1. Wisconsin’s Challenges in Health Care Access and Cost: A Look at the Numbers March 22, 2006 Donna Friedsam, MPH Associate Director for Health Policy University of Wisconsin Population Health Institute

2. The rich THE U.S. HEALTH INSURANCE SYSTEM The poor The near poor The broad middle class The Young Working- age people People age 65 and over The 40 million or so uninsured tend to be near poor The federal-state Medicaid program for certain of the poor, the blind and the disabled The employed and their families who are typically covered through their jobs, although many small employers do not provide coverage. For the rich, broad, unrestricted policies without rationing of any sort (Boutique medicine) Near poor children may be temporarily covered by Medicaid and S-Chip, although 7-10 million are still uninsured. Persons over age 65, who are covered by the federal Medicare program, but not for drugs or long-term care. Often the elderly have private supplemental MediGap insurance The very poor elderly are also covered by Medicaid

3. Health Insurance Coverage - Wisconsin  Employer-Sponsored: 65% (Adults <65: 75%)  Other private: 4%  Medicaid only: 7%(Any Medicaid: 9%)  Any Medicare: 14%  Other Types: 4%  No Insurance at a given point-in-time: 6% *****************************************  Adults > 65: 94% Medicare; 7% Medicaid  Medicaid: 9% of Wisconsin households  Medicaid coverage 19% of Wisconsin children

4. Medicare Spending

7. State Role in Health Care  Purchasers  Medicaid, HIRSP, other safety net programs  Employer  Dept. of Employee Trust Funds  $800 million annual health care expenditures  Policymakers  Regulate insurance market  Rules of pricing and competition

8. High Cost Burden on Employers Employers now spend on average about 15% of payroll – For insuring employers, close to 16% – Cost rising 10-25% per year – Adverse economic effects on Wisconsin – on wages, profits, job creation, new investment – Source: Wisconsin Health Project

9. Wisconsin’s Current Health Care Fiscal Pressures  Ongoing Medicaid deficits  Double-digit insurance cost increases  Employers dropping or limiting coverage  Increasing numbers of uninsured  Increasing under-insured  Dramatic enrollment increases for MA, BadgerCare, HIRSP

10. Safety Net Programs  19% of Wisconsin children have Medicaid coverage  9% of Wisconsin household residents have Medicaid coverage, including BadgerCare, Healthy Start, and other forms of Medical Assistance  Enrollment in the Wisconsin’s Health Insurance Risk Sharing Pool (HIRSP) has grown from 7,257 in FY 2000 to 18,820 in February 2000.

11. Who is Uninsured in Wisconsin?  545,000 residents (11%) of population for all or part of 2004  At any given point in time, 7% of Wisconsin’s residents (377,000) are uninsured.  91,000 Wisconsin children uninsured for all or part of 2004 Source: Wisconsin Family Health Survey, 2004, Wisconsin Department of Health & Family Services

12. Most Uninsured Adults are Employed

13. Medicaid Eligibility 0% 50% 185% 100% 200% 150% September 2001 Federal Poverty Level Eligibility Groups 250% 53% 93% 250% BadgerCare & Family Medicaid Caretaker Relatives in Family Medicaid Adults on SSI or SSI-related Medicaid Purchase Plan (MAPP) 200% (No Asset Test) ($2,000 Asset Limit)($15,000 Asset Limit) Parents & Children < 19 Caretakers who are not parents Elderly, Blind & Disabled Adults Working Disabled Adults Adults who are not: Elderly Disabled Caretaker Relatives 210% Long Term Care Medicaid ($2,000 Asset Limit) Persons in a a long term care institution or participating in a community waivers program

14. Medicaid & Badgercare Enrollment Trend

15. Trends in MA/BC Expenditures

16. Medicaid Expenditures  Elderly and disabled account for 28% of Medicaid enrollment, and account for more than 70% of the Medicaid expenditures.  Low income families and others represent 72% of enrollees and account for 28% of expenditures.

17. Medicaid Average Annual Cost per Person  Elderly: $21,724  Disabled: $11,956  Low-income family members: $ 2,107

18. Where are the Costs?

22. 25% of Population Accounts for 80% of Spending

23. Health Care Resource Consumption

24. 15 Health Conditions Drive Cost Inflation  Increased treatment prevalence or population growth  Increase in cost of treating these conditions  Top five conditions account for 31% of increase in spending between 1987-2000.  Obesity accounts for 27% of growth in spending, with associated increased spending in heart disease (41%), diabetes (38%), hyperlipidemia (22%). Source: Thorpe, KE and colleagues, Health Affairs, 2004

25. Increasing Cost per Treated Case  In 8 of top 15 conditions, increase cost per Tx, rather than rising numbers of cases, accounted for most increase spending.  More expensive and effective drugs and technologies accounted for nearly 70% of increase spending for CHD 1987-2000.  Rise in hypertension Tx cost accounted for 60% of the overall growth in spending.

26. Emergency Dept. Utilization  Urgent visits increased by 8%.  ER is the highest cost point of entry to care.  In Wisconsin, the number of non-urgent ER visits in 2000 increased by 17% from 1997.

27. Concerns of WI Residents  Health care now tied with taxes as subject of greatest concern: 17%  Unemployment & jobs: 16% Source: WI Policy Research Institute October 2004

29. What issues should be given the most attention by state government?  35%: “Controlling health care and prescription drug costs”  17%: improving the state’s economy”  15% “improving public education”  12%: “reforming the tax system”  11%: “placing limits on WI government agencies”  7%: “security from terrorist attacks”  3%: other or not sure Source: WI Policy Research Institute, October 2004

30. Contact Information Donna Friedsam Associate Director for Health Policy UW Population Health Institute V 608.263.4881 Email dafriedsam@wisc.edudafriedsam@wisc.edu http://www.pophealth.wisc.edu/wphi