HealthcareHealthcare

What are the issues?What are the issues?

Some Some interesting interesting statistics-statistics-Uninsured Uninsured by income by income levellevel

(WA state (WA state office of office of financial financial managemenmanagement)t)

Income as % of fpl

2002-% of pop.

2004-% of pop.

0-99% 17.9% 22.8%

100-199% 15.9 16.1

200-299% 10.6 12.2 (9.3 in ’06)

300-399 3.5 3.4

State total 8.4 9.8

Uninsured by ageUninsured by ageNew York Times, New York Times, March 2, 2010March 2, 2010

Age 2002 2004 2008

0-18 4.5% 6.0% 15.9%

19-64 11.5% 13.2% 18.3

18-24 17.7

25-44 40.5

45-64 24.5

65+ .5% .4% 1.4

Type of Insurance Type of Insurance CoverageCoverage

Kaiser StudyKaiser Study

Type of coverage

2002 2004 2008

Employer 62.4%(70% in ’87)

61.3% 55.8%

Purchased 10.6% 12.3% 5.7

Medicaid 15.6% 14% 12.8

Medicare 12.1% 12.9% 11.1

Other public 2.1% 1.9% 2.7%

DefinitionsDefinitions

Important terms:Important terms: Single payer systemSingle payer system Socialized/nationalized systemSocialized/nationalized system Universal healthcareUniversal healthcare

We have a variety of county, state, We have a variety of county, state, federal and private institutions federal and private institutions providing healthcare funding and providing healthcare funding and services.services.

Patient’s Bill of Rights Patient’s Bill of Rights Affordable Care Act, March Affordable Care Act, March

23, 201023, 2010 End limitations on care, e.g. pre-existing End limitations on care, e.g. pre-existing

conditions, cancelling insurance plan, conditions, cancelling insurance plan, lifetime limits.lifetime limits.

Remove insurance company barriers.Remove insurance company barriers. Review insurer premium increases.Review insurer premium increases. Medical care and efforts to improve care Medical care and efforts to improve care

must equal 80/85% of premium dollars.must equal 80/85% of premium dollars. Maintain young adult coverage.Maintain young adult coverage. Provide affordable coverage to those with Provide affordable coverage to those with

pre-existing conditions.pre-existing conditions.

Small Group StrategizingSmall Group Strategizing

You are given a collection of healthcare You are given a collection of healthcare services.services.

Your task is to define “Basic Health Care.” Your task is to define “Basic Health Care.” That is, which of these should everyone be That is, which of these should everyone be guaranteed? guaranteed?

Which should definitely NOT be included?Which should definitely NOT be included? Which are you unsure of? Why? Which are you unsure of? Why? What criteria or principles are you using?What criteria or principles are you using? What information would help you decide to What information would help you decide to

include or not include those in the “unsure” include or not include those in the “unsure” category?category?

DiscussionDiscussion

What criteria did you use?What criteria did you use? What were some of the differences What were some of the differences

of opinion?of opinion? What was the reason for the What was the reason for the

differences of opinion?differences of opinion?

Some Healthcare Some Healthcare ProgramsPrograms

1. Basic Health Plan1. Basic Health Plan Established in 1993 to insure more Established in 1993 to insure more

people and contain the costs of people and contain the costs of healthcare healthcare

State funded with individual State funded with individual contributioncontribution

Private providersPrivate providers Income guideline-200% of FPLIncome guideline-200% of FPL

2.2. Washington Association of Washington Association of Community and Migrant Health Community and Migrant Health ServicesServices

103 clinics in the state; examples-103 clinics in the state; examples-4545thth St. Clinic, Odessa Brown, Pike St. Clinic, Odessa Brown, Pike Market Medical Clinic, etc.Market Medical Clinic, etc.

Provides care for underserved Provides care for underserved populations.populations.

Accepts medicaid, private pay, Accepts medicaid, private pay, private insuranceprivate insurance

3.3. Indian Health Service, providing Indian Health Service, providing healthcare to members of the 557+ healthcare to members of the 557+ federally recognized tribes and federally recognized tribes and descendants…approximately 1.8 descendants…approximately 1.8 million Alaskan Natives and million Alaskan Natives and American Indians in the U.S. (from American Indians in the U.S. (from IHS website)IHS website)

• Includes direct services and contracted Includes direct services and contracted servicesservices

• Is funded enough to serve about 60% of Is funded enough to serve about 60% of those eligible.those eligible.

4.4. Medicaid-aka “coupons.”Medicaid-aka “coupons.” Federal and state fundedFederal and state funded Pregnant women up to 185% of fplPregnant women up to 185% of fpl People receiving SSI for a disabilityPeople receiving SSI for a disability Other groups of peopleOther groups of people

5.5. State Children’s Health Insurance State Children’s Health Insurance Program (SCHIP)-Apple Health for Program (SCHIP)-Apple Health for Kids)Kids)

200% of fpl for kids under 19 200% of fpl for kids under 19 250% WITH $20 co-pay250% WITH $20 co-pay 300% with a $30 co-pay300% with a $30 co-pay Funded by both state and federal Funded by both state and federal

gov’tgov’t

6. Public Health-Seattle/King County6. Public Health-Seattle/King County Some direct service provision Some direct service provision

(immunizations, asthma (immunizations, asthma prevention/tx services, etc).prevention/tx services, etc).

Emphasis on prevention of Emphasis on prevention of accidental death, disease, accidental death, disease, community health issues (SIDS, community health issues (SIDS, asthma) and environmental health.asthma) and environmental health.

7. Medicare7. Medicare• Healthcare for older adults and some Healthcare for older adults and some

people with disabilities.people with disabilities.• Part A-Hospitalization, post Part A-Hospitalization, post

hospitalization and hospice care.hospitalization and hospice care.• Part B-Medical insurance with a Part B-Medical insurance with a

monthly premium.monthly premium.

8.8. Veteran’s Affairs systemVeteran’s Affairs system

9.9. Private system, largely paid for Private system, largely paid for through employers but also through employers but also individuals can purchase.individuals can purchase.

10.10. In 2014, a new “health insureance In 2014, a new “health insureance marketplace” will exist. marketplace” will exist.

CONCLUSION? CONCLUSION?

A patchwork quilt of a A patchwork quilt of a healthcare system-lots of healthcare system-lots of possibilities, difficult to possibilities, difficult to

navigatenavigate..

An example of a socialized An example of a socialized system: Cubasystem: Cuba

Healthcare system is one of three Healthcare system is one of three priorities of the revolution: priorities of the revolution: Education, Healthcare and LiteracyEducation, Healthcare and Literacy

It is a socialized system, wherein the It is a socialized system, wherein the government both funds and provides government both funds and provides healthcare services.healthcare services.

Education is free in Cuba, which Education is free in Cuba, which means the country produces many means the country produces many healthcare personnel.healthcare personnel.

Quiz reviewQuiz review Define single payer, universal and socialized Define single payer, universal and socialized

healthcarehealthcare Healthcare services – Healthcare services –

Basic HealthBasic Health MedicareMedicare MedicaidMedicaid Washington Association of Community and Migrant Washington Association of Community and Migrant

Health ServicesHealth Services Public HealthPublic Health State Children’s Health Insurance ProgramState Children’s Health Insurance Program

Children and Family ServicesChildren and Family Services Institute of Family Development? Institute of Family Development?   CCORS stand for?  What is it?  CCORS stand for?  What is it?   What does the Casey Family Foundation focus on?     What does the Casey Family Foundation focus on?     

Quiz review, continuedQuiz review, continued

Senior ServicesSenior Services Adult Protective ServicesAdult Protective Services SNAPSNAP AFHAFH COPESCOPES GRATGRAT Long Term Care OmbudsmanLong Term Care Ombudsman What is an AFH?What is an AFH?