the problem so large as to be insurmountable? Breaking down the 47 million uninsured –11 million eligible for SCHIP, Medicaid, but not enrolled (“uninsured in name only”) –Approximately 18 million have annual incomes of more than $50,000 –Approximately 10 million non- citizens

4. NM The State Coverage Insurance (SCI) is a public/private partnership offers affordable health care coverage to eligible low-income working adults All you have to do is sign up for SCI if you are 200% FPL or lower Employees pay $0-$35 of their monthly premium Employers pay $75 of the employees monthly premium NV The Nevada Health Insurance Flexibility and Accountability (HIFA) waiver The waiver provides up to a $100 per month, per parent (maximum of $200 per family) to help offset costs of the insurance premium payment (must be employed with an eligible employer). Not as easy as just signing up employers have to meet more stringent guidelines to be eligible for the program for example: Employers must pay 50% of their employees’ monthly insurance premiums Employer must sponsor a group health plan Take up rate = 50%Take up rate =.01% Quasi Private Programs Well structured subsidy –Leverage employer, employee and private dollars –Must be coupled with outreach

5. Understanding the Uninsured: Most are in the workplace 80 percent of the uninsured are in wage- earning households –Half are not offered coverage by their employer –Half are offered insurance, but decline either self or family coverage Percentage of premiums covered by employers has stayed stable for years

6. Working and Uninsured: Why? HLC commissioned research by Atlanta-based Schapiro Group –National public opinion survey of target uninsured populations (young adults, families with children, Latino Americans, small business owners) –One-on-one in-depth interviews –Simulation experiment using different stimuli to encourage people to seek coverage info

7. Obstacles to Acquiring Coverage: Preconceptions about cost Research shows that many don’t pursue coverage because they believe they can’t afford it. –66 percent said they cannot afford health coverage, although most couldn’t say how much it cost Previous published research showed this to be true of small businesses also

8. Obstacles to Acquiring Coverage: Lack of Information People generally do not know how to find information on health coverage –54 percent said they did not know a reliable source of information –Among those who said they knew where to look, a majority cited the Internet or friends/family members

9. Obstacles to Acquiring Coverage: Buyer Resistance Interviews show: –The healthy uninsured feel no immediate, compelling need to buy health coverage –Seniors would enroll in Medicare Part D coverage when shown program facts; same is not true of health insurance –Needle does not move without repeated, persuasive contacts

10. Testing the Effectiveness of Outreach: Health Access America A campaign seeking answers to key questions: –Can we significantly reduce the uninsured rolls, using existing resources? –Can a targeted education/enrollment initiative reach and convince uninsured Americans? –What are the most effective strategies for overcoming obstacles to coverage?

11. The Health Access America Concept Launch a campaign dedicated to health coverage education and enrollment –Build broad-based outreach coalitions –Conduct information and enrollment activities –Use local events to bring greater visibility to the issue of the uninsured –Offer both public and private alternatives

12. Targeted Populations Small business employers and employees Young adults Children Latino Americans

13. Campaign Activities Grassroots education and enrollment Advocacy and education Earned media Partnership building Research and polling

14. Pilot Sites: Las Cruces, NM Raleigh, NC The HAA Target Sites

15. Criteria for Target Communities High uninsurance rate Growing number of uninsured Affordable insurance products available Key partner groups on-board Geographic diversity

17. Effective Health Coverage Outreach: Important Lessons Learned Building strong grassroots partner networks is critical –Establish credibility –Built-in means to drive people to events Leverage events and activities already taking place Create one-on-one interaction between attendees and coverage experts

18. Effective Health Coverage Outreach: Important Lessons Learned Utilize media to build credibility, generate attendance, educate public on issue Simplicity is critical – make materials, website clearly understandable Engage independent brokers – provide variety of plan options for individuals, small business owners

19. Health Access America: Policy Impact Outreach works! –Despite initial resistance, one of every two people who came in contact with HAA campaign acquired coverage Congress needs to follow through on legislative initiatives to invest dollars in outreach activities Emphasizing both public and private options enables outreach to more uninsured Communities can emulate effective approaches A well-structured subsidy works