joint commission on health care patrick w. finnerty executive director november 26, 2001 richmond,...

JOINT COMMISSION ON HEALTH CARE

Patrick W. FinnertyExecutive Director

November 26, 2001Richmond, Virginia

Joint Commission on Health Care

2Presentation Outline


2001 Legislative Studies

Probable 2002 Legislative Recommendations

Results of 2001 “Health Access Survey”


3Joint Commission on Health Care

Chairman

Senator William T. Bolling

Vice Chairman

Delegate Harvey B. Morgan

Sen. Benjamin J. Lambert, III Del. L. Preston Bryant, Jr.

Sen. Stephen H. Martin Del. Jay W. DeBoer

Sen. Linda T. Puller Del. Alan A. Diamonstein

Sen. Nick Rerras Del. Franklin P. Hall

Sen. Kenneth W. Stolle Del. Philip A. Hamilton

Sen. William C. Wampler, Jr. Del. S. Chris Jones

Del. Robert H. Brink Del. Kenneth R. Melvin

The Honorable Louis F. Rossiter (ex officio)


4

Broad Range of Issues


Health Insurance/Access for Uninsured

Medical Education

Health Care Cost & Quality

Health Workforce

Long-Term Care



Study Requests(Bill/SJR/HJR/Budget)

Public CommentPeriod

General AssemblySession (Jan-Feb/Mar)

JCHC PolicyInitiatives

Study Reports(May-Nov)

JCHC Recommend.(Dec.)

JCHC Legislationto G. A.



On The Internet•The JCHC web site includes meeting schedules, studies, reports, and legislation

•Interested parties can access the full text of JCHC reports and provide public comments through the Internet

•Visit the Joint Commission at: http://legis.state.va.us/jchc/jchchome.htm

•E-Mail address: [email protected]



Long-Term Care Related Studies— Voluntary Closure of Long-Term Care Facilities (SB

845/HB1920)— Exceptions to Medicaid Reimbursement for Nursing

Facilities (SB 1249)— Long-Term Care Insurance Reforms (HB 2228)— Employment Exceptions for Nursing Facility Employees (HB

2748)— Nurse Staffing Ratios in Nursing Facilities (SB 1125/HB

2257)



Virginia Medical Savings Account Program

Local Health Partnership Authorities (HB 2060)

Palliative Care Reimbursement

Multi-State Nurse Licensure Compact

Certificate of Public Need (COPN)— Follow-up to last year’s plan to phase out COPN


11


Establish a state “Critical Access Hospital” program through Medicaid cost-based reimbursement

Revise Virginia Medical Savings Account Program

Revise premium rate-setting process for long-term care insurance — Implements recommendations of National Association

of Insurance Commissioners

Establish a tax credit for persons who volunteer in a long-term care facility


12


Eliminate the local government “match” requirement for the state’s Auxiliary Grant Program— AG Program provides assistance to low-income residents

of assisted living facilities

Require state agencies conducting licensure or certification inspections of long-term care facilities to notify Adult Protective Services of any citations for adult abuse or exploitation

Extend peer review/disclosure protection to patient safety/medical errors information shared among providers and expert safety organizations


13


Revise requirements of state’s dental scholarship to require recipients to be participating providers in Medicaid and FAMIS

Extend authorization of health care data reporting for additional 5 years to 2008

Allow part-time nursing students to be eligible for existing nurse scholarship programs


14


Authorize Board of Dentistry to issue temporary permits to graduates of dental schools who have not yet been licensed and are practicing in Free Clinics or Community Health Centers

Authorize “general” supervision of dental hygienists— Likely will not be legislation . . . Board of Dentistry has

authority to revise supervision requirements through regulations

Numerous budget amendments also will be introduced


16

Virginia Health Care Foundation Sponsored 2001 Health Access Survey

Survey completed by Southeastern Institute of Research Telephone survey of 1,959 households; data on 4,801 individuals

— Findings are estimates only; statewide margin of error: 2%, others range from 2-5% unless otherwise noted

2001 survey updates data collected in 1993 and 1996 Two general types of measures are used in presentation:

— Uninsured rate: refers to the percentage of a population group that has no health insurance

For example . . . “14.9% of Virginians are uninsured” — Distribution of uninsured: refers to the percentage of the uninsured

who fall into a particular category For example . . . “20% of uninsured have income at or below the

poverty level”


17

The Uninsured Rate For All Virginians Has Increased Since 1996

14.0% 14.9%13.0%

0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%20.0%

1993 1996 2001

Uninsured Rate

Source: Health Access Surveys: 1993, 1996, 2001


18

Regional Uninsured Rates Range From 11% to 20%

14.9%

17.2%

13.1%11.0%

14.7%

20.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

State Central Eastern Northern Northwest Southwest

Source: Health Access Survey 2001


19

Number Of Uninsured Virginians Has Grown Due To Population Growth And

Increase In Uninsured Rate

1,051,000

858,000

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1996 2001

Number of Uninsured Virginians

Source: Health Access Surveys: 1996, 2001


20Number of Uninsured Persons By Region

209,652225,263

200,042

149,632

267,141

0

50,000

100,000

150,000

200,000

250,000

300,000

Central Eastern Northern Northwest Southwest

Number of Uninsured Persons



21

Persons At/Below 200% of Federal Poverty Level (FPL) Are Nearly Twice As

Likely To Be Uninsured

26.8%24.4%

13.6%

9.4%

14.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

<=100%FPL

101-200%FPL

201-300%FPL

301%+ FPL All



22

The Highest Uninsured Rate Is Among Young Adults

14.1%

19.7%

13.1%

1.1%

14.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Age 0-17 Age 18-44 Age 45-64 Age 65+ All



23Uninsured Rate By Race

12.8%

20.4% 21.0%

14.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

White African-American

Other All


Note: Error margins are in the range of 2% for statewide estimate; 2-5% for African-American and White estimates; and as much as 15% for “other” category


24

Employees Of Very Small Firms Have Highest Uninsured Rate

25.1% 26.6%

13.7%

21.8%

9.1%12.9%

18.9%

13.8%10.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

<5 5-9 10-24 25-49 50-99 100-249

250-499

500-999

1000+

Number of Employees In Firm

Percent Uninsured

Note: Error margins are in the range of 2% for statewide estimate; 4% for firms with 1000 or more; and 8-11% for other categories



25Distribution of Uninsured By Race

White, 63.0%

African-American,

28.0%

Other, 9.0%



26Distribution of Uninsured By Income

$50,001 +, 26.0%

$30,001-$50,000,

20.0%

$20,001-$30,000, 22.0%

<$10,000, 14.0%

$10,001-$20,000, 18.0%



27

Persons With Higher Incomes Represent An Increasing Share Of The Uninsured

Population

0%

20%

40%

60%

80%

100%

1996 2001

<=100% FPL 101-200% FPL 201%+ FPL

34.0%

29.0%

37.0%

49.6%

30.0%

20.4%



28

Over Two-Thirds Of Uninsured Adults Are Employed Full-Time

Employed, Full-Time,

67.0%

Employed, Pt. Time,

10.0%

Unemployed, Looking,

6.0%

Homemaker, 10.0%

Other, 6.0%



29

Percent Of Uninsured Adults Who Are Employed Full-Time Has Increased

Substantially Since 1993

41.0%

57.0%

67.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

1993 1996 2001

Percent of Uninsured Population



30

Approximately 133,000 Uninsured Children (0-18) Appear To Be Eligible For

Medicaid/FAMIS

50,497

31,788

89,757

0

50,000

100,000

150,000

200,000

250,000

300,000

Number of Uninsured ChildrenBy Income

301%+ FPL201-300% FPL101-200% FPL<=100% FPL

Note: margin of error ranges from 4-11%

Estimated Total Number of Uninsured Children: 254,300

82,286132,783

Source: 2001 Health Access Survey


31

Uninsured Persons Have Less Access To Health Care

3.9%10.3%

23.1%15.9%

27.6%

55.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Unable To GetNeeded Health

Care

Unable to GetPrescription Due to

Cost

Do Not Visit DentistRegularly

Insured Uninsured

Source: 2001 Health Access Survey

joint commission on health care patrick w. finnerty executive director november 26, 2001 richmond,...

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