Mary R. GrealyPresident

Healthcare Leadership Councilwww.hlc.org

December 11, 2007

Finding Health Insurance: The Ins, The Outs and Lessons

for Policymakers

National Congress on the Un and National Congress on the Un and UnderinsuredUnderinsured

Healthcare Leadership Council

• Consortium of leaders from all health care sectors• Shared vision of a health care system defined by

accessibility, affordability, quality and innovation• No greater priority than accessible health coverage

for all Americans

Understanding the Uninsured

• Is the problem so large as to be insurmountable?

• Breaking down the 47 million uninsured– 11 million eligible for SCHIP,

Medicaid, but not enrolled (“uninsured in name only”)

– Approximately 18 million have annual incomes of more than $50,000

– Approximately 10 million non-citizens

NMThe State Coverage Insurance (SCI) is a public/private partnership offers affordable health care coverage to

eligible low-income working adults

• All you have to do is sign up for SCI if you are 200% FPL or lower

• Employees pay $0-$35 of their monthly premium

• Employers pay $75 of the employees monthly premium

NVThe Nevada Health Insurance Flexibility andAccountability (HIFA) waiver

• The waiver provides up to a $100 per month, per parent (maximum of $200 per family) to help offset costs of the insurance premium payment (must be employed with an eligible employer).

• Not as easy as just signing up employers have to meet more stringent guidelines to be eligible for the program for example:

• Employers must pay 50% of their employees’ monthly insurance premiums

• Employer must sponsor a group health plan

Take up rate = 50% Take up rate = .01%

Quasi Private Programs• Well structured subsidy

– Leverage employer, employee and private dollars– Must be coupled with outreach

Understanding the Uninsured:Most are in the workplace

• 80 percent of the uninsured are in wage-earning households

– Half are not offered coverage by their employer

– Half are offered insurance, but decline either self or family coverage

• Percentage of premiums covered by employers has stayed stable for years

Working and Uninsured: Why?

• HLC commissioned research by Atlanta-based Schapiro Group– National public opinion survey of target uninsured

populations (young adults, families with children, Latino Americans, small business owners)

– One-on-one in-depth interviews– Simulation experiment using different stimuli to encourage

people to seek coverage info

Obstacles to Acquiring Coverage:Preconceptions about cost

• Research shows that many don’t pursue coverage because they believe they can’t afford it.– 66 percent said they cannot afford health coverage,

although most couldn’t say how much it cost

• Previous published research showed this to be true of small businesses also

Obstacles to Acquiring Coverage:Lack of Information

• People generally do not know how to find information on health coverage– 54 percent said they did not know a reliable source of

information– Among those who said they knew where to look, a

majority cited the Internet or friends/family members

Obstacles to Acquiring Coverage:Buyer Resistance

• Interviews show:– The healthy uninsured feel

no immediate, compelling need to buy health coverage

– Seniors would enroll in Medicare Part D coverage when shown program facts; same is not true of health insurance

– Needle does not move without repeated, persuasive contacts

Testing the Effectiveness of Outreach: Health Access America

• A campaign seeking answers to key questions:– Can we significantly reduce the uninsured rolls, using

existing resources?– Can a targeted education/enrollment initiative reach

and convince uninsured Americans?– What are the most effective strategies for overcoming

obstacles to coverage?

The Health Access America Concept

• Launch a campaign dedicated to health coverage education and enrollment– Build broad-based outreach coalitions– Conduct information and enrollment activities– Use local events to bring greater visibility to the issue of

the uninsured– Offer both public and private alternatives

Targeted Populations

• Small business employers and employees

• Young adults• Children• Latino Americans

Campaign Activities

• Grassroots education and enrollment

• Advocacy and education• Earned media• Partnership building• Research and polling

Pilot Sites:Las Cruces, NMRaleigh, NC

The HAA Target Sites

Criteria for Target Communities

• High uninsurance rate• Growing number of uninsured• Affordable insurance products available• Key partner groups on-board• Geographic diversity

Effective Health Coverage Outreach:Important Lessons Learned

• Building strong grassroots partner networks is critical– Establish credibility– Built-in means to drive

people to events

• Leverage events and activities already taking place

• Create one-on-one interaction between attendees and coverage experts

Effective Health Coverage Outreach:Important Lessons Learned

• Utilize media to build credibility, generate attendance, educate public on issue

• Simplicity is critical – make materials, website clearly understandable

• Engage independent brokers – provide variety of plan options for individuals, small business owners

Health Access America:Policy Impact

• Outreach works!– Despite initial resistance, one of every two people who came in

contact with HAA campaign acquired coverage

• Congress needs to follow through on legislative initiatives to invest dollars in outreach activities

• Emphasizing both public and private options enables outreach to more uninsured

• Communities can emulateeffective approaches

• A well-structured subsidy works