V – Cost and Coverage Quantitative Model Methodology and Assumptions
Adequate Health Care Task Force
Exhibit 5: Modeling Assumptions: Illinois Hospital Association
These estimates reflect a modeling approach designed to support comparisons across proposals. Using a common platform, the model provides high‐level cost, participation and financing estimates. The estimates consider major factors that affect cost and coverage, but may not (for reasons of time and available data) consider some factors that should be considered in developing more precise estimates, such as for a state legislative estimate.
Coverage/Access Approach
Public program expansion
Individual Mandate w/ public program expansion
New Purchasing Pool w/ creative Medicaid match
New Purchasing Pool featuring premium subsidies to individuals
Premium Interest Free Premium Subsidies
Bridge Loans
Subsidies
for COBRA Assistance for General Approach
Family Care Expansion to 200% FPL
Mandatory or Voluntary?
1.
Voluntary
Mandatory Coverage for ages 19‐23 in school w/ subsidy to 200% FPL
Mandatory for Individuals
Employer Sponsored Premium Small Employer ʺvouchersʺ for Purchasing Coop (SEPC) Employer & ʺvouchersʺ
Coverage
Voluntary
Voluntary
Voluntary
Voluntary
Voluntary
Insurance Initiative (ESI)(ineligible for vouchers)
Coverage
ICHIP Coverage Eligible (affected) Population(s)*
Age
Income
Adults (19‐64)
Adults (19‐23)
All ages 0‐64
All ages 0‐64
Adults (19‐64)
All age 0‐64
Adults (19‐64)
185%‐200% FPL
All Incomes
All Incomes
All Incomes
0‐200% FPL
All Incomes
0‐250% FPL
Parents
n/a
n/a
n/a
n/a
n/a
n/a
Workers and their Workers and their Dependents
Dependents
Workers
Unemployed
n/a
Family Status Work/Student Status
n/a
full‐time student
Firm Type
n/a
n/a
Current Coverage Status
Must be Uninsured
Draft and Preliminary ‐‐ 8/15/06
Must be Uninsured
1‐25; non‐offering
Must be Uninsured
V‐15
1‐25; non‐offering
Employer Offers
n/a
n/a
Not enrolled in public Not enrolled in Eligible for Eligible for coverage
public coverage
COBRA
ICHIP
Mathematica Policy Research, Inc.
V – Cost and Coverage Quantitative Model Methodology and Assumptions
Adequate Health Care Task Force
Exhibit 5: Modeling Assumptions: Illinois Hospital Association
These estimates reflect a modeling approach designed to support comparisons across proposals. Using a common platform, the model provides high‐level cost, participation and financing estimates. The estimates consider major factors that affect cost and coverage, but may not (for reasons of time and available data) consider some factors that should be considered in developing more precise estimates, such as for a state legislative estimate.
Coverage/Access Approach
Public program expansion
Individual Mandate w/ public program expansion
New Purchasing Pool w/ creative Medicaid match
New Purchasing Pool featuring premium subsidies to individuals
Premium Interest Free Premium Subsidies
Bridge Loans
Subsidies
for COBRA Assistance for General Approach
Family Care Expansion to 200% FPL
2.a.
Mandatory Coverage for ages 19‐23 in school w/ subsidy to 200% FPL
Employer Sponsored Insurance Initiative (ESI)(ineligible for vouchers)
Small Employer ʺvouchersʺ for Purchasing Coop (SEPC) Employer & ʺvouchersʺ
Coverage
Direct & Indirect
Direct
Premium Coverage
ICHIP Coverage Individual Premium Subsidy Detail:
What Type of Subsidy?
Reinsurance Subsidy ?
Indirect
Direct
No Reinsurance
No Reinsurance
n/a
n/a
Relief from Benefit Mandates
Indirect
90 percent of claims over 90 percent of claims over $200,000
$200,000
n/a
n/a
No Reinsurance
n/a
No Subsidy
Direct
No No Reinsurance
Reinsurance
n/a
n/a
0
0
A fixed dollar amount that would be 25% of full safety net coverage but considerably smaller for more comprehensive See below for specific coverage
subsidies
2.b.
Employer Premium Subsidy Detail:
Subsidy Percent
Draft and Preliminary ‐‐ 8/15/06
0%
0%
0%
V‐16
0%
0%
Mathematica Policy Research, Inc.
V – Cost and Coverage Quantitative Model Methodology and Assumptions
Adequate Health Care Task Force
Exhibit 5: Modeling Assumptions: Illinois Hospital Association
These estimates reflect a modeling approach designed to support comparisons across proposals. Using a common platform, the model provides high‐level cost, participation and financing estimates. The estimates consider major factors that affect cost and coverage, but may not (for reasons of time and available data) consider some factors that should be considered in developing more precise estimates, such as for a state legislative estimate.
Coverage/Access Approach
Public program expansion
Individual Mandate w/ public program expansion
New Purchasing Pool w/ creative Medicaid match
New Purchasing Pool featuring premium subsidies to individuals
Premium Interest Free Premium Subsidies
Bridge Loans
Subsidies
for COBRA Assistance for General Approach
Family Care Expansion to 200% FPL
3.
ages 19‐23 in school w/ subsidy to 200% FPL
Employer Sponsored Insurance Initiative (ESI)(ineligible for vouchers)
Small Employer ʺvouchersʺ for Purchasing Coop (SEPC) Employer & ʺvouchersʺ
Coverage
Premium Coverage
ICHIP Coverage Employer Requirements for Participation (if applicable):
Firm Type
Minimum ER Contribution (as a percent of premium)
4.
Mandatory Coverage for n/a
n/a
1‐25; non‐offering
1‐25; non‐offering
n/a
n/a
n/a
n/a
n/a
73%
73%
n/a
n/a
n/a
Safety Net Benefit Safety Net Benefit Typical Typical Current Package Package Commercial Commercial Coverage Health Benefit Detail:
Scope of Covered Services
Provider Discounts
SCHIP for SCHIP for Families>150% FPL (no Families>150% FPL (no maternity)
maternity)
Medicaid ‐ 50% Medicaid ‐ 50% Medicaid ‐ 50% Commercial ‐ 30% Commercial ‐ 30% Facility/75% Medicare Facility/75% Medicare Facility/75% Medicare Facility/125% Medicare Facility/125% Fees
Fees
Fees
Fees
Medicare Fees
17%
17%
Public Program ‐ 4% of Public Program ‐ 4% of Public Program ‐ 4% of Premium
Premium
Premium
Plus a Medicaid Provider reimbursement increase of
Administrative Expense
Draft and Preliminary ‐‐ 8/15/06
Commercial ‐ Commercial ‐ 30% Medicare Fees Medicare Fees
0%
V‐17
30% Facility/125% Facility/125% 0%
ICHIP Rates ‐ Average ICHIP Rates ‐ 6.3% of Average Employer ‐
6.3% of Employer ‐ 20% Premium
20% of premium
Premium
of Premium
Mathematica Policy Research, Inc.
V – Cost and Coverage Quantitative Model Methodology and Assumptions
Adequate Health Care Task Force
Exhibit 5: Modeling Assumptions: Illinois Hospital Association
These estimates reflect a modeling approach designed to support comparisons across proposals. Using a common platform, the model provides high‐level cost, participation and financing estimates. The estimates consider major factors that affect cost and coverage, but may not (for reasons of time and available data) consider some factors that should be considered in developing more precise estimates, such as for a state legislative estimate.
Coverage/Access Approach
Public program expansion
Individual Mandate w/ public program expansion
New Purchasing Pool w/ creative Medicaid match
New Purchasing Pool featuring premium subsidies to individuals
Premium Interest Free Premium Subsidies
Bridge Loans
Subsidies
for COBRA Assistance for General Approach
Family Care Expansion to 200% FPL
Mandatory Coverage for ages 19‐23 in school w/ subsidy to 200% FPL
Employer Sponsored Insurance Initiative (ESI)(ineligible for vouchers)
Small Employer ʺvouchersʺ for Purchasing Coop (SEPC) Employer & ʺvouchersʺ
Coverage
Premium Coverage
ICHIP Coverage Financing of Subsidies & 5.
Program Administration:
General
Is state effort eligible for Federal Match?
Up to 200% FPL
State Revenues (w/ State Revenues (w/ Federal Match)
Federal Match)
None specified; Employer Assessments Employer Assessments use consultants best approach None None specified; use specified; use consultants consultants best approach best approach Yes, at SCHIP Rates
Yes, at SCHIP Rates
Yes, at Medicaid Rates
No
No
No
No
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Amount of Insurers assessment (if applicable)
Amount of ER Payroll assessment (if applicable)
Amount of EE Payroll assessment (if applicable)
Draft and Preliminary ‐‐ 8/15/06
V‐18
Mathematica Policy Research, Inc.
V – Cost and Coverage Quantitative Model Methodology and Assumptions
Adequate Health Care Task Force
Exhibit 5: Modeling Assumptions: Illinois Hospital Association
These estimates reflect a modeling approach designed to support comparisons across proposals. Using a common platform, the model provides high‐level cost, participation and financing estimates. The estimates consider major factors that affect cost and coverage, but may not (for reasons of time and available data) consider some factors that should be considered in developing more precise estimates, such as for a state legislative estimate.
Coverage/Access Approach
Public program expansion
Individual Mandate w/ public program expansion
New Purchasing Pool w/ creative Medicaid match
New Purchasing Pool featuring premium subsidies to individuals
Premium Interest Free Premium Subsidies
Bridge Loans
Subsidies
for COBRA Assistance for General Approach
Family Care Expansion to 200% FPL
Mandatory Coverage for ages 19‐23 in school w/ subsidy to 200% FPL
Employer Sponsored Insurance Initiative (ESI)(ineligible for vouchers)
Small Employer ʺvouchersʺ for Purchasing Coop (SEPC) Employer & ʺvouchersʺ
Coverage
Premium Coverage
ICHIP Coverage Assumed Premium Subsidy Rates (By % of FPL)
<100%
100%
100%
100%
25%
25%
0%
100‐149%
100%
100%
100%
25%
25%
0%
80%
80%
150‐199%
94%
91%
100%
25%
25%
0%
50%
200‐249%
76%
0%
100%
0%
0%
0%
50%
250‐299%
76%
0%
100%
0%
0%
0%
0%
0%
0%
100%
0%
0%
0%
0%
90%
300%+
Assumed Participation Rates (By % of FPL)
<100%
90%
95%
100%
54.4% 90%
0%
100‐149%
90%
95%
100%
65%
90%
8%
90%
150‐199%
39%
94%
100%
65%
90%
8%
90%
200‐249%
39%
75%
100%
75%
90%
25%
90%
250‐299%
39%
75%
100%
75%
90%
40%
90%
300%+
39%
90%
100%
82%
90%
60%
90%
Lower for uninsured
* Note: this is program eligibility which may be different from subsidy eligibility
Draft and Preliminary ‐‐ 8/15/06
V‐19
Mathematica Policy Research, Inc.