- Social health insurance is defined as a system where society views ill health as a public concern, and insurance is mandatory rather than a personal choice.
- The US has forms of social insurance like Medicare, Medicaid, and Social Security. Medicare provides universal coverage for those over 65 and covers around 49 million elderly and disabled people.
- The Affordable Care Act includes some elements of social insurance like the individual mandate, employer penalties, and subsidies to expand coverage, but it does not create universal or mandatory coverage. Projections indicate around 26-30 million people will remain uninsured after the ACA's reforms.
1. Social Health InsuranceUS and Access Lynn A. Blewett, Ph.D. Professor, University of Minnesota Westlake Forum IIIHealthcare Reform in China and the US: Similarities, Differences and ChallengesEmory University, Atlanta, GA April 10-12, 2011 Funded by a grant from the Robert Wood Johnson Foundation
2. Overview of Presentation Definition of social insurance Examples of social insurance in the US Distribution of coverage by insurance type A few points on national health reform Projections of persistent rates of uninsurance Conclusions
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4. Society as a whole suffers from the resulting loss of wages, loss of productivity and loss of time
5. Ill health is viewed as a social concern, not simply a personal problem; obtaining health insurance is mandatory, not a personal choiceSource: OECD Glossary of Statistical Terms, 2011
6. Examples of Social Insurance in the United States Unemployment insurance Social Security Medicare Health Insurance Coverage
7. Source: SHADAC-Enhanced CPS for 2009. Military Coverage considered ESI. Order of primary coverage assignment: Uninsured, Medicaid,Private Non-Group, ESI, Medicare.
11. Key Facts: Medicare (2010) 2010 Expenditures: $509 Billion # Elderly and disabled: 49 million % of national health care spending: 23% % of federal budget: 12% Average cost per beneficiary: $8,344 For top 10% high cost beneficiaries: $48,211 (FFS)
12. Financing – 2010 HI: Hospital Insurance Trust Fund 1.45% payroll tax on employers/employees Deductibles (e.g. $1,100 per hospital stay) Coinsurance (e.g. $275 per day from days 61 to 90 of a hospital stay; $550 per day for days 91-150, all costs over 150 days) SMI: Supplemental Medical Insurance Premiums: $110.50 per month (now income tested ) Deductible ($155 year) Coinsurance (20%) General Fund Revenue ACA - increases the payroll tax for higher‐income taxpayers (more than $200,000/individual and $250,000/couple) from 1.45% to 2.35% in 2013
14. Employer-Sponsored Health Insurance (ESI) Primary source of coverage in US – 60% Voluntary offer and voluntary take up Tax advantages for employer and employee contributions Trend of dropping health care as costs go up The challenge: where do people get coverage if not through their employer? Individual Market Today? Probably not. No pooling, underwriting, and individual risk-rating Makes up about 4% of under-65 coverage
15. Source: SHADAC-Enhanced CPS for 2000 and 2009. Percentage is for any ESI and includes individuals with other sources of coverage.
20. Subsidies to purchase private coverageNo social contract or universal coverage commitment
21. Increasing Rates of Uninsurance 15 Millions of Uninsured, all ages 16.7% of Population Source: U.S. Census Bureau, Current Population Surveys (March), 2000-2009
22. Universal Coverage for the Poor 16 Medicaid Expansion 133% Premium Subsidy 400% Federal Poverty Level
23. Exemptions to the Individual Mandate Financial hardship Religious objections American Indians and Alaska Natives Incarcerated individuals Those for whom the lowest cost plan option exceeds 8% of income Those whose income is below the tax filing threshold And the undocumented: 12 million people
24. Estimate of Uninsured After Health Insurance Reform Penalty Source: Urban Institute Who Will be Uninsured After Health Insurance Reform? March 2011. Estimates using 2011 Population with 2014 eligibility for programs.
Exemptions will be granted for financialhardship, religious objections, American Indians, those without coverage for less than three months,undocumented immigrants, incarcerated individuals, those for whom the lowest cost plan optionexceeds 8% of an individual’s income, and those with incomes below the tax filing threshold
