Transcript Slide 1

Texas and National Health Reform:
Overview and Update Webinar
You must dial in to hear the audio for this
presentation!
Phone number: 1.866.740.1260
Access code: 3200112
1
Texas and National Health Reform:
Overview and Update Webinar
October 6, 2009
Eva DeLuna Castro, Senior Fiscal Analyst, [email protected]
Kymberlie Quong Charles, TVHR Coordinator, [email protected]
Anne Dunkelberg, Associate Director, [email protected]
Stacey Pogue, Senior Policy Analyst, [email protected]
Center for Public Policy Priorities
Phone (512) 320-0222 (X102) – www.cppp.org
www.texasvoiceforhealthreform.org
2
Texas Voice for Health
Reform Principles
1. Affordable access to good health care must be available for all Americans.
It should:
•
•
•
•
Be affordable for people at all income levels
Remain available and affordable when family and economic circumstances change
Establish both a responsibility for the public to contribute and an assurance of cost
containment for individuals and families
Eliminate health costs as the #1 cause of bankruptcy in America.
2. A decent standard of comprehensive care must be established. It should:
•
•
•
Keep people healthy and treat them when they’re ill
Cover the whole person
Not be lost or reduced based on pre-existing conditions or pregnancy
• These first 2 steps will not happen by accident: Americans must
choose to do this and demand it.
3. To be effective, sustainable, equitable, and balanced with our other important
priorities as a nation, national health reform should also address safe and high
quality care; costs and cost-effectiveness of health care; consumer choice; and
eliminating non-financial barriers to care
• Just working on Step 3 will not make Steps 1 or 2 happen.
3
Texas: the Most to Gain
• In 2008, Texas remained the state with the
highest uninsured rate in the nation (24.1%) with
an uninsured population that now tops 6 million
people.
• With so many Texans lacking health security,
Texas has more to gain than other states from
national health reform legislation, which the
Congressional Budget Office projects will cover
94 percent of Americans under age 65.
4
Texas Worst Among the States
U.S. average: 15.1%
Massachusetts:
4.1%
Texas:
24.1%
All Ages, 2008
5
Almost All Congressional Districts Worse than U.S. Average
U.S. average: 15.1% — Texas average: 24.1%
% Uninsured (All
Ages) by U.S.
Congressional
District, 2008
District 26
Inset: Dallas/
Fort Worth
District 3
24
32
District 16
Inset: Houston Area
25
20
15
28
7
27
6
For Children, All Districts are Worse than U.S.
U.S. average: 9.9% — Texas average: 17.8%
% Under 18
Uninsured by U.S.
Congressional
District, 2008
Inset: Dallas/
Fort Worth
District 3
32
District 16
Inset: Houston Area
11
25
20
15
28
27
7
Working-Age Texans Are Most Likely to be Uninsured
Millions of Texans
15
32% uninsured
10
19% uninsured
5
3% uninsured
0
Under 19
19 to 64
Job-based coverage
Medicaid
65 and over
Medicare
Uninsured
Source: CPS Annual Social & Econ. Supplement
8
www.census.gov/hhes/www/hlthins/hlthins.html
Employer-Sponsored Coverage Declining in Texas and
Nationwide, Even Before Recession
% of Residents With
Job-Based Insurance
75
U.S. Average
64.2
63.2
61.9
61
60.5
60.2
59.7
54
53.1
52.2
59.3
58.5
50.4
49.5
2007
2008
60
57.4
56.2
53
53
45
Texas
30
2000
2001
2002
2003
2004
2005
2006
Source: CPS Annual Social & Econ. Supplement
9
www.census.gov/hhes/www/hlthins/hlthins.html
Only the Highest-Income Families Have Better-ThanU.S.-Average Chance of Being Insured
36%
34%
24%
16%
11%
Below $25,000
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 and over
Texas average: 25.1%
42%
35%
29%
12%
Below poverty
100 to 200% of
poverty
200 to 300% of
poverty
Above 300% of
poverty
Source: CPS Annual Social & Econ. Supplement
10
www.census.gov/hhes/www/hlthins/hlthins.html
Uninsured Problem Especially Bad for Young Adults,
46%
Hispanics
Texas average: 25%
37%
36%
30%
23%
22%
19%
15%
12%
3%
Under 19
19 to 24
25 to 44
45 to 64
65+
White
Black
Hispanic
Asian
All Other
Source: CPS Annual Social & Econ. Supplement
11
www.census.gov/hhes/www/hlthins/hlthins.html
Most Uninsured Texans are U.S. Citizens
Uninsured by Citizenship Status, 2007-08 Average
Not a U.S.
Citizen
26%
Naturalized
U.S. Citizen
6%
U.S.-born
citizen
68%
Source: CPS Annual Social & Econ. Supplement
12
www.census.gov/hhes/www/hlthins/hlthins.html
Uninsured Texas
Children (0-18) in
2007-08, By
Family Income
Over 400%
8%
300 to 400% of
poverty
8%
Below 100% of
poverty
31%
200 to 300% of
poverty
20%
Total Uninsured
Children: 1.418
million
100-200% of
poverty
33%
Source: March 2008 and 2009 CPS Annual Social & Econ. Supplement
13
www.census.gov/hhes/www/hlthins/hlthins.html
Worse
IT'S NOT CROWDOUT!!
Since 2003, Texas Kids in Moderate to High Income
Families Saw the Biggest Increases in Number of
Uninsured
29.5%
Better
4.3%
Number of Uninsured
Kids betw een 100200% poverty declined
16.4%
-5.0%
Below 100%
100% to below 200% 200% to below 300%
300% and above
Source: 3-year average data (2002-2004 vs. 2006-2008) for children ages 0-18, Current Population Survey, U.S.
Census Bureau
14
Health Reform
Process
• Three bills drafted: Senate Finance; Senate HELP; House “TriCommittee” (E&C, W&M, Ed & Labor)
–
–
–
Senate Finance: Most influential, least adequate in affordability
HELP: Most adequate affordability, Kennedy Bill
• HELP-Finance merger process will begin as soon as Finance votes.
• Senate Leadership hopes to merge quickly and hold floor vote after Columbus Day. They
still hope to move a package under “regular order,” rather than through the reconciliation
process.
House: 3 committees’ amendments must be merged before a full House vote can happen.
• Leaders pare back the bill’s $1.2 B price tag while trying to preserve key provisions-- e.g.
the subsidy structure.
• Leaders still hope to bring the bill to the House floor in mid-October.
• House-Senate compromise process starts as soon as Chambers vote
their bills.
• If successful, bill could be voted on and signed in November,
December.
• If no deal reached, large portions of (but not all of) reform can/will be
passed through “Budget Reconciliation,” but this is less than ideal,
both politically and from policy standpoint.
–
Budget Reconciliation only requires 51 Senate votes, but limits what you can do.
15
Health Reform
Basics
•
Key elements of all 5 bills:
–
Builds on current system: If you like what you have now, you can keep it.
–
Medicaid expansion (e.g., cover all up to 133% of poverty (FPL): $14,404 for one; $29,327 for 4).
–
Reform Private Health Insurance: standardize benefits, limits on price variation, no denial of
coverage, no excluding pre-existing conditions, no annual or lifetime maximums. Changes
focused on individual and small employer coverage.
–
Create health insurance exchanges where participating private options can be compared
and purchased (like Amazon or Travelocity for insurance).
–
•
Will there be a Public or Non-profit plan option?
•
Exchange is just a framework: depends on subsidies, market reforms, standardized benefits,
individual mandate, and inclusion of most sellers to be effective
Premium assistance up to 300% or 400% of FPL? ($66,150 to $88,200 for family of 4)
•
–
What is maximum % of family income you must spend before getting help?
Out-of-pocket caps, too, to ensure real affordability/end (reduce?) medical bankruptcy
•
Needed at EVERY income level, including folks ABOVE the premium subsidy level.
–
Individual mandate to have coverage: but only if affordable coverage exists!
–
Requirements for employers to contribute, with exemptions for smallest employers;
•
Problematic SF “free rider” idea requires firms to pay for only employees who get premium
assistance; opposed by advocates for low-income Americans because creates disincentive to
hire low-income and single-parent workers.
16
Policy: Some Top
Health Reform
Concerns
• Will premiums and out-of-pocket be affordable for ALL?
– low-and moderate income families need both adequate help
with premiums, and caps on out-of-pocket spending.
– Middle-income and up need affordable, predictable
premiums and out-of-pocket caps.
• Small Business: encouraging employer responsibility without
excessive new costs.
• Children: Maintain comprehensive coverage and out-of-pocket
protections in the transition to reform?
• Public plan is not more important than affordable access for all.
Public plan is one tool to reduce overall coverage costs. But
Germany, the Netherlands and Switzerland all have universal, secure
coverage with no public option.
17
Affordability is Key to
Successful Reform
•
Special considerations:
– Low- and moderate-income populations
– People with high medical costs
– Small employers
•
Components of affordability:
– Premiums (including rate variation, e.g. age rating)
– Out-of-pocket medical costs
– Covered benefits
– Employer contribution
– Exceptions (individual mandate and exchange access with ESI)
•
If reform requires people to buy coverage, coverage must be affordable
at all income levels. If affordability provisions are not done well:
– People may be required to buy coverage they can’t afford or pay
penalties, leaving them unable to pay for other necessities; or
– Bills will have to exempt more people from the coverage requirement,
further reducing universal coverage.
18
Senate Finance Bill is Less Affordable for Low-Income Individuals
In com e
% FPL
S en ate H eath , E d u cation ,
S en ate F in an ce
L ab or, an d P en sion s
(C h airm an ’s m ark revised 9/22)
$ am ount
P rem ium $ (%
M axim um O ut-
P rem ium $ (%
M axim um O ut-of-
(fam ily o f
of incom e)
of-P ocket C osts
of incom e)
P ocket C osts (%
th ree)
(% of incom e)
of incom e)
133%
$ 2 4 ,3 5 2
$ 0 (M e d ic a id )
n /a (M e d ic a id )
$ 9 0 1 (3 .7 % )
$ 3 ,8 6 7 (1 6 % )
150%
$ 2 7 ,4 6 5
$ 2 7 5 (1 % )
$ 2 ,3 2 0 (8 % )
$ 1 ,2 3 6 (4 .5 % )
$ 3 ,8 6 7 (1 4 % )
200%
$ 3 6 ,6 2 0
$ 1 ,2 0 8 (3 .3 % )
$ 2 ,3 2 0 (6 % )
$ 2 ,5 6 3 (7 .0 % )
$ 5 ,8 0 0 (1 6 % )
250%
$ 4 5 ,7 7 5
$ 2 ,5 6 3 (5 .6 % )
$ 5 ,8 0 0 (1 3 % )
$ 4 ,3 4 9 (9 .5 % )
$ 5 ,8 0 0 (1 3 % )
300%
$ 5 4 ,9 3 0
$ 4 ,3 3 9 (7 .9 % )
$ 5 ,8 0 0 (1 1 % )
$ 6 ,5 9 2 (1 2 .0 % )
$ 7 ,7 3 3 (1 4 % )
350%
$ 6 4 ,0 8 5
$ 6 ,5 3 7 (1 0 .2 % )
$ 1 1 ,6 0 0 (1 8 % )
$ 7 ,6 9 0 (1 2 .0 % )
$ 7 ,7 3 3 (1 2 % )
400%
$ 7 3 ,2 4 0
$ 9 ,1 5 5 (1 2 .5 % )
$ 1 1 ,6 0 0 (1 6 % )
$ 8 ,7 8 9 (1 2 .0 % )
$ 7 ,7 3 3 (1 1 % )
In com e
% FPL
$ am ount
(fam ily o f
H ou se E d u cation an d L ab or
H ou se E n ergy an d C om m erce
an d W ays an d M ean s
C om m ittee
om m ittees
P rem ium $C (%
M axim um O utof incom e)
th ree)
of-P ocket C osts
P rem ium $ (%
M axim um O ut-of-
of incom e)
P ocket C osts (%
(% of incom e)
A family just over
150% FPL would
pay much higher
premiums and
OOP costs under
the SFC bill than
the other versions.
of incom e)
133%
$ 2 4 ,3 5 2
$ 3 6 5 (1 .5 % )
$ 9 0 0 (4 % )
$ 3 6 5 (1 .5 % )
$ 9 0 0 (4 % )
150%
$ 2 7 ,4 6 5
$ 8 2 4 (3 % )
$ 1 ,4 5 0 (5 % )
$ 8 2 4 (3 % )
$ 1 ,4 5 0 (5 % )
200%
$ 3 6 ,6 2 0
$ 1 ,8 3 1 (5 % )
$ 4 ,4 0 0 (1 2 % )
$ ,2 0 1 4 (5 .5 % )
$ 4 ,4 0 0 (1 2 % )
250%
$ 4 5 ,7 7 5
$ 3 ,2 0 4 (7 % )
$ 7 ,4 5 0 (1 6 % )
$ 3 ,6 6 2 (8 % )
$ 7 ,4 5 0 (1 6 % )
300%
$ 5 4 ,9 3 0
$ 4 ,9 4 4 (9 % )
$ 8 ,5 2 0 (1 6 % )
$ 5 ,4 9 3 (1 0 % )
$ 8 ,5 2 0 (1 6 % )
350%
$ 6 4 ,0 8 5
$ 6 ,4 0 9 (1 0 % )
$ 8 ,5 2 0 (1 6 % )
$ 7 ,0 4 9 (1 1 % )
$ 8 ,5 2 0 (1 6 % )
400%
$ 7 3 ,2 4 0
$ 8 ,0 5 6 (1 1 % )
$ 1 0 ,0 0 0 (1 4 % )
$ 8 ,7 8 9 (1 2 % )
$ 1 0 ,0 0 0 (1 4 % )
For the most part, bills do not protect against being underinsured (health coverage that does not
adequately protect against high medical expenses). The Commonwealth Fund standard includes out-of- 19
pocket medical expenses exceeding 5% of income for families under 200% FPL and 10% for others.
Reform Help Targeted at
Small Employers
•
All bills protect small employers from new, high costs for coverage by excluding them
from employer coverage mandates
–
–
–
•
Generous tax credits will help small employers offer coverage
–
–
–
•
House bill: fewer than 25 employees & average annual wages under $40K. Credit up to 50%
of the premium cost.
Senate HELP: fewer than 50 employees & average annual wages under $50K. Credit up to
$2,000 per employee
Senate Finance: fewer than 25 employees & average annual wages under $40K. Credit up
50% of the employers contribution.
Penalties for mid-size and large employers who do not offer coverage vary, but are less
than the costs of coverage.
–
•
House bill: exempts employers with annual payrolls less that $500,000 (82% of Texas
businesses)
Senate HELP: exempts employers with 25 or fewer workers (67% of Texas businesses)
Senate Finance: exempts employers with 50 or fewer workers (72% of Texas businesses)
For example, under the House Energy and Commerce Committee bill, a business with 30 fulltime employees and a payroll of $750,000 could either provide health insurance at a cost of
around $108,000 a year (to cover 75 percent of the premium for employee-only coverage) or
pay an assessment of $60,000 (8 percent of payroll). Under the Senate HELP bill, that same
business would face a penalty of just $3,750, but would also qualify for tax credits if it provides
coverage.
Standards for mid-size and large employer contributions toward coverage (60-72.5% of
premiums) will help ensure affordability for employees.
20
Reform will Reduce Rate Variation
for Small Employers
Average and Maximum Rates Being Paid by Texas Small Employers
(2006 market average for businesses with 2-50 employees)
Average Annual PerWorker Premium
MAXIMUM Annual PerWorker Premium
$3,851
$22,413
•
Small employer premiums in Texas today can vary by a factor of 26:1 –
greater variation than most states.
•
Rating factors used today that will be prohibited by reform: health status;
gender; industry type; number of employees.
•
In the exchange, rates will vary only by geography (reflects regional
differences in medical costs) and age (also tobacco use in SFC bill).
•
Senate Finance allows 4:1 variation for age; Senate HELP and House have
a much better 2:1 limit.
H ouse T ri-C om m
A ge
Senate H E L P
Senate F inance
annual prem ium (% of incom e at annual prem ium (% of incom e at annual prem ium (% of incom e at
401% FP L for individual)
401% FP L for individual)
401% FP L for individual)
24
$2,730 (6.3% )
$3,042 (7% )
$2,153 (5% )
64
$5,460 (12.6% )
$6,084 (14% )
$8,614 (19.8% )
21
Health Care: Family Budget Wild Card
Unlike food, shelter, transportation, and education, the cost of needed
health care varies wildly across otherwise similarly situated
families
•
A family with serious chronic condition, illness or injury may need hundreds
of thousands of dollars in care in a year, while one with routine needs may
need only thousands for basic preventive and primary care.
Current public programs:
•
cover too few adults,
•
end coverage abruptly at arbitrary income points (“cliffs”), creating
disincentives for increased earnings
•
Often present major barriers to enrollment by eligible persons
In Private marketplace:
•
No system TODAY to ensure that all can purchase coverage at or near the
average cost; thus average costs are meaningless - can even be
misleading
•
No system TODAY to fully address (in a progressive manner) the mismatch
between AVERAGE costs of family coverage ($13,000-$14,000 a year) and
median family incomes: e.g., ~$47,000 overall, $64,000 family of 4
22
Health Reform and Family Self-Sufficiency:
Bootstraps Out of Poverty
Social Security, Medicare, SSI, and Medicaid coverage of longterm care (70% of U.S. nursing home residents) have made
it possible for the generations since their creation to develop
assets for home ownership, higher education, and general
economic advancement.
Without these programs, income and assets would have been
devoted to the care of parents.
A progressively financed system of affordable comprehensive
care for every income level will have a similar effect on
enabling many more families in poverty to reach and hold
middle-class income and assets.
Also: Child well-being is directly improved when parents have
access to physical and behavioral health care they need.
23
Benefits of Health Reform
• Every Texan will have new health security. You cannot lose, be denied, or
priced out of coverage no matter your age, health status, or employment
status.
• Annual caps on out-of-pocket costs and no annual/lifetime benefit limits
mean critical financial protection at all income levels that does not exist
today.
• About 4.5 million Texans would gain coverage
– About 1 million uninsured Texan adults would get Medicaid—up to 133% FPL
– About 2.3 million uninsured Texans would get premium assistance--above
Medicaid and below 400% of poverty ($88,200 for family of 4)
• Small businesses and individuals can pay what large businesses do for
health insurance. Under Texas law today, small employers pay an average
high premium of $22,000 a year for a single worker.
• Depending on wages they pay, businesses with fewer than 25 employees
(67% of Texas businesses) can get tax credits to cover up to ½ the cost of
coverage.
24
Cost of Health Reform
•
•
Medicaid expansion—up to 133% FPL.
–
CPPP conservatively estimates Medicaid expansion (1 million adults at current costs) will add
$3.9 billion a year in new federal dollars to the Texas economy ($3.5 billion if 90% federal
share); with a multiplier effect of $10 to $13 billion a year, and
–
Could convert Texas from being a “donor state” that sends more to DC in taxes than we get
back by covering low-income adults in Medicaid.
–
What share will Texas have to pay for required Medicaid expansions & increased Medicaid
provider payment rates?
• 100% federally funded in House proposal; E&C amends to 90% from year 3 onward
• Senate Finance uses a more complicated formula with a similar effect (i.e., ~ <10% state share)
• 10% state share would mean $391 million state cost to pull down $3.5 billion federal funds, a
one-year net gain of $3.1 billion to the state economy.
Premium subsidies—up to 400% FPL
–
•
even more funding will flow to Texas from premium assistance to low-to-moderate income
families (Estimates likely available once House and Senate settle on bills).
Goal is to make the final bill 100% paid for (combo of cuts/savings and new
revenues); if “pay-fors” are cut, expect to see loss of affordability and/or health
benefits!
25
Recent Quotes
by Sen. Cornyn
On Sept.22nd, Senator Cornyn cited preliminary estimates of the impact of the Senate Finance
health reform bill, produced by the Texas Health & Human Services Commission (HHSC).
• The Senator stated that Texas Medicaid program costs would increase by “$20.4 billion over
10 years” and said that 2.5 million more Texans would end up “on a government plan.”
• HHSC’s model is generally reasonable, though:
– Some questionable key assumptions do result in dramatically higher numbers.
– The way their numbers were quoted inflates the costs and disregards the benefits.
Big Picture:
• Gain in federal funding is 6 times more than cost to the state: Net increase in federal
funding of $124 billion compared to state investment of $20.4 billion.
Numbers are Still In Flux:
• Range of estimates between CBO, Senate Finance, National Governors Association, and
Texas HHSC suggests that we need to look more deeply into all the projections, and not rely
too heavily on these preliminary efforts.
– SF predicts an increase in state-dollar layout from 2010 to 2019 (different period from HHSC’s model)
of $2.9 billion, or a 2.8% increase above the baseline without reform.
– CBO projects total net increase in Medicaid and CHIP 2010-2019 of 11 million nationwide;
– HHSC’s projected net increase of 1.7 million Medicaid, plus 768,000 in CHIP would mean Texans
would make up an unlikely 23% of CBO’s assumed total national enrollment growth in Medicaid and
CHIP (Texans just 13% of nation’s uninsured)
26
More on HHSC’s
Preliminary Estimate
Texas HHSC’s numbers are significantly higher than CBO, SF because:
•
•
Texas HHSC assumes very high percentage of eligible Texans (94%, vs. current 78%)
will enroll in Medicaid, and
Texas HHSC projects costs for 10 years (instead of the 7 used by CBO);
–
–
thus producing a bigger number primarily due to inflation and population growth.
This means the numbers cannot be compared to any of the CBO, SF, or NGA official
estimates, which are based on 2010-2019.
•
Even at the $20.4 billion figure, the cost of reform would be 8% higher than the cost of
the status quo, to cover 2.5 million more Texans (in a program that covers 2.9 million
Texans today).
•
Our state must pay more to catch up to what other states are already doing, because
we have been stingy historically, not because reform is too costly.
•
Of the $20.4 billion HHSC estimates, about $8.4 billion is due to Medicaid and CHIP
expansion (less than a 4% increase over current Medicaid trend).
•
The remainder is due to:
•
–
removing red-tape barriers and bureaucratic failures that keep eligible children out of Medicaid
today; plus
–
$6 billion if the state takes over paying its share of bonus (DSH) hospital payments that
currently are borne by local hospital districts. These are Texas legislative choices.
Reference to 2.5 million uninsured Texans being added to “government” health care
includes some 768,000 kids who would be covered with private insurance through their
27
parents and the health insurance exchange, but protected by a CHIP “wrap-around.”
Consumer Voices
Are Needed in Health
Reform!
• Having 5 different bills has made educating folks tough
• Supporters of Health Reform must be heard loudly in D.C.
– Texans should not “sit out” health reform
– Don’t let health care vested interests and far right be the only
voices!
– Tell Congress what matters to YOU
• Those who believe real reform is needed should tell our elected
officials and communicate that strong support FIRST, before
your special issues or concerns.
• POSTIVE MESSAGES MUST BE REPEATED OFTEN (not just
corrections to lies)
28
Get Involved with
Texas Voice for
Health Reform
•Join our email list for the latest updates on national health reform
•Follow us on Facebook and Twitter
•Visit www.texasvoiceforhealthreform.org for Fact Sheets, MythBusters, News and
More
•Get your organization involved in organizing for health reform by joining the TVHR
Partner’s Network (email [email protected] to join)
•Communicate with your elected representatives using the tools in our online Citizen
Advocacy Center: calls, letters Congress and newspapers, op-eds needed!
•Educate your community, congregation, friends and family using Texas Voice for
Health Reform Resources
•Contribute to our Story Bank project
www.texasvoiceforhealthreform.org
29
Use of This Presentation
The Center for Public Policy Priorities encourages you to reproduce and distribute these slides, which
were developed for use in making public presentations.
If you reproduce these slides, please give appropriate credit to CPPP.
The data presented here may become outdated.
For the most recent information or to sign up for
our free E-Mail Updates, visit www.cppp.org.
© CPPP
Center for Public Policy Priorities
900 Lydia Street
Austin, TX 78702
P 512/320-0222 F 512/320-0227
30
Additional Materials
31
Senate Finance
Senate H.E.L.P.
House 3-Committee
Medicaid to 133% FPL.
Medicaid to 150% FPL
Medicaid to 133% FPL
Reform Small Group 1-50;
Reform All Coverage
allows 4:1 for age; total premium range
of 7.5:1.
(except large self-insured);
Max range 2:1 for age.
Reform ALL private
insurance: Max range 2:1 for
Health Insurance Exchange:
Health “Gateways”:
•State-based
•Nonprofit coop instead of public option
• state-based
• Public Option
•national
•Public Option
Individual Mandate:
exempt if
lowest premium >8% of income;
income <100% FPL; other “hardship.”
Penalty = $1,500/family at 100-300%
FPL; and $1,900/family > 300% FPL
No penalty under <150% FPL;
penalty = 50% of price of least
expensive qualifying plan for
others; IRS collects.
Penalty of 2% tax on income,
not to exceed average cost of a
basic health plan; hardship
exemptions.
Premium Help: to 400% FPL, cap
Premiums: to 400% FPL,
Premiums: to 400% FPL,
at 12% of income
cap at 12.5% of income
cap at 10% of income
Out-of-Pocket limit: $5,800
OOP limit: X% family
OOP limit:
individual; $11,600 for a family
income (not set yet)
$5,000 individual;
$10,000 for a family
Employer Responsibility: pay fine
Cover, or pay $750/yr per
Cover, or pay 8% of payroll.
only for workers getting premium help
in exchange (exempt under 50
workers)
worker (exempt under 25
workers)
(Some small firms exempt, and
some tax credits for small
businesses)
age.
Health Insurance Exchange:
32
* As of 10/5/09
Uninsured Problem Will Worsen Without Health Reform
Projected Uninsured
Rate (%), 2010
1 3 .4 to 1 7 .8
1 7 .8 to 2 0 .2
2 0 .2 to 2 3 .4
2 3 .4 to 3 9 .0
Texas average:
25.5%
Source: Methodist Healthcare Ministries
www.mhm.org/advocacy/pdf/UninsuredData
ProjectionsJanuary2009.pdf
33
2 Out of 3 Uninsured Working-Age Texans Have a Job
Uninsured by Labor Force Status, 2007-08 Average
Not in Labor
Force
28%
Unemployed
7%
Employed
65%
Source: CPS Annual Social & Econ. Supplement
34
www.census.gov/hhes/www/hlthins/hlthins.html
Reform Basics:
Truth vs. Big Fat Lies
Medicare
•
•
•
•
•
NO CUTS to Medicare benefits
Changes to slow the growth rate of Medicare costs (shores up Medicare’s finances)
Ends subsidies to private health insurance companies that cost 14% more than regular
Medicare
HOUSE Phases out Part D “donut hole.”
No rationing in Medicare based on age, life-expectancy, disability, etc.
End-of-Life-Care Planning (living wills, advance directives)
•
•
•
•
•
NO provisions to encourage euthanasia
Will let doctors get reimbursed (for first time) for discussing end-of-life planning with patients
Planning is completely voluntary
Planning cannot presume the withdrawal of treatment of encourage hastening of death
These provisions may end up removed from reform because of the disinformation campaign
Undocumented Immigrants
•
•
•
Health reform does not include undocumented immigrants
Just like today, they are explicitly excluded from Medicaid or CHIP
They are explicitly excluded from premium subsidies
35