Health Coverage in Georgia and the Impact of Expanding Coverage Through MedicaidTimothy SweeneyDirector of Healthtsweeney@gbpi.org

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 insurance

MedicareFederally funded public program, serves Americans over 65

Medicaid State and federally funded program, serves low-income kids, pregnant women, individuals with disabilities, very low-income adults

No 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 Inco

me a

s a P

erc

ent

of

Povert

y,

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 Inco

me a

s a P

erc

ent

of

Povert

y,

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

Fa

mil

y I

nco

me

as a

% o

f P

ove

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)

Fa

mil

y I

nco

me

as a

% o

f P

ove

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

THANK YOU.

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