Health Insurance in the District of ColumbiaState Planning Grant

OverviewRaymond T. Terry, Sr., PhD, Project DirectorOffice of Policy, Planning and Research

November 8, 2004

HRSA State Planning Grant ‘04A Project of the District of Columbia

Department of Health

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What is a State Planning Grant?Purpose

Federally funded program to examine ways to expand health insurance coverage for uninsured residents in the District of Columbia

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State Planning Grant Objectives Conduct quantitative and qualitative analyses

to identify uninsured residents and reasons why they are uninsured, by utilizing several different health care and insurance data sources, such as the MEPS, CPS, BRFSS, US Census, etc. and focus groups;

Explore effective options to provide high quality affordable health insurance/coverage that will target actionable groups

Foster collaboration by convening an advisory panel of community partners and experts

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The State Planning Grant Project Team

D.C. Dept of Health – Lead State Agency

Urban Institute

Health Care

CoverageAdvisory

Panel

AcademyHealth

HRSA

SHADAC

ACHI AHRQ

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The Advisory Panel Chosen to represent a broad range of

District constituencies & expertise Designed to facilitate discussions and

foster collaboration among groups with competing interests in the public and private sectors

Expected to develop options for expanding coverage that balance these competing interests

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Advisory Panel ProcessThe balanced composition of the Panel will

allow competing interests to be considered The Panel will meet quarterly to discuss

relevant issues, ongoing projects, and develop further project concepts

Project staff will facilitate discussions and provide needed research and analysis

Panel recommendations will be included in the final grant report to the Mayor and HRSA

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Components of District’s Project7 Tasks

I Research and Assessment Tool DevelopmentTask 1: Establish Health Care Coverage PanelTask 2: Review prior experience in District and other

statesTask 3: Conduct relevant quantitative analysis with

existing and newly generated dataTask 4: Conduct relevant qualitative analyses with

existing and newly gathered data

II Decision Process--a public private collaborationTask 5: Refine options, analyze alternativesTask 6: Prioritize feasible options

III Prepare recommendations Task 7: Recommend course of action for the District

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Make-up of Uninsured Populationby Income

28%17%

34%

18%

38%

65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Uninsured All

Non-poorNear poorPoor

Adults 18-64, 2003

Source: Urban Institute estimates of the D.C. Health Care Access Survey, 2003

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Make-up of Uninsured Populationby Employment Status

54%71%

46%29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Uninsured All

UnemployedEmployed

Adults 18-64, 2003

Source: Urban Institute estimates of the D.C. Health Care Access Survey, 2003

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Uninsured Adults Who Are Working

Uninsured Uninsured & Employed

Full time 30% 55%

Part time 10% 18%

Self-employed 15% 27%

Employed 54% 100%

Adults 18-64, 2003

Source: Urban Institute estimates of the D.C. Health Care Access Survey, 2003

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A large share of firms in DC offer insurance

State % Firms Offering Insurance, 2001

U.S. Total 58%District 74%

Maryland 62%

Virginia 62%

State rates in U.S. range from 43% to 82%

Source:Source: Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey - Insurance Component. 2001.

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Still, many workers are not offered insurance

Don't know/refused

10%

No offer64%

Offer26%

Uninsured Workers 18-64, 2003

Source: Urban Institute estimates of the D.C. Health Care Access Survey, 2003

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Average Annual Cost of Employer-Sponsored Insurance, 2001

StateEmployee Share / Employer Share

Individual Family

DC $507 / $2,523 $2,003 / $6,709

MD $524 / $2,364 $2,178 / $5640

VA $580 / $2,122 $1,947 / $5,401

US $498 / $2,391 $1,741 / $ 5,768

Source: Kaiser Family Foundation, State Health Facts Online.

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Why are People Uninsured? High Cost of Coverage – vast majority of uninsured

are low-income workers and coverage is unaffordable or not offered;

Fragmentation of Systems of Coverage – e.g. Medicaid/Healthy Families, the Alliance

Complicated Life Circumstances – (homelessness, mental illness, family transitions between DC/MD/VA;

Immigration Status – national data indicate that most non-native uninsured are legal residents or who have lived in the US for 6+yrs.

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Consequences of Uninsurance

Poor access to care - Less likely to have usual source of care - Less likely to have medical visits Inappropriate use of the ER Poorer health outcomes Greater financial burden when obtaining

care

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Questions for the Project What is being spent in the District on

care for people who are uninsured? What is being spent on uncompensated

care for non-District residents? How many uninsured residents are

eligible for Medicaid or SCHIP? How should Medical Homes be funded? What does expanded insurance mean

for patients, for safety-net providers?

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Focus Group Approach Total of eight focus groups Two with publicly insured individuals Two with uninsured individuals Two with insurance carrier

representatives Two with small business employers Each with English and Spanish speaking

participants

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Preliminary Findings from the Uninsured Focus Groups

Some Reasons for not having insurance Most had periods of insurance in past Failed to renew coverage Made attempts to renew, but had problems with

complex system (too much documentation required) No staff in eligibility office Didn’t make attempt to apply Didn’t know where to apply; needed more info Couldn’t afford coverage offered by employer Didn’t feel the need for insurance

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“Live” Options on the Table Being Considered

District government health plan Buy-In/High Risk Insurance Pool: “Equal Access Act”, proposed by the District’s insurance commissioner

Strengthen and expand current services - HIFA Waiver

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From Recommendations to Action

The District is learning from progress in 42 other state planning grant states;

The District is building state agency capacity; Regional collaborative efforts in progress with

MD and VA; Additional new or expanded health coverage

options will be identified; Advisory Panel’s recommendations will have

a major impact on health coverage policy in the District of Columbia

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Health Insurance in the District of ColumbiaState Planning Grant

OverviewFor more information, please contact:Raymond T. Terry, Sr., PhD, Project DirectorOffice of Policy, Planning and Research825 North Capitol Street, NE 3rd Fl.Washington, DC 20002Rterry@dchealth.com(202) 442-9377