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• The Problem: A Growing Number of Uninsured Working
Adults

•

Solution: Three Share Health Insurance Model

• The Uninsured Adult Population in Santa Clara County
• Employer Characteristics in California
•

Firm Characteristics in Santa Clara County

•

Health Care Costs

• State and Local Health Expansion Programs
• Next Steps

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More working adults are becoming uninsured
• Between 2000 and 2004 employer-based health coverage dropped
from 61% to 58% for adults in CA and the number of uninsured rose to
24%.

•

Low and middle income adults are most at risk of losing health care
coverage from their employer in the next five years
• By 2010, only 30% of adults under 300% of FPL will have health
insurance from their employer and 42% will be uninsured

•

Virtually all low and middle income adults are ineligible for a public
program and many cannot afford to purchase private health insurance
• Only 28% of adults are enrolled in a public program or have private
coverage. This is expected to remain unchanged in the next five
years, despite a jump in uninsurance.

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Demographics of the Uninsured in Santa
Ciara County
•

Number of uninsured adults below 300% of FPL: 108,000

•

Racial demographics (adults below 300% of FPL)
• African American: 2%
•

Latino: 43%

•

Asian: 25%

•

Other: 9%

• Age (adults below 300% of FPL)
. 19-24:29% v

, 9,

• 25-39: 32% /
• 40-64: 39%

•

Gender: Male: 56%, Female: 44%

•

Number of uninsured adults below 300% of FPL working full time:
48,000

WORKING PARTNERSHIPS USA
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Employer Characteristics in California
• Offer rates by firm size:
• 49% for fewer than 10 employees
• 60% 10-50 employees

• Take up rate for low-wage firms(35% or more of workforce
earns $20,000 or less): 75%

• 80% of low wage firms have between 3-25 employees,
(89% of low wage firms have between 3-50 employees)

• 34% of small businesses between 3-25 employees are
low-wage
(52% of small business between 3-50 employees are low wage)
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• Number of firms in Santa Clara County with fewer
than 50 workers: 28,430
• If we assume that 52% of these firms are low wage

then our targeted number of firms are 13,650
• Numbers of employees in firms with 50 or fewer
workers: 203,650
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Note: this data includes Santa Clara and San Benito counties

Target nu mber
df Firms in.
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SGC: ] 3,650

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Health Care Costs
•

Average employer premiums for employee only coverage in 2005:
$321/ month or $3,852/yr
• Average employer contribution: $277/ month

• Average worker contribution for employee only coverage: $41/ month
($54 for low wage firms)

•

Major barriers to coverage (as reported by employers):
• High premiums: 66%
• Firm too small: 49%

• Average amount employers (currently not offering coverage) could
contribute toward health insurance: $124/ month

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St^te and Local Hoalth E^cpanslon
Programs
• Models studied include:
• Maine

Hawaii

• New York

New Mexico

• Massachusetts

San Francisco

• Illinois

San Mateo

• Tennessee

Sacramento

• Michigan (Muskegon County)

Contra Costa

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S tate Health Expansion

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Maine: Dirigo Health

•

Eligibility: Small businesses (2-50 workers), self employed, sole

•
•

proprietors, uninsured workers
Benefits: comprehensive health coverage
Costs: Based on sliding scale by income
• Average cost of health plan: $300/ month, employer pays 60%
•

State subsidies are available to workers at 300% of FPL or less

Monthly premium for workers below 200% of FPL: $24- $48
Monthly premium for workers between 200% and 300% of FPL: $72- $96

•

Enrollment (7,400 as of Feb-06)
• 57% of all enrollees are between 100%-200% of FPL
•

18% of all enrollees are between 200%-300% of FPL

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St^te Health Expansion Programs
• Tennessee (TennCare program prior to 2005 cuts)
•

Eligibility: This is a Medicaid expansion program, all uninsured Tennessee
residents are eligible; however discounts are only available to residents under
300% of FPL

•

Benefits: Comprehensive- outpatient, hospitalization, prescription drug, vision

•

Costs: Based on a sliding scale
Below 100% of FPL: $0/ month
100%-200% of FPL: $20-$35/ month
200%-300% of FPL: $100/ month

•

Enrollment:
838,560 Below 100% of FPL
303,950 between 100%-200% of FPL
57,150 above 200% of FPL

WORKING PARTNERSHIPS USA

Local Health Expansion Programs
•

Muskegon County, Michigan

•

Eligibility:
• Employers: businesses must be located in the county, median worker wage
$11.50/hr or below, employers must have gone 12 months without offering coverage

•

Benefits: Comprehensive- inpatient, outpatient, prescription drugs, home
health

• Plan does not cover services outside the county
Costs:

• Adults; $46, Employer; $46, Community: $56. The community share is funded by
disproportionate hospital payments(DSH)
•

Enrollment:

• December 2005: 1,500 workers (county is only 170,000 people)
• 430 participating businesses

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Local Health Expansion Programs
•

Sacramento County(Sac Advantage)

•

Eligibility;
• Employer: must be based in Sacramento county, have at least 2-50 employees and have
not offered health care for previous six months. 70% of eligible workers must enroll.
•

Workers: must work 30hrs/ week and income must be below 300% of FPL

•

Benefits: Offers two comprehensive commercial plans- Blue Shield and Kaiser

•

Cost; Based on sliding scale by income( $300/month for health plan)
• Employers/workers split cost of the monthly premiums
• Subsidy is available to workers below 300% of FPL
• Cost to worker and employer (after subsidy):
•

Under 200% of FPL: $52

. 200-250% of FPL: $75
•

250-300% of FPL: $90

Enrollment
•

80 businesses, 230 workers

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state Health Expansion Programs
•

New York: Healthy New York

•

Eligibility:
•
•

Individuals (or sole proprietors): uninsured for at least 12 months, income below 250% of FPL
Employers: Fewer than 50 employees, 30% of workers must earn less that $34,000/yr, cannot have
offered coverage in last 12 months

Benefits: comprehensive coverage- inpatient, outpatient, maternity/ ER, prescription drugs. Some pre-existing
conditions are excluded.

•

Costs: Cost of plan varies from $186-$288/month
• Employers/workers split cost of the monthly premiums

• State reimburses health plans for 90% for their claims between $5,000 and $75,000 on
behalf of the member.

•

Enrollment (by monthly premium level): 100,000 as of December 2004
•

Below $125/mo: 12%

•

$125-$150/mo: 30%

•

$150-$175/: 20%

•

$175-$200/mo: 34%

•

$200-$225/mo:5%

WORKING PARTNERSHIPS USA

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state Health Expansion Programs
•

New Mexico Health Insurance Alliance

Eligibility:
• Employers: Fewer than 50 workers, 50% of workers must live in NM and 50% of
eligible employees must participate.
•

Workers: income must be below 200% of FPL.

Benefits: Program offers three commercial plans- HMO, PPO and Indemnity. All provide

•

comprehensive health benefits- outpatient, inpatient, prescription drugs, mental health
•

Costs:

• Employer: $75.
• Worker pays: $0-35 (Self employed individuals pay both employer and worker share)
• State pays the remaining cost through unspent SCHIP money. Enrollment(program
began in July 2005)

•

-

2,300 members

*

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