1. The Building Blocks of State Expansions National Congress of the Un- and Underinsured December 11, 2007 Christine Barber, Cheryl Fish-Parcham and Ella Hushagen Community Catalyst and Families USA

2. What’s Driving State Reform? Health reform is shifting to the states:  Increased demand  Increased opportunity  Lack of action from federal government  Increased political understanding and willingness to tackle the issue  The “me too effect”

3. States are tackling tough questions  How to make health coverage affordable?  How to expand access in the private insurance market?  How to incorporate comprehensive benefits?  How to increase accessibility of health care services?  How to fund state expansions?  How to improve quality and reduce long term health spending?

4. Core component #1: Medicaid & SCHIP  Kids to 300% FPL or higher Enacted in CT, MA, MD, NJ, NH, WA; proposed in NY.  All Kids Expansions Enacted in IL, PA, WI; proposed in CA, OR.  Parents to 200% FPL or higher Enacted in AZ, DC, ME, MN, WI.  Childless adults to at least 100% FPL Enacted in HI, MA, ME, MN, NY, OR, VT, MD; proposed in CA.

5. Core component #2: New affordable coverage options  Stack subsidized coverage on top of Medicaid and SCHIP In MA, choice of regulated private plans offered by Medicaid MCOs (community rated, guaranteed issue, standards on covered benefits, no deductibles, limited cost-sharing) In ME, single private plan In VT, standard plan offered by multiple insurers

6. Core component #3: Private market reform  Guaranteed availability of coverage Guaranteed issue in the nongroup market; enacted in MA, ME, NJ, NY, VT, WA Affordable high-risk pool or designated carrier.  Community rating (or modified community rating) in the small and nongroup markets Enacted in small group in CT, ME, MD, MA, NJ, NY, OR, VT, WA. Enacted in nongroup in ME, MA, NJ, NY, OR, VT, WA.  Rate review

7. Core component #3: Private market reform, new tools  Merged small and nongroup markets  Subsidized reinsurance  Require employers to establish pre-tax Section 125 plans  Extended dependent coverage for young adults (to age 25-26)  Connectors

8. Core component #4: Comprehensive benefits  Medicaid & SCHIP Good benefits for currently covered and expansion populations Premium assistance only for qualified private plans  Subsidized coverage Same benefits as Medicaid or SCHIP?  Private market Standardized benefit packages Minimum coverage guidelines

9. Core component #5: Access to Health Services  Improve outreach, enrollment & retention Medicaid and SCHIP New subsidized coverage program  Address provider capacity issues Public programs Rural and other underserved areas  Reduce racial and ethnic health disparities

10. Core component #6: Secure sustainable financing  Increase federal dollars Maximize federal match  Redirect current spending In MA, Uncompensated Care Pool  Generate new dollars “Sin” taxes, provider assessments, etc.  Employer pay-or-play Assessment per employee, or % payroll

11. Core component #7: Cost-containment strategies  Medical loss ratios  Preventive care & medical homes  Medical loss ratios & standardized billing  Certificate of Need  Chronic care management  P4P and Hospital Error Reduction  Rx Reform

12. Thank you! Any questions?  Christine Barber, Community Catalyst www.communitycatalyst.org 617-338-6035  Cheryl Fish-Parcham & Ella Hushagen, Families USA www.familiesusa.org 202-628-3030