Introduction to State Health Policy: A Seminar for New State Legislators

Slide Presentation by Kenneth E. Thorpe, Ph.D.

On April 2, 2005, Kenneth E. Thorpe made a presentation in a seminar entitled Introduction to State Health Policy.

This is the text version of Dr. Thorpe's slide presentation. Select to access the PowerPoint® Slides (80 KB).

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

The Emory University logo appears in the lower corner.

Slide 1

Issues

• Who are the uninsured?
• Who pays for care received by the uninsured?
• Access to care among the uninsured.
• Options for covering the uninsured.

Slide 2

Who Are the Uninsured?

Estimated Number of Non-elderly People Without Health Insurance in 2003, millions

On a bar graph, the x-axis lists different time periods for measuring the uninsured and the y-axis represents the numbers of non-elderly people without health insurance in 2003 as estimated, to the nearest hundred thousand, by three different surveys.

• The Survey of Income and Program Participation gives 21.1 million uninsured for the entire year, 40.5 million uninsured at a specific point in the year, and 56.8 uninsured at any time during the year.
• The Medical Expenditure Panel Survey gives 31 million uninsured for the entire year, 42.6 million uninsured at a specific point in the year, and 59 uninsured at any time during the year.
• The Current Population Survey gives 45 million uninsured at a specific point in the year.

Slide 3

Uninsured by Age: 45 Million in 2003; Most are Young Adults

A pie chart indicates that 59 percent of the uninsured in 2003 were between the ages of 18 and 44, 22.40 percent were 45 or over, and 18.60 percent were 17 or under.

Slide 4

Most Uninsured Children Are Eligible for Medicaid or SCHIP Today

A pie chart indicates that 5.2 million uninsured children are eligible for Medicaid, 1.9 million are eligible for SCHIP, and 2.2 million are not eligible for either program. The caption reads: Total Uninsured Children 0 to 18 equals 9.3 million.

Slide 5

Most Uninsured Adults Work During the Year in Small Firms

At the left is a bar chart. The y-axis gives the number of uninsured adults in millions. The x-axis shows the number who worked and didn't work during the year. The bars show 20.6 for Work during Year and the number 9.7 for Didn't Work.

At the right, a pie chart titled Firm Size of Employer presents the percent of working uninsured adults by the size of the firm where they work. The chart indicates that 50 percent of uninsured adults work in firms with fewer than 25 employees, 13.60 percent work in firms with 25 to 99 employees, 13.80 percent work in firms with 100 to 999 employees, and 22.60 percent work in firms with 1,000 or more employees.

Slide 6

Who Pays for the Health Care Received by the Uninsured?

• Estimated Uncompensated Care in 2005 equals 44 billion dollars
• Sources of Funding
  • Federal Government
    • Medicaid DSH: 8.5 Billion dollars.
    • Medicare DSH: 8.0 Billion dollars.
  • State and Local
    • Tax Levy Support: 10 Billion dollars.
• Residual equals Unsponsored: 17.5 Billion dollars.

Slide 7

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.

Slide 8

Options for Covering the Uninsured

2. Medicaid and SCHIP Options
   • Enroll currently eligible children.
   • Expand Medicaid to parents and childless adults.
   • HIFA and 1115 Waivers.

Slide 9

Options for Covering the Uninsured

3. Mandated slash Comprehensive Returns
   • Pay or play approach, California.
   • Mandate health plans include young adults to age 25 or 26 on parents policy.
   • Require all college students to have coverage.
   • Require vendors to have health insurance as conditions of receiving State contract.

Current as of October 2005

Internet Citation:

What Can States Do About the Uninsured? Text version of a slide presentation at Introduction to State Health Policy: A Seminar for New State Legislators. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/statepolicy/thorpetxt.htm

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