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Universal Coverage

Universal Coverage. American Cancer Society/BALCONY Access to Healthcare Forum November 8, 2007. Universal Coverage Initiatives. Picture of Uninsured in New York Executive Budget Achievements Charge to Commissioner and Superintendent Public Hearings/Stakeholder Meetings Modeling

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Universal Coverage

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  1. Universal Coverage American Cancer Society/BALCONY Access to Healthcare Forum November 8, 2007

  2. Universal Coverage Initiatives • Picture of Uninsured in New York • Executive Budget Achievements • Charge to Commissioner and Superintendent • Public Hearings/Stakeholder Meetings • Modeling • Next Steps

  3. Percent with and without CoverageNew York 2005 2.5 million uninsured 16.5 million insured 19 Million New Yorkers

  4. Distribution of Insurance CoverageNew York 2005 Uninsured 2.6 million Directly Purchased .4 million Employer Sponsored 9.3 million Public 7.2 million 19 Million New Yorkers

  5. Distribution of Public Coverage Child Health Plus 400,000 Family Health Plus 500,000 Medicare 2.7 million Medicaid 3.6 million

  6. Percent Uninsured by Family Income Over 300% FPL 22% Less than 100% FPL 36% 201-300%FPL 15% 27% 100-200% FPL 2.5 Million Uninsured

  7. Age Distribution of the Uninsured <19 50+ 16% 16% 19-29 40-49 17% 31% 20% 30-39

  8. 2007 Executive Budget and Session • Child Health Plus Expansion • Streamlining/simplifications • Universal coverage consultant • FHP Buy-in • Managed Care Reform

  9. FHP Buy in Provisions • Allows any employer or Taft-Hartley fund to buy in to FHP, for all employees or members regardless of income eligibility. • Permits State subsidies for employees who are government program eligible if employer: • does not currently offer insurance; or • offers insurance, but their ability to continue to provide coverage is in jeopardy

  10. FHP Buy in Provisions • Requires employer to pay at least 70% of the premium • Requires that coverage be community rated. • Premiums set by DOH • State funding for the employer share subsidies is subject to appropriation • Sunsets home care demonstration program

  11. Managed Care Reform • Payment for pre-authorized services • External review • PPO quality • Cooling off period • Claims submission deadlines

  12. Charge to DOH and SID • Building block approach • Initiatives to get closer to universal coverage • Importance of restructuring delivery system to improve value • Reduce costs • Improve quality • Learn from experience of other states

  13. Public Hearings • Eight public hearings scheduled • Glens Falls September 5, 2007 • Buffalo October 3, 2007 • Conference Call October 10, 2007 • NYC October 30, 2007 November 2, 2007 • Syracuse November 13, 2007 • Rochester November 26, 2007 • LI December 5, 2007

  14. Public Hearings/StakeholderMeetings • Series of questions • Point of hearing is to solicit input • No preconceived notions of what the outcome should be • Experience

  15. Modeling of Proposals • Budget • RFP - July 9, 2007 • Responses due September 14, 2007 • Consultant under contract by year end • Modeling first quarter 2008 • Recommendations for Governor May 2008

  16. 2008/2009 Executive Budget • Potential additional building blocks • Government programs • Expansions? • Streamlining/simplification? • Consolidation of programs • Cost containment • Reimbursement reform

  17. 2008/2009 Executive Budget • Insurance Reforms • Markets? • Individual and small group • Insurer Surpluses, Medical loss ratios, Reserves • Medical malpractice? • Benefits?

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