health coverage in georgia and the impact of expanding coverage through medicaid
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GAMHPAC Meeting October 16, 2012. Health Coverage in Georgia and the Impact of Expanding Coverage Through Medicaid. Timothy Sweeney Director of Health [email protected]. Georgia has…. t he 5th largest number of uninsured individuals in the nation at nearly 1.9 million. - PowerPoint PPT PresentationTRANSCRIPT
Health Coverage in Georgia and the Impact of Expanding Coverage Through MedicaidTimothy SweeneyDirector of [email protected]
GAMHPACMeeting
October 16, 2012
the 5th largest number of uninsured individuals in the nation at nearly 1.9 million
an uninsured population that grew by 700,000 in the last 10 years (60% increase)
Photo Credit: Excelencia in Education www.edexcelencia.org
Georgia has…
How are Georgians Insured?
Employer-sponsored InsuranceDominant method of private health coverage where employers and workers share the costs
52.4%5.8 million
Individual Insurance More costly method of private health insuranceMedicareFederally funded public program, serves Americans over 65Medicaid State and federally funded program, serves low-income kids, pregnant women, individuals with disabilities, very low-income adultsNo Insurance Coverage
8.0%782,600
11.0%1.1 million
13.7%1.3 million
19.6%1.9 million
Health Coverage (and Type) Varies Greatly by Age and Family Income
Public Programs Reduce Uninsured for Children and Elderly (2011)
29%$2.6 billion
71%$5.2 billion
47%56%
36%37%
8%
97%
9%
27%
1%0%
25%
50%
75%
100%
Kids < 18 Adults 18-64 Adults 65+
Employer Coverage Public Coverage No Coverage
Source: 2011 American Community Survey data compiled by GBPI
Working Age Adults Depend on Private Coverage More than other Age GroupsLow-Income Adults Often Uninsured
<138% 138-250% 250-400% >400%0%
25%
50%
75%
100%
Employer Coverage Uninsured
$26,300 for fam-ily of three
$47,700 for family of three
$76,400 for fam-ily of three
Fam
ily In
com
e as
a P
erce
nt o
f Pov
erty
, 20
11
Source: 2011 American Community Survey data compiled by GBPI
Health Coverage for Children and Adults Low-Income Kids Far More Likely to be Covered than Adults at Same Income
<138% 138-250% 250-400% >400%0%
25%
50%
75%
100%
Children Adults
$26,300 for fam-ily of three
$47,700 for family of three
$76,400 for fam-ily of three
Fam
ily In
com
e as
a P
erce
nt o
f Pov
erty
, 20
10
Source: U.S. Census figures compiled by Custer & Ketsche, PhDs, GSU Center for Health Services Research
Public Programs Maintained Coverage for Kids & Elderly
Employer Coverage is Declining (in GA and US)• Key issue for small
business & low-wage workers
Photo Credit. University of British Columbia
Coverage Trends in
Last Decade
Adult Uninsured Rates Climbing
Coverage Trends Over Time – Adults 18-64Employer Coverage Declines Offset by Increased Public Coverage
1999-00 2003-04 2006-07 2009-100%
10%
20%
30%
40%
50%
60%
70%
80%
70.0% 67.5% 65.3%
56.7%
10.6% 11.5% 13.2% 14.9%17.9% 19.3% 21.5%26.2%
Employer Coverage Public CoverageUninsured
Source: U.S. Census figures compiled by GBPI
Coverage Trends Over TimeLow-Income Kids Far More Likely to be Covered than their Parents
1999-00 2003-04 2006-07 2009-100%
10%
20%
30%
40%
50%
60%
70%65.5%
58.8% 57.4%53.3%
27.1%33.3% 35.5%
38.5%
9.7% 11.3% 11.9% 10.9%
Employer Coverage Public CoverageUninsured
Source: U.S. Census figures compiled by GBPI
A Closer Look at Georgia’s Medicaid and PeachCare Programs Illustrates Gaps
Current Eligibility for Medicaid and PeachCare Focused on Children
Pregnant Women
Kids < 1 Kids 1-5 Kids 6-18 Parents Childless Adults
Elderly & Disabled
0
50
100
150
200
250
Medicaid PeachCare
Fam
ily In
com
e as
a %
of
Pove
rty
(Poverty = $11,200 for individual, $19,100 for family of three)
Federal Funds Pay 100% of the Costs for 3 Years• Federal funds pay
at least 90% in the long term
Photo Credit. University of British Columbia
ACA Expands
Medicaid to Fill
Coverage Gaps
Expands Eligibility to Adults up to 138% of Poverty Level• About $15k for
individual; $26k for family of three
Other Key Changes:• Higher Primary
Care Payment Rates
• 12-Month Eligibility Determinations
• Federal Funding for Computer Upgrades
Optional Medicaid Expansion Under ACA
Pregnant Women
Kids < 1 Kids 1-5 Kids 6-18 Parents Childless Adults
Elderly & Disabled
0
50
100
150
200
250
Medicaid PeachCare Affordable Care Act (New Coverage)
Fam
ily In
com
e as
a %
of
Pove
rty
(Poverty = $11,200 for individual, $19,100 for family of three)
Supreme Court Ruling Creates a Wrinkle:
Medicaid Expansion Now a State Option
Photo Credit. University of British Columbia
Examining the Decision in Georgia
Election Year Uncertainty Muddles IssueDelay Decision Past November
Uncertainty Surrounding Existing Medicaid Program• Ongoing “redesign” efforts, program underfunded
Structural State Budget Deficit Complicates Issue• State Revenue among lowest in nation (50th per-capita) • State is underfunding current program• Budgetary costs are easier to quantify than savings, economic benefits, or social benefits
Medicaid Funding Fails to Keep Pace With Enrollment Growth Since Recession (2008)
2009 2010 2011 2012
-3.00%
0.00%
3.00%
6.00%
9.00%
12.00%
15.00%
Funding Compared to
2008
9.3%
Enrollment Compared to 200814.9%
Funding above pvs year Enrollment above pvs year
State Projects $4.5 B / 10 yrs• Includes $2 B not
dependent on expansion
• Does not count savings in state programs serving uninsured
• Expansion costs amount to <2% state spending over 10 yrs
Photo Credit. University of British Columbia
A Closer Look At State’s
Numbers
Predicts 600,000 Newly Covered Georgians• Includes nearly
100,000 kids already eligible
• Represents one-third of currently uncovered Georgians
Assumes New Enrollees to be 17% More Expensive• Problematic
assumption, could inflate forecast by >$300 million / 10 years
Federal Funds Cover Bulk of Expansion Costs10-Year Coverage Related Costs – State Share ≈ 7.5 percent of totalNew State spending ≈ 1-2 Percent of Total State Budget
Source: State Cost Estimates
$2.7 B
$33.4 B State Costs
Federal Funds
Economic Impact of Expansion in Georgia
Dramatic Impact in Short Term (2014-16)• No state costs for newly eligible• More than $7.4 B in new federal funds
New Spending Benefits Providers, Overall System• Could reduce uncompensated care by > $2 B / yr
Economic Benefits & State Savings Will Offset Some Costs• New economic activity will generate some state revenues• State will save on programs serving uninsured Georgians• Reduced uncompensated care will benefit privately insured and employers who sponsor coverage
Mental Health Services Part of Expansion
Medicaid would cover mental health servicesFor new enrollees• Federal funds could ease burden on state and local governments
Projecting Savings is Difficult; Need State Cooperation
Broad Implications of Expanded Access to MH/SA Services• Increased coverage of adults increases access to care• State will save on programs serving uninsured Georgians• Reduced uncompensated care will benefit privately insured and employers who sponsor coverage
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