Foster Public-Private Coverage Solutions - What the Blues are Doing - Helping Those 'Squeezed Out'
Fifty-six percent – about 25 million – uninsured individuals are ineligible for public programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) but have difficulty affording health coverage (Urban Institute, 2006). Some may be between jobs or recent college graduates who decide to go without coverage, or they work for firms that don't offer health benefits. Others cannot afford health insurance because they are unemployed or do not earn enough to pay for coverage on their own. Some may be offered coverage from their employers, but cannot afford their share of the premium.
Helping Low-Wage Workers in Small Firms
Many Blue Plans have developed products and programs to help make coverage more affordable for employees of small businesses.
Blue Cross and Blue Shield of Oklahoma was instrumental in creating a premium assistance program for Oklahoma – a program closely tracking BCBSA's recommendation to provide tax credits based on the cost of insurance. Funded by a tobacco tax, the Oklahoma program provides premium assistance to low-income workers (less than 200 percent of the federal poverty level (FPL)) in eligible small firms offering a qualified health plan. Employers contribute 25 percent of the monthly premium; employees pay up to 15 percent of the premium (up to 3 percent of their income). Currently over 3,400 lives are covered, and eligibility for the program was recently expanded.
BlueCross BlueShield of Western New York launched Aqua in 2007, a small group product aimed at reducing costs for employers while providing members with exceptional coverage. Members are given a $500 (single) or $1,000 (family) Aqua Allowance to be used as "first dollar" coverage for eligible medical expenses, with members able to carry over up to $500 single/$1,000 family in their allowances to the next year. After the allowance is used, deductibles and coinsurance are applied. In-network hospitalization and well-child visits are covered in full. Preventive care also is an important aspect, with members given $250 (single) or $500 (family) for gym memberships or other health and wellness services.
Blue Cross and Blue Shield of Kansas offers the Value Blue plan at 50 percent savings to eligible individuals and small groups with incomes up to 200 percent of FPL who have been uninsured for 12 months. Healthcare providers accept a 50 percent discount and BCBS of Kansas absorbs all administrative costs. The Value Blue plan provides the first five office visits for a $25 co-pay, then a $1,000 deductible with 20 percent coinsurance is applied with no annual benefit limit.
Helping Individuals Struggling with Healthcare Costs
Many Blue Plans offer innovative products and programs for individuals who may have trouble affording health coverage. These products can cost significantly less by reducing administrative costs and negotiating deeper discounts with providers for select populations.
Blue Cross of Northeastern Pennsylvania developed a new product in early 2007 called Blue Care Direct for individuals who have traditionally had trouble finding insurance – young and healthy individuals, retirees not yet eligible for Medicare and self-employed individuals. BlueCare Direct eliminates the gap between what individuals perceive they can afford and what is available in the individual health insurance marketplace. BlueCare Direct was designed with four deductible options, prescription drug coverage, health and wellness programs and an extensive network of local and national doctors and hospitals.
Blue Cross and Blue Shield of Florida created a series of products for individuals and groups to provide a range of coverage options. Called BlueOptions, these plans include a routine care plan as well as a hospital and surgical care plan. The Plan negotiated lower payment agreements for this population with providers that resulted in lower costs to members. The Plan is rolling out additional enhancements to its BlueOptions plans, including adding a 90-day retail benefit for pharmacy, lower cost sharing for e-visits (online visits between doctors and patients in lieu of an in-person office visit), access to a new discount program for prescription drugs not covered under an existing pharmacy plan, and a hospital network utilizing the most efficient hospitals.
Blue Cross & Blue Shield of Rhode Island has a premium assistance program for its individual market members. The program works with all direct coverage offered by the Plan, with the amount of assistance provided determined by a members' gross annual household incomes and whether they have an individual or family plan. The Plan set aside $9 million in 2006 for premium subsidies.
Blue Cross and Blue Shield of Oklahoma worked with local hospitals in 2004 to encourage the Oklahoma legislature to enact the Oklahoma Employer/Employee Partnership for Insurance Coverage (O-EPIC). This program provides premium assistance to both individuals without employer coverage as well as employees with coverage through their small employers. Blue Cross and Blue Shield of Oklahoma currently participates in O-EPIC by offering policies that qualify for the subsidies.
Mountain State Blue Cross & Blue Shield works closely with the West Virginia Workforce Agency to help displaced manufacturing workers obtain health coverage eligible for the federal health coverage tax credit. When the state workforce agency meets with workers to explain the trade adjustment assistance benefits available to them, Mountain State representatives provide literature and answer workers' questions about health coverage.
Helping States Develop Tailored Initiatives
Blue Cross and Blue Shield Plans have created several innovative programs in their local communities to assist the uninsured.
In January 2007, Blue Cross and Blue Shield of Florida's Blue Foundation for a Healthy Florida announced over $651,000 in grants to community organizations that serve the uninsured. Examples are a $100,000 grant to the St. Petersburg Free Clinic to expand the clinic's Walk-In Now program, a supplemental medical care program that serves uninsured and underserved patients in Pinellas County, and a $40,000 grant to BayCares, Inc. to establish a prescription drug assistance program for uninsured patients. In 2007, the Foundation plans to donate $2.5 million, all focused on the uninsured.
The Blue Cross and Blue Shield of North Carolina Foundation directs much of its effort and resources to improving health outcomes for the uninsured, low income and other vulnerable populations. This includes a five-year partnership with the North Carolina Association of Free Clinics to sustain and expand services of free clinics and pharmacies, with a goal of providing statewide access by 2009. Since the partnership began in 2004, the number of clinics has increased by 27 percent. North Carolina now has the nation's largest network of free clinics. The Foundation also is in the midst of a five-year initiative with the N.C. Medical Society Foundation to support the Community Practitioner Program, which recruits primary healthcare providers to rural and other high need areas of the state. The partnership is expected to generate millions of dollars in care for the uninsured, and increase patient visits in rural and economically distressed areas by hundreds of thousands annually.
The Regence Caring Foundation for Children provides dental services for children whose parents work but do not qualify for government assistance and cannot afford dental insurance coverage. In 2006, more than 2,600 children received comprehensive dental care at no cost to their families. Regence Blue Cross Blue Shield of Utah and Regence Blue Shield of Idaho provide all the administrative support for the Foundation – which included more than $600,000 in cash and in-kind contributions last year. This level of commitment allows 100 percent of all donations to provide direct services to children from low-income families.
BlueCross BlueShield of Tennessee Health Foundation has as one of its 2007 funding objectives "Innovations of Care for the Uninsured." Examples of Foundation grants in 2006 include funding of about $500,000 for community-based volunteer clinics that treat the uninsured and underinsured, and providing administrative services in a pilot program with the Memphis Church Health Center, a clinic that directs uninsured persons into physician practices and hospitals that will treat them. The Plan tracks these encounters so doctors can have a record of patient care.
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