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House Insurance CommitteeCSHB 636 by Zerwas

March 1, 2011

Anne Dunkelberg, Assoc. Director, dunkelberg@cppp.org Center for Public Policy Priorities, 900 Lydia Street - Austin, Texas 78702

Phone (512) 320-0222 (X102) – www.cppp.org

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Our Principles:•Quality affordable health insurance available for

every Texan

•Sustainable health care system

•Long term services and supports are provided in the most integrated setting possible

•Maximum federal funding for Texas health care by preserving CHIP and Medicaid

•Improved small business’ access to affordable health insurance

•Common-sense protections for Texas health insurance consumers in state law

•Transparent, open systems that meet consumers’ needs

Cover Texas Now Goals for the 82nd Texas Legislature:

• To get the best deal for Texans, we must take 3 steps in 2011: – Start building a strong Texas insurance exchange to help

families and small businesses get affordable insurance in 2014.

– Make sure the Texas Department of Insurance can enforce popular insurance reforms—like no pre-existing denials for kids, keeping kids on your policy until age 26, and making sure rate hikes are fair.

– Give state agencies and the exchange the authority and tools to build consumer-friendly systems for enrolling in health coverage

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ADAPT of TexasAdvocacy, Inc.Alamo Breast Cancer FoundationCenter for Public Policy PrioritiesConsumers Union – Southwest Regional OfficeChildren's Defense Fund – TexasLa Fe Policy Research and Education CenterLa Union del Pueblo Entero (LUPE)National MS Society – Lone StarMethodist Healthcare MinistriesTexans Care for ChildrenTexas AFL-CIOTexas ImpactTexas Organizing ProjectTexPIRG

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Under Reform - 2019

Employer

159 million

56%

Medicaid/CHIP51 million

18%

Nongroup & Other26 million 9%

Private Exchanges24 million

9%

Uninsured23 million

8%

Americans’ Insurance Coverage in 2019:If Nothing Changed compared to Health Reform Law

Employer

162 million

58%

Medicaid/CHIP35 million

12%Uninsured

54 million

19%

Nongroup & Other

30 million 11%

Without Reform - 2019

Source: The Congressional Budget Office Cost Estimate of H.R. 4872, Reconciliation Act of 2010, Mar. 20, 2010, http://www.cbo.gov/doc.cfm?index=11379 .

282 Million U.S. Residents Under Age 65

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>$88,400 for a family of four;>400% of FPL

Job-based coverage, or Full-cost coverage in the exchange

$66,200-$88,400; 300-400% of FPL

Job-based coverage, or Subsidized exchange coverage: premiums capped

at 9.5% of income

$44,100-$66,200;200-300% of FPL

Job-based coverage, or Subsidized exchange coverage: premiums capped

at 6.3 – 9.5% of income

$29,300-$44,100;133-200% of FPL CHIP

• Job-based coverage, or• Subsidized exchange coverage:

premiums capped at 3% - 6.3% of income

<$29,300 for a family of four; < 133% FPL

Medicaid Medicaid

Children Adults (non-disabled adults,

not eligible for Medicare)

Fam

ily

Inco

me

Health Reform Coverage Options by Income

Family income based on 2009 federal poverty income levels for a family of four

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Texas Uninsured by Income Today… 88% of 6.4 million uninsured <400% FPL

758K

628K

693K1.170

Million

1.752 Million

525K

Annual income limits given for a family of four, 2009 federal poverty level U.S. Census, CPS

901K

6.4 million includes 1.6 million non-

citizens; ~2/3 of these ( just over 1 million) likely undocumented

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Which Texans would Gain Coverage If Reform were Fully Implemented Today?

≈ 2.5 million (adults and kids) would qualify for help with coverage in the

exchange

≈ 700,000+ would qualify for exchange coverage at full cost

≈ 1.3 million U.S. citizen adults would newly qualify for Medicaid

≈ 500,000 to 600,000 kids qualify for Medicaid or CHIP right now

CBO predicts ≈ 1.1 to 1.8 million would remain uninsured

2.5M

700K

1M

500K

1.5M

0 0.5 1 1.5 2 2.5 3

≈ 2 Texans gain private exchange coverage for each 1 gaining through Medicaid

Of the 6.4 Million Uninsured Texans today…

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Texas Medicaid/CHIP Enrollment

August 2010, HHSC data

Total enrolled 8/1/2010: 3.4 million Medicaid; 523,000 CHIP

Texas Connector: Critical to Covering low- and moderate-income working Texas families

• U.S. Census data indicate 2 uninsured Texans stand to gain private coverage for every 1 added to Medicaid or CHIP.

• Every month, 25,000-40,000 children leave CHIP and another 100,000 to 150,000 leave Medicaid.

– Texas HHSC has reported fewer than 30% of kids leaving these programs gain coverage later

– National studies have shown that only a small minority of uninsured kids in families under 400% FPL have access to ESI

– With connector and premium assistance, demand among low-income families will be high and systems MUST be interoperable to guarantee easy transtion to private coverage.

• 90% federal match for adapting Medicaid systems to interact with Exchanges thru end of 2015 (proposed and may be extended); then 75% thereafter.

– Fiscal note should be revisited, as it indicates 31% state share

• Interoperability of Connector enrollment systems with Medicaid systems is critical, and integration should be explicitly directed in HB 636.

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