centers for medicare & medicaid services tom scully cms administrator
TRANSCRIPT
CENTERS for
MEDICARE & MEDICAID SERVICES
Tom Scully
CMS Administrator
Total CMS budget ~ $429 billion in FY 2003 ($549 billion w/ Medicaid state match)
Medicare:
• FY 2003 ~ $254.8 billion
• 5.7% average annual growth rate
• $246.7 billion (FY 2002) to $428.6 billion (FY 2012)
Medicaid:
• FY 2003 ~ $158.7 billion
• Plus state spending of $120 billion
• 8.4% spending rate increase over next 10 years
Medicare and Medicaid Budget
Beneficiaries covered (in millions - September 2002)
Total: 42.5
Aged: 4.5
Blind/Disabled: 7.5
Children: 21.5
Adults: 9.0
Medicaid Coverage
Total new eligibles: 2,902,102
• HIFA waivers expanded coverage: 476,750
• Pharmacy Plus: 555,294
• Family Planning: 88,000
Enhanced coverage: 6,703,597
Waiver Coverage
Home/Community Based Services
Expanded opportunities for Medicaid beneficiaries to live in their homes or in the community rather than in nursing homes, hospitals, or other institutions
Total: 688,152
AIDS/Tech Dependents 21,843
Disabled/Physically Disabled 24,997
MR/DD 259,561
Aged / Disabled 381,751
Waiver Coverage
Federal matching payments ~ $147 billion
Largest source of federal funds to states = 43% of all grants-in-aid.
Mandatory Spending
Acute Care ~80%
Long Term Care 12%
Medicare ~8%
Optional Spending
Long Term Care 58%
Other Acute Care 31%
Prescription Drugs 10%
Medicaid Spending (FY 2002)
62.6%
8.3% 9.8%13.5%
3.4% 1.7%
14.6%
0%
10%
20%
30%
40%
50%
60%
70%
Employer
Sponsored
Insurance
Other
Pr ivate
Insurance
Medicaid Medicar e Mi l i tary Other
Insurance
Uninsured
Uninsured Issues
Insurance Coverage Rates: 41.2 million uninsured
The Uninsured Rate Over Time
12.8% 13.0%13.8% 14.1% 14.0% 14.2% 14.5% 14.9% 15.0% 14.5% 14.2% 14.6%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Uninsured Distribution by Citizenship
Foreign Born Naturalized
Citizens
5%
Foreign Born Non-Citizens
21%
Native U.S. Citizens
74%
41.2 million Uninsured
2.1 million
30.4 million
8.8 million
28%
23%
16%
13% 13%
1%
12%
0%
5%
10%
15%
20%
25%
30%
Below 18 18-24 25-34 35-44 45-54 55-64 Over 65
Uninsured Rates by Age
Uninsured Rates by Race
10%
19%
33%
25%
18%
0%
5%
10%
15%
20%
25%
30%
35%
40%
White Black Hispanic Amer ican Indian Asian/ Pacifi c
Islander
Kaiser Commission on Medicaid and the Uninsured 2001
Kaiser Commission on Medicaid and the Uninsured 2001
Uninsured receive health care
• Less care than insured people
• Uninsured average $1253 in medical care
• Privately insured average $2484 in medical care
Uninsured Care
Benefits• Health insurance reduces mortality rates by
10 to 15 %
• Better health associated with insurance coverage boosts yearly income 10 to 30 %
• Least efficient care – after people get sick and need emergency or hospital care
Decreasing the Number of Uninsured
About $30-40 billion a year in new funding
• About $1000 per person per year for about 40 million people
• $31 billion - current spending on uncompensated care
• $9 billion from President’s Tax Credit Proposal ($89 billion over 10 years)
• Additional $20-30 billion a year would allow essential insurance coverage for all.
Cost of Covering the Uninsured
Goal:To Reduce the Number of Uninsured
Credit Amounts
Adult/child: $1,000/$500
Family Max: $3,000
Income range covered
Single: full up to $15,000--phase out at $30,000
Families: full up to $25,000--phase out at $60,000
President’s Tax Credit Proposal
Goal:To Reduce the Number of Uninsured
• “Minimum standards”
• Individual private insurance market
• Existing state rules
• Based on last year’s income as reported to the IRS
• No change to current law
• Federal program
President’s Tax Credit Proposal
CMS – Improving Health Care
• Long Term Care – Reverse Mortgages
• Medicare Reform
• Quality – Nursing Homes– Home Health– Hospitals
• Medicaid Reform– Secretary Thompson
Other Issues