Presentation by Lynn Blewett to professional students at St. Thomas University in Saint Paul, MN, March 7 2009.

1. State Roles in Health Reform Lynn A. Blewett, PhD University of Minnesota, School of Public Health Presentation to: University of St. Thomas Minneapolis, Minnesota March 7, 2009 Funded by a grant from the Robert Wood Johnson Foundation

3. STATE BUDGETS NOT LOOKING SO GOOD

5. Source: Center on Budget and Policy Priorities, February 2009

6. Revenue Outlook for FY 2009 Optimistic, n = 3 Stable, n = 10 Concerned, n = 34 Pessimistic, n = 4 Puerto Rico Source : NCSL survey of state legislative fiscal offices, April 2008. Rhode Island Delaware

7. State Budget Deficits % Source: Center on Budget and Policy Priorities, February 2009 Notes: 2009 gaps are mid-year gaps 2010 gaps are projected

8. State General Fund Spending Source: NASBO 2006 State Expenditure Report

9. Medicaid Spending Projected to Increase by 8% Annually to Over $700 Billion in Ten Years: 2008 - 2018 Source: Health Management Associates estimates based on data from CBO and CMS, 2008. All funds: Federal, State and Local 63 million Enrollees in 2008 $ 73 million Enrollees In 2018

11. STATES CONTINUE INCREMENTAL HEALTH REFORM

12. Drivers of State Health Reform Increasing Health Care Costs % GDP Source: Centers for Medicare and Medicaid Services, 2009

13. Drivers of State Health Reform Reduction in Employer-Sponsored Coverage Percent - % Source: U.S. Census Bureau Income, Poverty and Health Insurance Coverage in the U.S.

14. Drivers of State Health Reform Increasing Number of Uninsured Millions of Uninsured, all ages Source: U.S. Census Bureau, Current Population Surveys (March) 2000 - 2007

16. State Options: Reform Framework Public Sector Reform Employer-Based Reform Individual Market Reform -Individual mandate -High-risk pools -Community rating -Limited-benefit plans - State Children's Health Insurance Program (SCHIP) expansion -Medicaid reform -Insurance exchanges -Employer mandate -Reinsurance -Purchasing pools -Employer Premium Assistance Subsidy

17. Cover All Kids: IL, PA, WA State Free Sliding Scale Premium Full Cost Eligibility IL < 150% > 150% > 300% All children PA < 200% 200-300% > 300% Citizens, legal residents, refugees WA < 200% 200-250% NA All children

22. MINNESOTA SPECIFIC HEALTH REFORM ACTIVITIES

24. Minnesota Monthly Unemployment Rate, 2003 - 2008 Source: MN Dept of Employment and Economic Development

28. Percent of Minnesotans Covered 1999 2007 Drop in Employer-Based Coverage

31. Governor Pawlenty’s Proposed Cuts Current Guidelines Governor’s Proposed Guidelines % Federal Poverty Level % Federal Poverty Level Medical Assistance Pregnant Women ≤ 275% ≤ 275% Parents with children < 19 ≤ 100% ≤ 100% Infants < 2 ≤ 280% ≤ 280% Children ages 2 – 18 ≤ 150% ≤ 150% Children ages 19 - 20 ≤ 100% ≤ 100% General Assistance Medical Care Full Medical Benefits ≤ 75% ≤ 75% Hospital Only Coverage 76% - 175% No coverage for adults without children MinnesotaCare Adults without children ≤ 200% No coverage Pregnant Women ≤ 275% No coverage Parents with children < 19 ≤ 275% No coverage Infants < 2 ≤ 275% 151% - 275% Children ages 2 – 18 ≤ 275% 151% - 275% Children ages 19 - 20 ≤ 275% 101% - 275%

33. Minnesota Budget Deficit (in millions) 4,570 1,318 Stimulus Surplus from unallotments for 08-09??

41. A FEW WORDS ON: THE STATE HEATH ACCESS REFORM EVALUATION (SHARE) PROGRAM

44. State Health Access Reform Evaluation