Transcript One Illness Away

One Illness Away
The crisis of the underinsured
National Congress on the Un- and
Under Insured
December 11, 2007
Washington, DC
How Did We Get Here?
“One Illness Away”
The Crisis of the Underinsured
A large portion of
the American
population is
unable to access
health care
services because
they simply cannot
afford them
“One Illness Away”
The Sad History of Health Care Cost
Containment as Told in One Chart
10
Annual Change in Private Health Spending Per Capita
Percent Change in Spending
8
6
4
2
0
-2
Wage & price
controls
Medicare & Medicaid
-4
Voluntary
effort
Managed care &
threat of health
reform
The cost of providing
coverage has increased
80% in our state in the
last five years.
A recent study
demonstrated that
New Jersey paid the
highest premiums for
single plans and the
third highest for
family plans.
As a result, businesses providing
coverage for their workers has
dropped so dramatically that
now, one in every five New
Jersey small business owners
simply cannot afford health
insurance and those who can are
increasingly shifting costs to
their workers.
We are home to more than 1.3 million
uninsured, 240,000 of them children
“One Illness Away”
One out of every
seven children in
our state received
NO medical care last
year as a result of
being uninsured.
Where “Here” Is
Medical Innovation =
more people are
living with chronic
illness and ongoing
treatment costs
“One Illness Away”
For most underinsured
Americans, there is no
health care “system,”
but rather a blotchy
and frayed patchwork
of unreliable and
inconsistent
programs, providers,
and facilities.
“One Illness Away”
The underinsured routinely experience delays in
getting care for a variety of medical problems.
The underinsured
receive less
preventive care
and poorer
treatment for
both minor and
serious chronic
and acute
illnesses.
The bottom line: In
many cases, the
underinsured live
shorter lives than
comparable insured
populations.
Where “Here” Is
Increased patient
cost-sharing is
exacerbating, not
helping, the
problem.
“One Illness Away”
Where “Here” Is
Insurers and
employers typically
do not anticipate copayment problems
when they design or
select a health plan
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Where “Here” Is
New kinds of
insurance benefits
are often abysmal
for the seriously ill
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Where “Here” Is
Patients required to pay
more out-of-pocket are
less likely to be
compliant
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Where “Here” Is
Underinsured
patients use a
variety of
strategies to
stretch their
medications
“One Illness Away”
Where “Here” Is
Not seeking
treatment until
their condition
becomes more
severe
“One Illness Away”
What We Are Doing
HEALTHWELL
FOUNDATION
©
“One Illness Away”
How do copayment foundations help?
 Screen applications to determine if patients qualify for
assistance based on their
 Income
 Insurance situation
 Disease being treated
 Award patients a grant for full or partial assistance, typically
to cover one year’s treatment
 Process requests for reimbursement based on a patient’s
award and actual expenses
“One Illness Away”
What We Are Doing
 Independent, National
Charity
 committed to help
individuals unable to
afford critical
medications for serious,
chronic conditions
 HealthWell has granted
assistance to more than
40,000 patients
“One Illness Away”
What We Are Doing
 HealthWell fields
more than 20,000
inquiries in a typical
month
 HealthWell
provides more than
$5 million each
month in relief.
“One Illness Away”
What We Are Doing
 HealthWell beneficiaries
 Have chronic and lifethreatening diseases
 Have some form of
health care coverage
 Still cannot afford the
out-of-pocket costs of
their treatment
“One Illness Away”
What We Are Doing
Assistance from HealthWell is based on
disease state, not prescribed treatment

Acute Porphyrias

Hodgkin’s Disease

Age-Related Macular Degeneration


Anemia associated with Chronic Renal
Insufficiency or Chronic Renal Failure
Immunosuppressive Treatment
for Solid Organ Transplant
Recipients

Ankylosing Spondylitis

Asthma, Moderate to Severe

Breast Cancer

Carcinoid Tumors and Symptoms
Related to Carcinoid Tumors

Chemotherapy Induced Anemia and
Neutropenia

Colorectal Carcinoma

Cutaneous T-Cell Lymphoma

Head and Neck Cancer

Iron Overload as a Result of
Blood Transfusions
 Multiple Myeloma

Myelodysplastic Syndromes
 Non-Hodgkin’s Lymphoma
 Non-Small Cell Lung Cancer
 Psoriasis

Psoriatic Arthritis
 Rheumatoid Arthritis
 Secondary Hyperparathyroidism
 Wilms’ Tumor
They are our friends and neighbors.
Gordon “Keith” Parke
Middleburg, Florida
Macular Degeneration
Age 50
“One Illness Away”
They are our family members.
Beatrice Szeles
Orange, California
Rheumatoid Arthritis
Age 56
“One Illness Away”
What We Can Do
We
must
do
more!
“One Illness Away”
What Reform Might Look Like
One State’s Proposal . . .
“One Illness Away”
“One Illness Away”
We knew where to start.
1. Enroll all who are eligible for state
sponsored coverage and manage the
Federal dollars available to us for
this purpose.
2. Make sure that those who have
health care coverage are able to keep
it.
3. Provide an affordable and adequate
coverage alternative for every man,
woman and child in our state.
“One Illness Away”
Total Uninsured =
1,300,000
New Jersey Total Population = 8,500,000
“One Illness Away”
New Jersey’s Uninsured
600,000
remaining
uninsured
300,000
Eligible but
not enrolled
400,000
undocumented
“One Illness Away”
Successful
Health Care Reform
Commercial Universal & Affordable &
Grade
Portable
Sustainable
Mandated
Comprehensive & Transformational
Reform
Elements
“One Illness Away”
Individuals will
be responsible to
provide proof of
health insurance
when they file
their state income
tax return.
“One Illness Away”
If they do not provide proof
of health insurance, they will
be placed by the state into the
new state health insurance
plan.
“One Illness Away”
If, for whatever reason, a New
Jersey resident seeks care
without insurance, their
provider will place them into
the new plan and provide
billing information to the new
plan.
“One Illness Away”
Combine in one,
self-funded plan
so the healthy
and the sick
balance each
other out yielding
a more affordable
health insurance
product.
“One Illness Away”
This new health insurance plan. . .
 Statewide network of providers,
 Available in an HMO and a PPO
format.
 Commercial grade, with
commercial reimbursements
 Modeled after the standard plan in
New Jersey’s small employer
market.
“One Illness Away”
Where an employee does not have
employer-based coverage his or her
employer must provide them access
to a flexible-spending account under
Section 125 of the IRS Code so the
employee can purchase their coverage
with before tax dollars.
Final Elements
 Offered to all New Jersey
residents,
 State subsidy provided based
on individual or family
affordability
 Charity care and related
hospital subsidies redirected to
premium assistance
“One Illness Away”
Comparison to the Massachusetts Plan
Massachusetts
New Jersey
 Individual Mandate
 Individual Mandate
 Expand Medicaid & SCHIP
 Expand Medicaid & SCHIP
 Section 125 Required
d
 Section 125 Required
 Connector to Private market
 State-Run Public Plan
 Multiple Insured Plans
 Single, Self-Insured Plans
 Employer Mandate
 No Employer Mandate
“One Illness Away”
We must be wary
of ungenerously
throwing upon
posterity the
burden which we
ourselves ought
to bear.
What We Can Do
“One Illness Away”
How You Can Make a Difference, Too
 Encourage
Transformational
Health Reform
 Support HealthWell
Foundation or other
Co-Payment Relief
Oranizations
 Spread the Word
“One Illness Away”
HEALTHWELL
FOUNDATION
©
Web: www.healthwellfoundation.org
Email: [email protected]
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