1. What Can States Do About the Uninsured? Kenneth E. Thorpe, Ph.D. Robert W. Woodruff Professor and Chair Department of Health Policy and Management Rollins School of Public Health Emory University

2. Thorpe # 2 Issues 1.Who are the uninsured? 2.Who pays for care received by the uninsured? 3.Access to care among the uninsured 4.Options for covering the uninsured

3. Thorpe # 3 Who are the Uninsured?

4. Thorpe # 4 Uninsured by Age: 45 Million in 2003; Most are Young Adults

5. Thorpe # 5 Most Uninsured Children Are Eligible for Medicaid or SCHIP Today

6. Thorpe # 6 Most Uninsured Adults Work During the Year in Small Firms

7. Thorpe # 7 Who Pays for the Health Care Received by the Uninsured? Estimated Uncompensated Care in 2005 =$44 Billion SOURCES OF FUNDING Federal Government  Medicaid DSH $8.5 Billion  Medicare DSH $8.0 Billion State and Local  Tax Levy Support $10 Billion RESIDUAL = UNSPONSORED$17.5 Billion

8. Thorpe # 8 Policy Options 1.Reduce Cost of Private Insurance  Stop-loss for small firms using purchasing pools  Pool State employees, Medicaid, and SCHIP to negotiate payments  Health insurance tax credit  Allow “no-mandate” insurance policies for small employers

9. Thorpe # 9 Options for Covering the Uninsured 2.Medicaid/SCHIP Options  Enroll currently eligible children  Expand Medicaid to parents and childless adults  HIFA and 1115 Waivers

10. Thorpe # 10 Options for Covering the Uninsured 3.Mandated/Comprehensive Returns  Pay or play approach (California)  Mandate health plans include young adults to age 25/26 on parents policy  Require all college students to have coverage  Require vendors to have health insurance as conditions of receiving State contract