Pres westlake2011 apr10_blewett

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  • Exemptions will be granted for financialhardship, religious objections, American Indians, those without coverage for less than three months,undocumented immigrants, incarcerated individuals, those for whom the lowest cost plan optionexceeds 8% of an individual’s income, and those with incomes below the tax filing threshold
  • 32% will face penalty or 6.1 million people….
  • Pres westlake2011 apr10_blewett

    1. 1. Social Health InsuranceUS and Access <br />Lynn A. Blewett, Ph.D.<br />Professor, University of Minnesota <br />Westlake Forum IIIHealthcare Reform in China and the US: Similarities, Differences and ChallengesEmory University, Atlanta, GA <br />April 10-12, 2011<br />Funded by a grant from the Robert Wood Johnson Foundation<br />
    2. 2. Overview of Presentation<br />Definition of social insurance<br />Examples of social insurance in the US<br />Distribution of coverage by insurance type<br />A few points on national health reform<br />Projections of persistent rates of uninsurance<br />Conclusions<br />
    3. 3. Definition of Social Insurance<br />A social insurance scheme is one in which the policy-holder is obliged or encouraged to insure by the intervention of a third party<br />Social Health Insurance (SHI):<br /><ul><li>The costs of ill health are considered a public concern
    4. 4. Society as a whole suffers from the resulting loss of wages, loss of productivity and loss of time
    5. 5. Ill health is viewed as a social concern, not simply a personal problem; obtaining health insurance is mandatory, not a personal choice</li></ul>Source: OECD Glossary of Statistical Terms, 2011<br />
    6. 6. Examples of Social Insurance in the United States<br />Unemployment insurance<br />Social Security<br />Medicare Health Insurance Coverage<br />
    7. 7. Source: SHADAC-Enhanced CPS for 2009. Military Coverage considered ESI. Order of primary coverage assignment: Uninsured, Medicaid,Private Non-Group, ESI, Medicare.<br />
    8. 8. Medicare: Program Design<br />Title 18 Social Security Act - 1965<br />Part A - Entitlement/Compulsory<br />Part B - Supplementary/Voluntary<br /><ul><li>With generous federal general fund subsidy</li></ul>Based on Principal of Social Insurance<br /><ul><li>All employers/employees contribute
    9. 9. Universal coverage for those eligible
    10. 10. Administered by Federal government (CMS)</li></li></ul><li>Eligibility<br />Age 65+<br />Disabled (after a 24-month waiting period)<br /><ul><li>HIV/AIDs </li></ul>Railroad Retirees<br />End Stage Renal Disease (RSRD)<br />Beneficiary or spouse paid into social<br />security for 40 quarters or 10 years of work history <br />
    11. 11. Key Facts: Medicare (2010)<br />2010 Expenditures: $509 Billion<br /># Elderly and disabled: 49 million<br />% of national health care spending: 23%<br />% of federal budget: 12%<br />Average cost per beneficiary: $8,344 <br />For top 10% high cost beneficiaries: $48,211 (FFS)<br />
    12. 12. Financing – 2010<br />HI: Hospital Insurance Trust Fund<br />1.45% payroll tax on employers/employees<br />Deductibles (e.g. $1,100 per hospital stay)<br />Coinsurance (e.g. $275 per day from days 61 to 90 of a hospital stay; $550 per day for days 91-150, all costs over 150 days)<br />SMI: Supplemental Medical Insurance<br />Premiums: $110.50 per month (now income tested )<br />Deductible ($155 year)<br />Coinsurance (20%)<br />General Fund Revenue <br />ACA - increases the payroll tax <br />for higher‐income taxpayers (more than $200,000/individual and $250,000/couple) from 1.45% to 2.35% in 2013<br />
    13. 13. Projected Worker-to-Medicare Beneficiary Ratio<br />
    14. 14. Employer-Sponsored Health Insurance (ESI)<br />Primary source of coverage in US – 60%<br />Voluntary offer and voluntary take up<br />Tax advantages for employer and employee contributions<br />Trend of dropping health care as costs go up<br />The challenge: where do people get coverage if not through their employer?<br />Individual Market Today? Probably not. <br />No pooling, underwriting, and individual risk-rating<br />Makes up about 4% of under-65 coverage<br />
    15. 15. Source: SHADAC-Enhanced CPS for 2000 and 2009. Percentage is for any ESI and includes individuals with other sources of coverage.<br />
    16. 16. Variation in ESI by State<br />
    17. 17. National Reform:Affordable Care Act (ACA)<br />Are there any elements of social insurance?<br /><ul><li>Individual mandate
    18. 18. Employer penalties
    19. 19. Tax credits for small employers to offer coverage
    20. 20. Subsidies to purchase private coverage</li></ul>No social contract or universal coverage commitment<br />
    21. 21. Increasing Rates of Uninsurance<br />15<br />Millions of Uninsured, all ages<br />16.7%<br />of Population<br />Source: U.S. Census Bureau, Current Population Surveys (March), 2000-2009<br />
    22. 22. Universal Coverage for the Poor<br />16<br />Medicaid Expansion 133%<br />Premium Subsidy 400%<br />Federal Poverty Level<br />
    23. 23. Exemptions to the Individual Mandate<br />Financial hardship<br />Religious objections<br />American Indians and Alaska Natives<br />Incarcerated individuals<br />Those for whom the lowest cost plan option exceeds 8% of income<br />Those whose income is below the tax filing threshold<br />And the undocumented: 12 million people<br />
    24. 24. Estimate of Uninsured After Health Insurance Reform<br />Penalty<br />Source: Urban Institute Who Will be Uninsured After Health Insurance Reform? March 2011. Estimates using 2011 Population with 2014 eligibility for programs.<br />
    25. 25. Conclusion<br />US has adopted social health insurance for the elderly/disabled - Medicare<br /><ul><li>A welfare system for the poor </li></ul>Tension between private health insurance industry and social compact<br />Increasing costs of care, budget pressures at both state and national level<br />Reform may sever the link between ESI and uninsured by expanding Medicaid and providing tax credits in exchanges – Making other affordable options available<br />
    26. 26. Contact information<br />Lynn Blewett<br />State Health Access Data Assistance Center (SHADAC)<br />blewe001@umn.edu<br />612-624-4802<br />20<br />©2002-2009 Regents of the University of Minnesota. All rights reserved.The University of Minnesota is an Equal Opportunity Employer<br />
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