Hawai i s Uninsured Population and Health Insurance Reform

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1 Hawai i s Population and Health Insurance Reform Health Access in Hawai i April 7, 2010 Gerard Russo russo@hawaii.edu Department of Economics, UHM 1

2 Topics U.S. Health Care Financing Hawai i Population Population Age Income Children Health Insurance Reform 2

3 U.S Health System National Health Expenditures (2008) $2.3 Trillion; 16.2% of GDP; $7,681 per person Projected to be $2.5 Trillion; 17.3% GDP 2009 Public Insurance Medicaid Medicare CHIP Employer Sponsored Insurance USA 46,340,000 ; 15.4% (2008) Hawaii 98,000 ; 7.8% (2008) 3

4 US National Health Expenditures as a Percent of GDP: % % Source: Centers for Medicare & Medicaid Services (CMS), Office of the Actuary William S. Richardson School of Law, UHM

5 Social Security Amendments: Public Health Insurance USA Medicare: Title XVIII of the Social Security Act 1965 Federal Program Age 65+, Disabled, ESRD, ALS Medicaid: Title XIX of the Social Security Act 1965 State/Federal Program Poor, Blind, Disabled, Medically Indigent SCHIP: Title XXI of the Social Security Act 1997 Low-Income Children Age

6 The Nation s Health Dollar, CY 2008 Medicare, Medicaid, and SCHIP account for one-third of national health spending. Medicaid and SCHIP 15% Other Public 12% Other Private 7% CMS Programs 35% Private Insurance 33% 6 Medicare 20% Out-ofpocket 12% National Health Spending = $2.3 Trillion 1 Other public includes programs such as workers compensation, public health activity, Department of Defense, Department of Veterans Affairs, Indian Health Service, and State and local hospital subsidies and school health. 2 Other private includes industrial in-plant, privately funded construction, and non-patient revenues, including philanthropy. 3 Out of pocket includes co-pays, deductibles, and treatments not covered by Private Health Insurance. Note: Numbers shown may not sum due to rounding. Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.

7 Health Insurance by Type of Coverage 2008: Percent of the Population Covered Medicaid & SCHIP Medicare Military Private ESI Private Non-Group USA 14.1% 14.3% 3.8% 58.5% 8.9% 15.4% Hawaii 13.3% 16.5% 11.1% 66.3% 6.2% 7.8% Source: Current Population Survey, Annual Social & Economic Supplement 2009 Note: Categories are not mutually exclusive as many individuals have multiple types of coverage. 7 Department of Economics, UHM in collaboration with the Health Law Policy Center,

8 Percent Hawai`i with 95% Confidence Intervals: Current Population Survey (CPS) % 7.1% 10.0% 10.0% 9.1% 9.2% 9.8% 9.6% 8.3% 8.3% 8.8% 7.5% 7.8% 8

9 Persons Hawai`i Current Population Survey Persons (thousands) Calendar Year 9

10 180, ,000 Estimated Population with 95% Confidence Intervals 140, , ,000 80,000 60, , , , , , , , , ,629110,383 95,143 83,533 40,000 20,

11 Population, U.S. and Hawaii: CPS United States Hawaii Survey Year Population Population Population Population ,792,407 41,093, % 1,174, , % ,093,736 42,084, % 1,182,536 83, % ,742,834 42,653, % 1,200, , % ,087,002 37,551, % 1,215, , % ,517,360 38,088, % 1,202, , % ,081,971 39,452, % 1,213, , % ,933,410 41,749, % 1,224, , % ,280,635 43,128, % 1,253, , % ,166,198 43,161, % 1,248, , % ,834,358 44,489, % 1,279, , % ,824,002 46,598, % 1,254, , % ,105,719 45,305, % 1,267,409 95, % Source: U.S. Census Bureau, Current Population Survey (CPS), Annual Social and Economic (ASEC) Supplement, U.S. and Hawaii Samples, Weighted tabulations. University of Hawai i at Mānoa. Preliminary results. Revised June Subject to further revision. 11

12 Survey Year Population Hawaii Population, by Age Group: CPS All Ages Age 0-18 Age Age 65 and Older Population Children Children Elderly Elderly ,174, , % 310,153 16, % 716,108 83, % 148,134 1, % ,182,536 83, % 308,287 17, % 707,128 65, % 167, % ,200, , % 329,394 31, % 707,793 85, % 163,677 3, % ,215, , % 349,500 33, % 722,963 85, % 142,710 2, % ,202, , % 317,951 26, % 733,017 81, % 151,992 2, % ,213, , % 326,952 27, % 728,444 80, % 157,931 2, % ,224, , % 340,545 25, % 718,501 92, % 165,229 2, % ,253, , % 327,080 23, % 755,251 95, % 170,737 1, % ,248, , % 302,462 11, % 765,150 89, % 181,167 2, % ,279, , % 320,172 17, % 776,816 85, % 182,015 3, % ,254, , % 310,010 20, % 777,347 86, % 167,425 2, % ,267,409 95, % 304,770 14, % 779,400 77, % 183,238 2, % Source: U.S. Census Bureau, Current Population Survey (CPS), Annual Social and Economic (ASEC) Supplement, Hawaii Sample, Weighted tabulations. University of Hawai i at Mānoa. Preliminary results. Revised June Subject to further revision. 12

13 Hawaii Population, by Detailed Adult Age Group: CPS Survey Year Age Age Age ,489 43, % 254,144 26, % 153,476 13, % ,722 32, % 271,868 22, % 162,538 10, % ,818 39, % 271,673 33, % 147,301 12, % ,360 47, % 291,091 31, % 160,513 6, % ,586 43, % 268,745 22, % 198,686 14, % ,968 35, % 278,524 23, % 201,952 22, % ,250 43, % 272,120 32, % 183,132 17, % ,104 50, % 277,182 22, % 217,965 21, % ,405 45, % 285,668 28, % 224,077 15, % ,875 33, % 275,065 26, % 245,876 26, % ,873 38, % 264,677 26, % 234,798 22, % ,169 33, % 249,927 17, % 247,304 26, % Source: U.S. Census Bureau, Current Population Survey (CPS), Annual Social and Economic (ASEC) Supplement, Hawaii Sample, Weighted tabulations. University of Hawai i at Mānoa. Preliminary results. Revised June Subject to further revision. 13

14 Family Size 2009 US HHS Poverty Guidelines: Hawaii vs. 48 Contiguous States & DC Hawaii Annual Family Income 48 Contiguous States & DC Annual Family Income 1 $12,460 $10,830 2 $16,760 $14,570 3 $21,060 $18,310 4 $25,360 $22,050 5 $29,660 $25,790 6 $33,960 $29,530 7 $38,260 $33,270 8 $42,560 $37,010 Note: For Hawaii family size more than 8 persons add $4,300 for each additional person. For U.S. Mainland family size more than 8 persons add $3,7400 for each additional person. Alaska has separate rates which are higher than Hawaii. Valid until at least March 31, Source: Federal Register, Vol. 74, No. 14, Friday, January 23,

15 Income Limits Hawai i Family of Four % FPL up to $50, % FPL up to $63, % FPL up to $76,080 15

16 16 Hawaii Population, Age 19-64, by Federal Poverty Level Above & Below 250% FPL: CPS Survey Year 250% of the federal poverty level (FPL) and below Above 250% of the federal poverty level (FPL) ,683 61, % 426,426 22, % ,844 43, % 391,284 22, % ,356 58, % 415,437 26, % ,124 67, % 427,839 18, % ,046 52, % 485,971 28, % ,374 50, % 444,070 30, % ,706 58, % 454,795 34, % ,534 56, % 492,717 39, % ,444 55, % 503,706 33, % ,482 52, % 522,334 33, % ,520 53, % 497,828 32, % ,069 39, % 535,331 38, % Source: U.S. Census Bureau, Current Population Survey (CPS), Annual Social and Economic (ASEC) Supplement, Hawaii Sample, Weighted tabulations. University of Hawaii at Mānoa. Preliminary results. Revised June Subject to further revision. Note: Federal poverty level is based on the Hawaii-specific U.S. Department of Health and Human Services (DHHS) Federal Poverty Guidelines.

17 17 Hawaii Population, Age 19-64, by Federal Poverty Level Above & Below 250% FPL, 3-Year Moving Average: CPS Survey Years 250% of the federal poverty level (FPL) and below Above 250% of the federal poverty level (FPL) ,294 54, % 411,049 23, % ,108 56, % 411,520 22, % ,175 59, % 443,082 24, % ,515 56, % 452,627 25, % ,042 53, % 461,612 31, % ,205 54, % 463,861 34, % ,561 56, % 483,739 35, % ,487 54, % 506,252 35, % ,148 53, % 507,956 33, % ,357 48, % 518,498 34, % Source: U.S. Census Bureau, Current Population Survey (CPS), Annual Social and Economic (ASEC) Supplement, Hawaii Sample, Weighted tabulations. University of Hawaii at Mānoa. Preliminary results. Revised June Subject to further revision. Note: Federal poverty level is based on the Hawaii-specific U.S. Department of Health and Human Services (DHHS) Federal Poverty Guidelines.

18 3-year Moving Average: Percent Hawaii Age % 20% 15% 10% Below 250% FPL Above 250% FPL 5% 0% 18 William S. Richardson School of Law, UHM

19 Hawaii Children Age 0-18: with 95% Confidence Intervals CPS Survey Years ,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,

20 Hawaii Children Age 0-18, by Federal Poverty Level Above & Below 250% FPL, 3-Year Moving Average: CPS Survey Years 250% of the federal poverty level (FPL) and below Above 250% of the federal poverty level (FPL) Children Children Children Children ,249 17, % 115,695 4, % ,137 21, % 128,923 5, % ,742 23, % 145,540 6, % ,305 22, % 142,163 6, % ,982 19, % 144,501 6, % ,372 18, % 144,154 7, % ,197 14, % 149,165 5, % ,954 12, % 150,617 4, % ,826 12, % 152,056 4, % ,176 12, % 152,475 5, % Source: U.S. Census Bureau, Current Population Survey (CPS), Annual Social and Economic (ASEC) Supplement, Hawaii Sample, Weighted tabulations. University of Hawai i at Mānoa. Preliminary results. Revised June Subject to further revision. Note: Federal poverty level is based on the Hawaii-specific U.S. Department of Health and Human Services (DHHS) Federal Poverty Guidelines.

21 3-year Moving Average: Percent Hawaii Children Age % 12% 10% Below 250% FPL Above 250% FPL 8% 6% 4% 2% 0% 21 William S. Richardson School of Law, UHM

22 U.S. Health Policy Goals Increased Efficiency Lower Expenditures Improved Health Outcomes Higher Productivity Reduction in the number of 22

23 U.S Health Insurance Reform Expand Medicaid Tighten Medicare Young treated as Dependents: Age 26 Individual Mandate with exceptions Employer Mandate: Employers Play-or-Pay Government Sponsored Market Clearinghouse with Subsidies/Tax Credits: Exchanges Special Provision for Hawaii Prepaid Health Care Act. 23 William S. Richardson School of Law, UHM

24 Mahalo! This research is funded in part by U.S. Department of Health and Human Services Health Resources & Services Administration, Hawaii State Department of Health. 24