Private Sector Strategies to Cover

the Uninsured

Illinois Health ForumChicago, Illinois

December 7, 2005

Enrique Martinez-VidalDeputy Director

RWJF’s State Coverage Initiatives program

Purchasing Pools

Mixed results: improves plan choice in small firms and has increased coverage, but enrollment has generally been low

Have not generated significant administrative savings or price discounts to date

Adverse selection problems States continue to express interest in

this option

Efforts to Make InsuranceMore Affordable

Limited benefits– At least 13 states have passed minimum

benefit legislation – Low enrollment

Consumer directed health care– Options for state and local employees– Legislation to allow qualifying High Deductible

Health Plans to be sold in the state Prevention strategies – healthy behaviors

Mandating Health Insurance

Employer mandates– Several states have considered, only 1 with laws

on the books• Hawaii’s Prepaid Health Care Act – 30 years old this

year• California’s Health Insurance Act of 2003 -repealed • Maryland’s Fair Share Health Act - vetoed

Individual mandates– States have talked about, but none have

enacted: Massachusetts

Comprehensive Models:

Maine’s Dirigo Health Voluntary program Maine’s health system

Cost• Certificate of Need Moratorium• Capital Investment Fund• Voluntary expenditure limits• Electronic claims• Price disclosure

Quality• Maine Quality Forum

Access: DirigoChoice New Insurance product offered by Anthem

DirigoChoiceSmall Employers,

Individuals,Self-employed

MedicaidEmployerPremiums

General FundsIndividualPremiums

Savings OffsetPayment

PremiumSubsidy

< 300% FPL

DirigoChoice… con’t

Federal poverty level

100

400

MaineCare

300

200

Children Parents Childless Adults

Sliding Scale Discount

150%- 200% FPL

125%- 150% FPL

DirigoChoice