Wisconsin’s Challenges in Health Wisconsin’s Challenges in Health Care Access and Cost:Care Access and Cost:

A Look at the Numbers A Look at the Numbers

March 22, 2006Donna Friedsam, MPH

Associate Director for Health Policy

University of Wisconsin

Population Health Institute

The rich

THE U.S. HEALTH INSURANCE SYSTEM

The poor

The near poor

The broad middle class

The Young

Working-age people

People age 65 and over

The 40 million or so

uninsured tend to be near poor

The federal-state Medicaid

program for certain of the

poor, the blind and the disabled

The employed and their families who are typically covered through their jobs, although many small employers do not provide coverage.

For the rich, broad, unrestricted policies without rationing of any sort (Boutique medicine)

Near poor children may be temporarily covered by Medicaid and S-Chip, although 7-10 million are still uninsured.

Persons over age 65, who are covered by the federal Medicare program, but not for drugs or long-term care. Often the elderly have private supplemental MediGap insurance

The very poor elderly are also covered by Medicaid

Health Insurance Coverage - WisconsinHealth Insurance Coverage - Wisconsin

Employer-Sponsored: 65% (Adults <65: 75%) Other private: 4% Medicaid only: 7%(Any Medicaid: 9%) Any Medicare: 14% Other Types: 4% No Insurance at a given point-in-time: 6%***************************************** Adults > 65: 94% Medicare; 7% Medicaid Medicaid: 9% of Wisconsin households Medicaid coverage 19% of Wisconsin children

Medicare SpendingMedicare Spending

                                  

                                 

State Role in Health Care State Role in Health Care

PurchasersMedicaid, HIRSP, other safety net programs

EmployerDept. of Employee Trust Funds $800 million annual health care expenditures

PolicymakersRegulate insurance marketRules of pricing and competition

High Cost Burden on High Cost Burden on EmployersEmployers

Employers now spend on average about 15% of payroll – For insuring employers, close to 16%– Cost rising 10-25% per year– Adverse economic effects on Wisconsin – on

wages, profits, job creation, new investment

– Source: Wisconsin Health Project

Wisconsin’s Current Wisconsin’s Current Health Care Fiscal PressuresHealth Care Fiscal Pressures

Ongoing Medicaid deficits Double-digit insurance cost increases Employers dropping or limiting coverage Increasing numbers of uninsured Increasing under-insured Dramatic enrollment increases for MA,

BadgerCare, HIRSP

Safety Net ProgramsSafety Net Programs

19% of Wisconsin children have Medicaid coverage

9% of Wisconsin household residents have Medicaid coverage, including BadgerCare, Healthy Start, and other forms of Medical Assistance

Enrollment in the Wisconsin’s Health Insurance Risk Sharing Pool (HIRSP) has grown from 7,257 in FY 2000 to 18,820 in February 2000.

Who is Uninsured in Wisconsin?Who is Uninsured in Wisconsin?

545,000 residents (11%) of population for all or part of 2004

At any given point in time, 7% of Wisconsin’s residents (377,000) are uninsured.

91,000 Wisconsin children uninsured for all or part of 2004

Source: Wisconsin Family Health Survey, 2004, Wisconsin Department of Health & Family Services

Most Uninsured Adults are Most Uninsured Adults are EmployedEmployed

Medicaid Eligibility

0%

50%

185%

100%

200%

150%

September 2001

FederalPoverty Level

Eligibility Groups

250%

53%

93%

250%

BadgerCare &Family Medicaid

Caretaker Relatives in

Family Medicaid

Adults onSSI or

SSI-relatedMedicaid

MedicaidPurchase Plan

(MAPP)200%

(No Asset Test) (No Asset Test) ($2,000 Asset Limit) ($15,000 Asset Limit)

Parents &Children < 19

Caretakers who are not

parents

Elderly, Blind& Disabled

Adults

WorkingDisabledAdults

Adults who are not:•Elderly• Disabled•Caretaker Relatives

210%

Long TermCare

Medicaid

($2,000 Asset Limit)

Persons in aa long term care

institution or participating

in a communitywaivers program

Medicaid & Badgercare Enrollment TrendMedicaid & Badgercare Enrollment Trend

Trends in MA/BC ExpendituresTrends in MA/BC Expenditures

Medicaid ExpendituresMedicaid Expenditures

Elderly and disabled account for 28% of Medicaid enrollment, and account for more than 70% of the Medicaid expenditures.

Low income families and others represent 72% of enrollees and account for 28% of expenditures.

Medicaid Average Medicaid Average Annual Cost per PersonAnnual Cost per Person

Elderly: $21,724

Disabled: $11,956

Low-income family members: $ 2,107

Where are the Costs?Where are the Costs?

25% of Population Accounts for 25% of Population Accounts for 80% of Spending80% of Spending

Health Care Resource ConsumptionHealth Care Resource Consumption

Catastrophic

Chronic

Episodic

Well

24

33

25

18

1

5

14

81

Percent Of Resources Used

Percent Of Population

Chart: RWHC, 9/03Data: Cerner Corporation, '99 and Wisconsin Hospital Association, 9/03

National Health Reform Needs To Follow The Money

Type Of Care

15 Health Conditions Drive Cost Inflation15 Health Conditions Drive Cost Inflation

Increased treatment prevalence or population growth

Increase in cost of treating these conditions Top five conditions account for 31% of increase in

spending between 1987-2000. Obesity accounts for 27% of growth in spending,

with associated increased spending in heart disease (41%), diabetes (38%), hyperlipidemia (22%).

Source: Thorpe, KE and colleagues, Health Affairs, 2004

Increasing Cost per Treated CaseIncreasing Cost per Treated Case

In 8 of top 15 conditions, increase cost per Tx, rather than rising numbers of cases, accounted for most increase spending.

More expensive and effective drugs and technologies accounted for nearly 70% of increase spending for CHD 1987-2000.

Rise in hypertension Tx cost accounted for 60% of the overall growth in spending.

Emergency Dept. UtilizationEmergency Dept. Utilization

Urgent visits increased by 8%.

ER is the highest cost point of entry to care.

In Wisconsin, the number of non-urgent ER visits in 2000 increased by 17% from

1997.

Concerns of WI ResidentsConcerns of WI Residents

Health care now tied with taxes as subject of greatest concern: 17%

Unemployment & jobs: 16%

Source: WI Policy Research Institute

October 2004

What issues should be given the most What issues should be given the most attention by state government?attention by state government?

35%: “Controlling health care and prescription drug costs”

17%: improving the state’s economy” 15% “improving public education” 12%: “reforming the tax system” 11%: “placing limits on WI government agencies” 7%: “security from terrorist attacks” 3%: other or not sure

Source: WI Policy Research Institute, October 2004

Contact InformationContact Information

Donna FriedsamAssociate Director for Health Policy

UW Population Health InstituteV 608.263.4881

Email dafriedsam@wisc.eduhttp://www.pophealth.wisc.edu/wphi