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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….
  • Transcript

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