Health Insurance for Utah Children and Small Businesses

1. Expanding Health Insurance Coverage for Utah’s Uninsured Citizens Health Insurance for Utah Children and Small Businesses November 15, 2006

2. What is our focus and why? • Nearly 300,000 Utahns are uninsured • This is a problem • A. Most of the cost of uncompensated care is being passed on to Utah’s businesses that provide health benefits to their employees • B. Uninsured people get less effective and more expensive health care • Over 70,000 of the uninsured are children (0-18) • Over 100,000 of the uninsured work for small businesses • Our two primary goals: • Make sure Utah children have health insurance • Make it easier for employees of Utah small businesses to get health insurance

3. Who are the 11.6%? • Currently Uninsured (11.6%) 292,800 By Age: • Children, Under 19 years old (24%) 71,300 • Young Adults, 19 to 34 years old (45%) 132,000 • Adults, 35 years old or older (31%) 91,500 • Note: Figures in these categories do not sum to the total because of missing values on the grouping variable. By Employment Status: • Adults, 19-64 with Full-time jobs (38%) 110,300 • Adults, 19-64 with Part-time jobs (14%) 43,000 • Adults, 19-64 who are Self-employed (16%) 46,700 • Utah’s “Most Likely” Uninsured Person: • White male • Between the ages of 19 and 34 • High school graduate, with no college degree • Full time job • Household income between $20,000 and $45,000

4. Key Factors – The Young Immortals • 70% of the 11% (205,000) are under age 34 • 71% of uninsured adults (157,000) have jobs • 70% of uninsured workers (105,000) work for small business • There are also many uninsured who are dependents of people with jobs • There are around 25,000 uninsured full-time college students • The Young Immortals are the primary group of free riders in the health care system

5. Who are Utah’s Uninsured Children? By poverty level Source: 2005 Health Status Survey Note: 100% FPL = $20,000 a year for a family of four

6. Who are Utah’s Uninsured Children? By Hispanic ethnicity Source: 2005 Health Status Survey Figures in these categories may not sum to the total because of missing values on the grouping variable.

7. Who are Utah’s Uninsured Children? By urban or rural location Source: 2005 Health Status Survey Figures in these categories may not sum to the total because of missing values on the grouping variable.

8. Who are Utah’s Uninsured Children? By full-time worker in the household Source: 2005 Health Status Survey Figures in these categories may not sum to the total because of missing values on the grouping variable.

9. Who are Utah’s Uninsured Children? By length of time uninsured Source: 2005 Health Status Survey Figures in these categories may not sum to the total because of missing values on the grouping variable.

10. Progress to Date • CHIP Expansion and Continuous Open Enrollment – Almost 10,000 more children on CHIP than a year ago • PCN Renewal – Since July 2002, PCN has provided coverage for 48,680 Utahns that wouldn’t have been able to afford it otherwise • HB 156 – Allows previously uninsurable individuals to purchase coverage that excludes non-life-threatening conditions at an affordable rate • Premium Assistance – 2006 Legislature approved funding for a demonstration premium assistance program for around 1,000 Utahns. Our HIFA waiver application was approved in October, 2006, creating the Utah Premium Partnership for Health Insurance (UPP).

11. Moving Forward – The Governor’s Proposal FIRST STEPS: • Insure Utah’s Children • Use Private Market Solutions – The Utah Premium Partnership for Health Insurance (UPP) • Help Small Business

12. Insuring Utah’s Children Utah’s Uninsured Children – All children living in the State of Utah should have health insurance. ParentalResponsibility Parental Responsibility – Parents should be responsible to pay for their children’s needed health care. Should werequire that parents provide evidence of ability to pay, either through insurance or some other way? Uninsured Children

13. 27,800 Household income less than 100% of FPL* They are eligible for Medicaid but haven’t signed up yet. They should be enrolled in Medicaid. How Utah Will Cover Its Uninsured Children Parental Responsibility – All parents can provide health insurance for their children. 18,900 Household income greater than 200% of FPL* Must buy private insurance without financial help. 24,600 Household income between 100% and 200% of FPL* Meet income guidelines for CHIP. Qualify for the UPP subsidy for private policies. Total uninsured children71,300 *”FPL” is the Federal Poverty Level, currently $20,000 per year for a family of four.

14. Private Market Solutions UPP – Our current HIFA waiver created Utah’s Premium Partnership for Health Insurance (UPP) that allows families to use state and federal funds to purchase private health insurance for qualifying children, adults, and possibly their families.

15. Helping Small Business • An Insurance “Exchange” – A clearinghouse that facilitates individual and small businesspurchase of health insurance. • Tax free premium payments • Employers control their costs • Portable and flexible health plans for employees The Insurance Exchange

16. Overall Marginal Tax Rates (Example: One parent with two children, Wisconsin state information)

17. Choice of Private Health Plan Working Families Pre-tax Premiums Employers Defined contribution(pre-tax) UPP Subsidy for qualifying families Insuring Individuals and Employees of Small Business Utah Insurance Exchange • The Utah Insurance Exchange is a clearinghouse for private health plans. • Employers offer a pre-tax health plan to all employees • Allows employers to use a defined contribution system • Working families choose plans to meet their needs • Health insurance premiums are tax free • Health insurance becomes portable and flexible Private Health Plans

18. Putting it All TogetherUtah’s Plan to Expand Health Insurance Coverage for the Uninsured Parental Responsibility Insuring Utah’s Uninsured Citizens The Insurance Exchange Uninsured Children