Idaho State Planning Grant on the Uninsured

1. Idaho State Planning Grant on the Uninsured

2. ISPG • Is one of 31 state planning grants funded by HRSA • Chaired by Idaho Department of Commerce and Saint Alphonsus Regional Medical Center • Grew out of work at Boise Chamber to establish plan for small business membership

3. Charge to ISPG 1. Identify and describe Idaho’s uninsured, 2. Evaluate policy options, and 3. Develop a plan for providing access to insurance for all Idahoans

4. Economics of Uninsured • 8/10 uninsured adults are working or in working families

5. Economics of Uninsured • Small businesses have difficulty in offering employee insurance due to cost • Difficult to be competitive in marketplace, which may retard growth of state economy

6. Economics of Uninsured • In addition, a high percentage of uninsured means that hospitals pay for high proportions of bad debt and charity care • This adds to increasing health costs and rising premiums for all of us • This makes it more difficult for businesses who DO offer insurance to continue to offer it

8. State Economics • Hospitals apply for county indigent funds (from property taxes) • If above $10K, the state catastrophic fund kicks in (from general fund) • These funds pay for expensive acute and emergent care that may have been unnecessary if the patient had had access to more inexpensive primary/preventive care • All indigent funds are unmatched by the federal government

10. State Economics • We do need a safety net and should keep ours • However, indigent/uninsured costs now burden hospitals, counties, the state and all Idahoans • We are all paying for care of the uninsured right now • Therefore, if indigent funds could be matched and partially used to fund insurance, more Idahoans would have access to cheaper primary/preventive care • This would be more efficient use of scarce state dollars

11. Strategic Plan, February 2002 • Public Education (constant and on-going) • Mandated coverage for college students (implemented by State Board of Ed) • Expansion of CHIP to 200% FPL • A public-private insurance partnership for working adults • Expansion of CHIP to parents up to 200% FPL

12. CHIP/Access Card proposal • Idaho CHIP eligibility currently 133% to 150% FPL • ISPG recommending expansion of CHIP to 200% through a new parallel program: • From 150% to 200% FPL, implement a new version of CHIP with some cost sharing and fewer benefits • Parallel to both regular CHIP and pared-down CHIP, implement a premium assistance program (access card) • All CHIP beneficiaries from 133% to 200% would have choice of CHIP or access card

13. Informed Choice

14. More on Access Card • A premium assistance subsidy to purchase commercial insurance • Commercial = ESI or individual policies • Benefit to keeping entire family on one policy • Allows flexibility in benefit designs for commercial products • Only service requirement is immunizations

15. Adult Component • Access card may not work for adults; parallel choice too expensive • ISPG currently looking at voucher program for working uninsured adults without parallel choice • Premium assistance through DHW would be marketed by brokers • Would encourage purchase/maintenance of small group plans • Very small, capped, experimental program to 100% FPL

16. Implementation • Graduated expansion, moving eligibility for child component to 200% FPL over several years • Enrollment capped by eligibility and available funding • E.g., could go to 185% FPL next year but still cap by available state dollars • Adult component important to tack on as soon as possible but would be capped at low level

17. Next Steps • Shape proposal into acceptable and financially viable program to meet needs of Idaho’s uninsured through: • Continued analysis of concept • Continued conversations with state and federal partners • Continued review of other state waivers • Feedback/input gathering from: potential beneficiaries, employers, insurers • Possible legislative action

18. Questions?