1. A QUESTION OF ACCESS

2. WHAT ACCESS MEANS IN THE UNITED STATES

3. ACCESS IS RESTRICTED TO THOSE WHO HAVE HEALTH INSURANCE THROUGH THEIR EMPLOYERS THOSE COVERED UNDER A GOVERNMENT HEALTH CARE PROGRAM.

4. THOSE WHO CAN AFFORD TO BUY INSURANCE OUT OF THEIR OWN PRIVATE FUNDS, AND THOSE WHO ARE ABLE TO PAY FOR SERVICES PRIVATELY.

5. Some Statistics about access

6. Health Insurance Coverage in the U.S., 2006 NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, SCHIP, other state programs, and military-related coverage. Those enrolled in both Medicare and Medicaid (1.8% of total population) are shown as Medicare beneficiaries. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS. Total = 296.1 million

7. IL Uninsured Rates Among the Nonelderly, by State, 2005-2006 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 KY TN NC NH MA VT PA VA WV CT NJ DE MD RI HI DC AK SC NM OK GA SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute analysis of the March 2006 and 2007 Current Population Survey. Two-year pooled estimates for states and the US (2005-2006). TX FL AL 13-17% (18 states & DC) 18%-20% (9 states) < 13% (13 states) US Average = 18% NE >20% (10 states)

8. Children’s Access to Care, by Health Insurance Status, 2006 NOTE: MD contact includes MD or any health care professional, including time spent in a hospital. Data is for all children under age 18, except for dental visit and unmet dental need, which are for children age 2-17. Respondents who said usual source of care was the emergency room were included among those not having a usual source of care. All estimates are age-adjusted. SOURCE: Kaiser Commission on Medicaid and the Uninsured analysis of National Center for Health Statistics, CDC. 2007. Summary of Health Statistics for U.S. Children: NHIS, 2006.

9. Characteristics of the Uninsured, 2006 Family Income Family Work Status Total = 46.5 million uninsured 1 or More Full- Time Workers 71% No Workers 18% Part-Time Workers 11% Age 55-64 9% 35-54 32% 19-34 39% 0-18 20% The federal poverty level was $20,614 for a family of four in 2006. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

10. Health Insurance Coverage of the Nonelderly by Poverty Level, 2006 NOTE: The federal poverty level (FPL) was $20,614 for a family of four in 2006. Data may not total 100% due to rounding. Nonelderly defined as age 0-64. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

11. The Nonelderly Uninsured, by Age and Income Groups, 2006 Total = 46.5 million uninsured Low-income includes those with family incomes less than 200% of the federal poverty level. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

12. Number of Nonelderly Uninsured Americans, 2004 - 2006 Uninsured in Millions SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March CPS for each year. 43.0 44.4 46.5

13. Uninsured Nonelderly vs. All Nonelderly, by Race and Ethnicity, 2006 NOTES: American Indian category includes Aleutian Eskimos. Data may not total 100% due to rounding. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS. Black Multiracial (1%) White Hispanic Am. Indian (1%) Asian 2% 1% 46.5 Million260.0 Million

14. Health Insurance Coverage of Nonelderly Adults, 2006 181.8 Million Nonelderly Adults SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

15. Adults' Health Insurance Coverage by Household Type, 2006 13.1 M 59.3 M 53.7 M 19.6 M 28.9 M Number 7.2 M Married, no children Other with children 2 parents with children 1 parent with children Adults, living together Adults, living alone NOTES: Other households with children include families with at least three generations in a household, plus families in which adults are caring for children other than their own (e.g., a niece living with her aunt). Adults includes all individuals aged 19 to 64. Data may not total 100% due to rounding. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

16. Access to Employer-Based Coverage by Family Income, 2005 NOTE: The Federal Poverty Level (FPL) was $16,090 for a family of three in 2005. SOURCE: Garrett B. and L. Clemens-Cope. Changes in Employer-Sponsored Health Insurance Coverage: 2001-2005. Kaiser Commission on Medicaid and the Uninsured report #7599, Dec. 2006 (Family Income <100% FPL) (Family Income 400%+ FPL)

17. FLORIDA’S UNINSURED

18. FLORIDA HAS THE 3 rd LARGEST UNINSURED POULATION IN THE NATION

19. 17.8 % OF FLORIDA’S NON-ELDERLY POPULATION DOES NOT HAVE HEALTH INSURANCE COVERAGE

20. IN 2008, 18.8% OF FLORIDA’S CHILDREN WERE UNINSURED

21. 43% OF FLORIDIANS AGES 21-24 DO NOT HAVE HEALTH INSURANCE

22. ETHNIC GROUPS WITHOUT HEALTH INSURANCE HISPANIC – 32% BLACKS – 31% WHITES – 19%

23. EARLY RETIREES ARE A RAPIDLY GROWING GROUP OF UNINSURED FLORIDIANS. FEWER EMPLOYERS ARE PROVIDING HEALTH BENEFITS FOR EARLY RETIREES.

24. 75% OF FLORIDA’S UNINSURED ARE EMPLOYED.

25. THE VAST MAJORITY OF EMPLOYERS ARE SMALL AND ARE LESS LIKELY TO PROVIDE HEALTH CARE INSURANCE.

26. WHY ARE PEOPLE LOSING HEALTH CARE INSURANCE?

27. WHEN HEALTH CARE COSTS RISE FASTER THAN WAGES THERE IS A DECREASE IN INSURANCE COVERAGE. LOW INCOME WORKERS CANNOT AFFORD TO BUY HEALTH CARE INSURANCE.

28. COST OF HEALTH INSURANCE PREMIUMS IS THE PRIMARY REASON PEOPLE DO NOT HAVE HEALTH INSURANCE COVERAGE. BECAUSE OF COST INCREASES, EMPLOYERS ARE SHIFTING MORE OF THE COST OF COVERAGE TO EMPLOYEES.

29. WHEN PREMIUM COSTS RISE, EMPLOYERS OF ALL SIZES ARE LIKELY TO SWITCH FROM CONVENTIONAL COVERAGE TO MANAGED CARE PLANS, RESTRICT HEALTH PLAN ELIGIBILITY (NO COVERAGE FOR PART-TIME OR TEMPORARY WORKERS), AND INCREASE COST- SHARING REQUIREMENTS.

30. SOME EMPLOYERS ARE ELIMINATING COVERAGE FOR DEPENDENTS OR SHIFTING THE ENTIRE COST TO THE EMPLOYEE.

31. MORE EMPLOYERS USE CONTRACT OR PART-TIME EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE.

32. WELFARE REFORM IS MOVING PEOPLE OFF WELFARE AND INTO JOBS. IN MANY CASES, THEY TEND TO MAKE TOO MUCH INCOME TO QUALIFY FOR MEDICARE. THE JOBS THEY TAKE DON’T ALWAYS OFFER INSURANCE.

33. IMPLICATIONS OF BEING UNINSURED

34. MOST PEOPLE WHO LACK HEALTH CARE COVERAGE RECEIVE LITTLE OR NO PREVENTATIVE CARE. THEY ARE LESS LIKELY TO FILL A PRESCRIPTION OR RETURN FOR FOLLOW UP CARE.

35. THE EMERGENCY ROOM BECOMES THE SOURCE OF PRIMARY CARE

36. HEALTH CONDITIONS THAT GO UNMANAGED CAN RESULT IN SERIOUS CONDITIONS REQUIRING HOSPITALIZATION.

37. EMERGENCY ROOM CARE REPRESENTS 7% OF ALL PATIENTS ADMITTED TO FLORIDA HOSPITALS.

38. IMPLICATIONS FOR THE FUTURE

39. THE 1998 STATE LEGISLATURE PASSED THE “FLORIDA KID CARE PROGRAM” ENROLLING THEM REMAINS A CHALLENGE.

40. INCREASES IN HEALTH INSURANCE COSTS WILL RESULT IN MORE PEOPLE BEING UNABLE TO AFFORD COVERAGE.

41. HOSPITALS, FACING LOWER PAYMENTS FROM MEDICARE, MEDICAID AND MANAGED CARE COMPANIES, WILL STRUGGLE TO ABSORB THE COST OF CARING FOR THE UNINSURED.

42. PROGRAMS FOCUSING ON PRIMARY AND PREVENTATIVE CARE FOR THE UNINSURED POPULATIONS WILL BE THE KEY TO MANAGING THE COST OF CARING FOR THESE PATIENTS.

43. TAX INCENTIVES TO ENCOURAGE INDIVIDUALS WILL RESULT IN MORE AFFORDABLE COVERAGE. SPECIAL FUNDING MUST BE AVAILABLE TO THE “SAFETY NET” HOSPITALS, I.E., THOSE HOSPITALS WHO SERVE A DISPROPORTIONATE AMOUNT OF UNINSURED PATIENTS.

44. Key Points to Remember Most of the uninsured either work or come from a working family. There is a higher incidence of un- insurance in the low-income, younger adults, and minority populations. Most of the uninsured are U.S. citizens

45. Loss of health care delivery capacity Less effective control of communicable diseases. Losses to the community’s economic base.

46. Being uninsured effects the emotional health of individuals and families by: Creating a fear of being denied health care or being bankrupt by illness Forcing individuals to choose which medical services to utilize.

47. Internal Costs to individuals, families, and business firms Greater morbidity and premature mortality Developmental losses for children Family financial uncertainty and stress, depletion of assets.

48. Lost income or uninsured breadwinner in ill health. Workplace productivity losses (absenteeism, reduced efficiency on the job) Diminished sense of social equality and self-respect.

49. End of Lecture for August 27 th 2012, 6 th Period Questions? Discussion?