Health Insurance
Enrollment, Benefits, Funding, and Other Characteristics of State High-Risk Health Insurance Pools Gao ID: GAO-09-730R July 22, 2009A growing number of states--35 as of June 2009--have created high-risk health insurance pools (HRPs) primarily to provide coverage to individuals whose health status limits their access to coverage in the private individual health insurance market. HRPs--typically state-run nonprofit associations--often contract with a private health insurance carrier to administer the pool and offer a range of health plan options to such individuals, who are commonly referred to as medically uninsurable. Plan options vary within pools and from state to state, and like the private individual market, HRPs typically impose waiting periods for coverage of preexisting conditions to discourage medically uninsurable individuals from foregoing health insurance until they require care. Because of the higher health care costs typically incurred by medically uninsurable individuals, all pools operate at a loss. Premiums for HRP health plans are higher than for plans offered to healthy individuals in the private health insurance market; however, these premiums are capped to limit enrollees' costs and are thus insufficient to cover the costs of enrollee health care claims. As a result, all HRPs supplement their revenues through various funding mechanisms, such as assessments on health insurance carriers and state general revenues. Federal grants are also awarded to establish and fund HRPs. As part of the Trade Adjustment and Assistance Reform Act of 2002, Congress established a program to provide grants to HRPs to offset losses and establish HRPs--commonly referred to as operational and seed grants, respectively. Subsequent legislation authorized funding for the program through 2010, including grants to be used for supplemental consumer benefits--commonly referred as bonus grants. Since 2003, the grant program has awarded nearly $286 million to state HRPs for various purposes. The Centers for Medicare & Medicaid Services (CMS), withiDepartment of Health and Human Services (HHS), administers this federal grant program. Recent health care reform proposals call for an expanded role for HRPs to enhance health insurance options for the medically uninsurable. Because of the federal funding provided to HRPs, you expressed interest in obtaining data on several aspects of each state HRP. In this report, we describe (1) HRP enrollment and enrollee demographics; (2) HRP plans' cost-sharing provisions, coverage restrictions, and premiums, and comparable information for certain private market health plans; and (3) HRPs' governance, expenditures, and funding.
HRP enrollment--enrollees and their dependents--totaled 199,418 in the 34 HRPs in 2008. We estimated nearly 4 million additional individuals to be potentially eligible for enrollment in an HRP based on their uninsured status and preexisting health conditions. In 2008, the average annual deductible for the most popular plan offered by each of the 34 HRPs was $1,593--almost three times as high as the average annual deductible of $560 among employer-sponsored health insurance plans. About 63 percent of enrollees in these most popular HRP plans had deductibles of $1,000 or greater. In comparison, almost 88 percent of enrollees in employer-sponsored plans had a deductible of under $1,000 or no deductible. Collectively, in 2008, HRP governing boards included representatives from health insurance carriers (41 percent of board members), state government (13 percent), medical providers (9 percent), enrollees (7 percent), and employers (3 percent), among others. Total claims paid by HRPs in 2008 were about $1.9 billion, accounting for almost 95 percent of total HRP expenditures. The average claims per enrolled individual totaled $9,437 in 2008, an increase of about 39 percent since 2003. In 2008, premium revenue contributed 54 percent of HRP funding, and insurance carrier assessments contributed about 23 percent. HRPs were awarded a total of approximately $286 million in federal grants between 2003 and 2008, according to CMS. Almost 83 percent of these funds were operational grants, almost 15 percent were bonus grants, and less than 3 percent were seed grants. Federal grants comprised less than 2 percent of total HRP funding in 2008.
GAO-09-730R, Health Insurance: Enrollment, Benefits, Funding, and Other Characteristics of State High-Risk Health Insurance Pools
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GAO-09-730R:
United States Government Accountability Office:
Washington, DC 20548:
July 22, 2009:
The Honorable Henry A. Waxman:
Chairman:
Committee on Energy and Commerce:
House of Representatives:
The Honorable John D. Dingell:
Chairman Emeritus:
Committee on Energy and Commerce:
House of Representatives:
The Honorable Frank Pallone, Jr.
Chairman:
Subcommittee on Health:
Committee on Energy and Commerce:
House of Representatives:
Subject: Health Insurance: Enrollment, Benefits, Funding, and Other
Characteristics of State High-Risk Health Insurance Pools:
A growing number of states--35 as of June 2009--have created high-risk
health insurance pools (HRPs) primarily to provide coverage to
individuals whose health status limits their access to coverage in the
private individual health insurance market.[Footnote 1] HRPs--
typically state-run nonprofit associations--often contract with a
private health insurance carrier to administer the pool and offer a
range of health plan options to such individuals, who are commonly
referred to as medically uninsurable.[Footnote 2] Plan options vary
within pools and from state to state, and like the private individual
market, HRPs typically impose waiting periods for coverage of
preexisting conditions to discourage medically uninsurable individuals
from foregoing health insurance until they require care.[Footnote 3]
Because of the higher health care costs typically incurred by medically
uninsurable individuals, all pools operate at a loss. Premiums for HRP
health plans are higher than for plans offered to healthy individuals
in the private health insurance market; however, these premiums are
capped to limit enrollees' costs and are thus insufficient to cover the
costs of enrollee health care claims.[Footnote 4] As a result, all HRPs
supplement their revenues through various funding mechanisms, such as
assessments on health insurance carriers and state general revenues.
Federal grants are also awarded to establish and fund HRPs. As part of
the Trade Adjustment and Assistance Reform Act of 2002, Congress
established a program to provide grants to HRPs to offset losses and
establish HRPs--commonly referred to as operational and seed grants,
respectively.[Footnote 5] Subsequent legislation authorized funding for
the program through 2010, including grants to be used for supplemental
consumer benefits--commonly referred to as bonus grants.[Footnote 6]
Since 2003, the grant program has awarded nearly $286 million to state
HRPs for various purposes. The Centers for Medicare & Medicaid Services
(CMS), within the Department of Health and Human Services (HHS),
administers this federal grant program.
Recent health care reform proposals call for an expanded role for HRPs
to enhance health insurance options for the medically uninsurable.
Because of the federal funding provided to HRPs, you expressed interest
in obtaining data on several aspects of each state HRP. In this report,
we describe (1) HRP enrollment and enrollee demographics; (2) HRP
plans' cost-sharing provisions, coverage restrictions, and premiums,
and comparable information for certain private market health plans; and
(3) HRPs' governance, expenditures, and funding.
To address our three objectives, we administered a Web-based data
collection instrument (DCI) to senior officials of the 34 HRPs in
operation in 2008.[Footnote 7] The data obtained were generally for
fiscal year 2008, although for certain questions we obtained additional
historical data. Because each HRP offers multiple plan options to
enrollees, in order to simplify comparisons of plan-specific cost-
sharing provisions, benefits, coverage restrictions, and premiums, we
limited many of our comparisons to each pool's most popular plan--i.e.,
the plan chosen by the most enrollees. Collectively, the most popular
plans covered 41 percent of the enrollees across the 34 HRPs.[Footnote
8] To ensure the clarity and precision of our DCI questions, we
pretested the DCI with officials of the National Association of State
Comprehensive Health Insurance Plans (NASCHIP), an organization that
provides educational resources and information to assist state HRPs in
their operation. We also received comments on the DCI from a CMS
official involved in the HRP federal grant program. We received
responses to the DCI from all 34 HRPs, although not every HRP responded
to every question in the DCI. We relied on the data as reported by the
HRPs and did not independently verify or evaluate these data. However,
we reviewed all responses for reasonableness and consistency, and we
clarified apparent irregularities by comparing the data to other
sources, such as an annual compendium of HRP statistical information
compiled by NASCHIP. In addition, we followed up with state HRP
representatives for clarification where necessary. Based on these
activities, we determined these data were sufficiently reliable for the
purpose of our report.
We supplemented information obtained through the DCI with additional
data and analyses. For our first objective, we estimated the number of
individuals potentially eligible for HRP enrollment because they were
uninsured and had one or more preexisting health condition. To do this,
we used 2006 Medical Expenditure Panel Survey (MEPS) data to determine
the percentage of uninsured individuals with at least one chronic
condition that was diagnosed or treated in 2006. We then applied that
percentage to Current Population Survey (CPS) estimates of the number
of uninsured individuals in each of the 34 states with HRPs.[Footnote
9],[Footnote 10] We assessed the reliability of the MEPS and CPS data
by reviewing related documentation and by testing the MEPS data to
identify outliers, missing data, and other potential sources of errors,
and we determined they were sufficiently reliable for our purposes. For
our second objective, we compared selected HRP benefits and coverage
restrictions to those found in employer-sponsored health insurance
plans by obtaining data from two annual surveys--the Kaiser Family
Foundation and Health Research and Educational Trust (KFF/HRET)
Employer Health Benefits Annual Survey and the Mercer National Survey
of Employer-Sponsored Health Plans.[Footnote 11] KFF/HRET presents
annual data based on its survey of a random sample of private and
public-sector employers, which it implements from July through May each
year. Mercer presents annual data based on its survey of a random
sample of private-sector employers, which it implements in July of each
year. For each of these surveys, we reviewed the survey instruments and
methodology and determined that the data were sufficiently reliable for
our purposes. To compare trends in HRP premiums to those in the private
health insurance market, we compared HRP premium data reported in our
DCI to premium estimates for the private individual health insurance
market published by America's Health Insurance Plans (AHIP)--a health
insurance trade association--and for the employer-sponsored health
insurance market published by KFF/HRET. Finally, for our third
objective, we supplemented the HRP funding information we obtained
through the DCI with CMS documentation on the federal grants and
through interviews with the CMS official who manages these grants. We
did not independently verify or evaluate information we received from
CMS.
We conducted our work from July 2008 to June 2009 in accordance with
all sections of GAO's Quality Assurance Framework that are relevant to
our objectives. The framework requires that we plan and perform the
engagement to obtain sufficient and appropriate evidence to meet our
stated objectives and to discuss any limitations in our work. We
believe that the information and data obtained, and the analysis
conducted, provide a reasonable basis for any findings and conclusions
in this product.
Results in Brief:
HRP Enrollment and Demographics of Those Enrolled:
* HRP enrollment--enrollees and their dependents--totaled 199,418 in
the 34 HRPs in 2008. We estimated nearly 4 million additional
individuals to be potentially eligible for enrollment in an HRP based
on their uninsured status and preexisting health conditions.[Footnote
12]
* All HRPs accepted new applicants in 2008 except for California, which
had a waiting list of about 1,030, and Florida, which has been closed
to new enrollment since 1991.
* The average age of HRP enrollees in 2008 was 49 years and their
average length of enrollment was 3 years. Among the 6 HRPs that
collected employment or income data,[Footnote 13] about half of the
enrollees were employed, and the average household income was about
$41,000.
Enclosure I provides additional information on HRP enrollment and
enrollee demographics.
HRP Cost-sharing Provisions, Coverage Restrictions, and Premiums:
* In 2008, the average annual deductible for the most popular plan
offered by each of the 34 HRPs was $1,593--almost three times as high
as the average annual deductible of $560 among employer-sponsored
health insurance plans. About 63 percent of enrollees in these most
popular HRP plans had deductibles of $1,000 or greater. In comparison,
almost 88 percent of enrollees in employer-sponsored plans had a
deductible of under $1,000 or no deductible.
* About 18 percent of enrollees in the 34 most popular HRP plans in
2008 were in plans that did not cover maternity care and about 3
percent were in plans that did not cover mental health services. Almost
all enrollees in the most popular plans had access to prescription drug
and transplant coverage.
* Fifteen percent of the most popular plans (5 plans) in 2008 had
annual maximum coverage limits. These annual limits ranged between
$75,000 and $300,000 and averaged $175,000. By comparison, 10 percent
of employer-sponsored plans had annual limits. Almost 90 percent of the
most popular plans (30 plans) had lifetime dollar limits, which ranged
between $500,000 and $5,000,000 and averaged $1.6 million. By
comparison, 56 percent of employer-sponsored plans had lifetime limits.
* Between 2004 and 2008, average monthly HRP premiums rose by 14
percent across all plans, from $424 to $485. During the period 2004
through 2006, HRP average monthly premiums increased by 6 percent while
average premiums in the employer-sponsored health insurance and the
individual health insurance markets both increased by 15 percent.
During the period 2007 through 2008, HRP average monthly premiums
increased by 6 percent and employer-sponsored market premiums increased
by 5 percent. No comparable individual market premium data were
available for these 2 years.
* Fourteen percent of all HRP enrollees received income-based premium
subsidies, which were offered by 12 HRPs in 2008. The average monthly
subsidy received was $261, or about 49 percent of the subsidy
recipients' average monthly premium of about $538.
Enclosure II provides additional information on HRP cost-sharing
provisions, coverage restrictions, and premiums.
HRP Governance, Expenditures, and Funding:
* Collectively, in 2008, HRP governing boards included representatives
from health insurance carriers (41 percent of board members), state
government (13 percent), medical providers (9 percent), enrollees (7
percent), and employers (3 percent), among others.[Footnote 14]
* Total claims paid by HRPs in 2008 were about $1.9 billion, accounting
for almost 95 percent of total HRP expenditures. The average claims per
enrolled individual totaled $9,437 in 2008, an increase of about 39
percent since 2003.
* In 2008, premium revenue contributed 54 percent of HRP funding, and
insurance carrier assessments contributed about 23 percent.
* HRPs were awarded a total of approximately $286 million in federal
grants between 2003 and 2008, according to CMS. Almost 83 percent of
these funds were operational grants, almost 15 percent were bonus
grants, and less than 3 percent were seed grants. Federal grants
comprised less than 2 percent of total HRP funding in 2008.
* Of the $75 million in federal grants that HRPs were awarded in 2006,
about 55 percent were used to cover operational losses, about 17
percent to reduce premiums, and about 14 percent to support income-
based premium subsidy programs, according to reports submitted to CMS.
HRPs used the rest of the funds for various purposes, such as disease
management programs and reduction in cost sharing, increasing benefit
coverage, and marketing and outreach.[Footnote 15]
Enclosure III contains more information on HRP governance,
expenditures, and funding.
Agency Comments:
We provided a draft of this report to HHS and NASCHIP for comment. In
response, HHS provided written comments, stating that our report
contains a wealth of valuable information on HRPs. We have reproduced
these comments in enclosure IV. HHS and NASCHIP also provided technical
comments, which we incorporated as appropriate.
As agreed with your offices, unless you publicly announce its contents
earlier, we plan no further distribution of this report until 30 days
from its issue date. At that time, we will send copies of this report
to the Secretary of HHS, relevant congressional committees, and other
interested members. The report will also be available at no charge on
GAO's Web site at [hyperlink, http://www.gao.gov].
Signed by:
John E. Dicken:
Director, Health Care Issues:
Enclosures - 5:
[End of section]
HRP Enrollment and Demographics of HRP Enrollees, Fiscal Year 2008:
Table 1: HRP Enrollment in 2008 and Estimate of the Potentially
Eligible Population, 2005-2007 State Averages:
HRP: AL;
Total HRP enrollees: 2,272;
Total HRP enrollees and dependents: 2,410;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 79,632.
HRP: AK;
Total HRP enrollees: 469;
Total HRP enrollees and dependents: 469;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 14,490.
HRP: AR;
Total HRP enrollees: 3,079;
Total HRP enrollees and dependents: 3,079;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 61,110.
HRP: CA;
Total HRP enrollees: 6,809;
Total HRP enrollees and dependents: 7,036;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 846,720.
HRP: CO;
Total HRP enrollees: 8,552;
Total HRP enrollees and dependents: 8,552;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 100,674.
HRP: CT;
Total HRP enrollees: 2,073;
Total HRP enrollees and dependents: 2,336;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 43,344.
HRP: FL;
Total HRP enrollees: 292;
Total HRP enrollees and dependents: 292;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 465,948.
HRP: ID;
Total HRP enrollees: 1,272;
Total HRP enrollees and dependents: 1,337;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 27,216.
HRP: IL;
Total HRP enrollees: 16,063;
Total HRP enrollees and dependents: 16,063;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 218,610.
HRP: IN;
Total HRP enrollees: 6,261;
Total HRP enrollees and dependents: 6,561;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 96,516.
HRP: IA;
Total HRP enrollees: 2,732;
Total HRP enrollees and dependents: 2,732;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 34,524.
HRP: KS;
Total HRP enrollees: 1,693;
Total HRP enrollees and dependents: 1,863;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 40,320.
HRP: KY;
Total HRP enrollees: 4,185;
Total HRP enrollees and dependents: 4,354;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 71,694.
HRP: LA;
Total HRP enrollees: 1,117;
Total HRP enrollees and dependents: 1,117;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 101,682.
HRP: MD;
Total HRP enrollees: 11,366;
Total HRP enrollees and dependents: 14,691;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 95,886.
HRP: MN;
Total HRP enrollees: 23,511;
Total HRP enrollees and dependents: 27,386;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 55,188.
HRP: MS;
Total HRP enrollees: 3,468;
Total HRP enrollees and dependents: 3,468;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 68,418.
HRP: MO;
Total HRP enrollees: 3,015;
Total HRP enrollees and dependents: 3,015;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 91,098.
HRP: MT;
Total HRP enrollees: 3,016;
Total HRP enrollees and dependents: 3,016;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 18,900.
HRP: NE;
Total HRP enrollees: 5,126;
Total HRP enrollees and dependents: 5,126;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 26,712.
HRP: NH;
Total HRP enrollees: 1,038;
Total HRP enrollees and dependents: 1,094;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 17,388.
HRP: NM;
Total HRP enrollees: 6,020;
Total HRP enrollees and dependents: 6,020;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 53,550.
HRP: ND;
Total HRP enrollees: 1,463;
Total HRP enrollees and dependents: 1,463;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 8,568.
HRP: OK;
Total HRP enrollees: 2,276;
Total HRP enrollees and dependents: 2,276;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 80,640.
HRP: OR;
Total HRP enrollees: 13,953;
Total HRP enrollees and dependents: 15,318;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 78,246.
HRP: SC;
Total HRP enrollees: 2,329;
Total HRP enrollees and dependents: 2,329;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 88,830.
HRP: SD;
Total HRP enrollees: 669;
Total HRP enrollees and dependents: 669;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 10,962.
HRP: TN;
Total HRP enrollees: 3,768;
Total HRP enrollees and dependents: 3,768;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 104,580.
HRP: TX;
Total HRP enrollees: 24,170;
Total HRP enrollees and dependents: 26,908;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 716,562.
HRP: UT;
Total HRP enrollees: 3,621;
Total HRP enrollees and dependents: 3,621;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 50,274.
HRP: WA;
Total HRP enrollees: 3,397;
Total HRP enrollees and dependents: 3,397;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 97,020.
HRP: WV;
Total HRP enrollees: 568;
Total HRP enrollees and dependents: 652;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 33,768.
HRP: WI;
Total HRP enrollees: 16,284;
Total HRP enrollees and dependents: 16,284;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 60,480.
HRP: WY;
Total HRP enrollees: 716;
Total HRP enrollees and dependents: 716;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 9,198.
HRP: Across all HRPs;
Total HRP enrollees: 186,643;
Total HRP enrollees and dependents: 199,418;
Estimated number of individuals potentially eligible for HRP
enrollment[A]: 3,968,748.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008 and analysis of data from the 2006 Medical
Expenditure Panel Survey (MEPS) and U.S Census Bureau, Income, Poverty,
and Health Insurance Coverage in the United States: 2007.
[A] GAO estimated the potentially eligible population, including
dependents, by (1) determining the percentage of uninsured individuals
with at least one chronic condition using 2006 MEPS data, and (2)
applying that percentage to Current Population Estimates (CPS)
estimates of the 3-year average uninsured population in each of the 34
states with an HRP (2005-2007). The CPS estimates are subject to
sampling error of plus or minus 1.3 percent at the 90 percent
confidence level. The MEPS and CPS data used were the most current
available at the time we performed our work.
[End of table]
Table 2: HRPs with Waiting Lists or Closed to Enrollment, 2004-2008:
Year: 2004;
HRPs with a waiting list (maximum number of individuals on the list):
Illinois (279);
HRPs closed to enrollment: Florida.
Year: 2005;
HRPs with a waiting list (maximum number of individuals on the list):
Illinois (173);
HRPs closed to enrollment: Florida.
Year: 2006;
HRPs with a waiting list (maximum number of individuals on the list):
California (864);
HRPs closed to enrollment: Florida.
Year: 2007;
HRPs with a waiting list (maximum number of individuals on the list):
California (232);
HRPs closed to enrollment: Florida.
Year: 2008;
HRPs with a waiting list (maximum number of individuals on the list):
California (1,030);
HRPs closed to enrollment: Florida.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
[End of table]
Table 3: Demographics of HRP Enrollees, by State HRP, 2008:
HRP: AL;
Average age (years): 51;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 45.6;
Average length of enrollment (in months): 9;
Percent who are HIPAA-eligible[D]: 100.0[F];
Percent who are HCTC-eligible[E]: 0.0.
HRP: AK;
Average age (years): 50;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 48.6;
Average length of enrollment (in months): 50;
Percent who are HIPAA-eligible[D]: 32.4;
Percent who are HCTC-eligible[E]: 0.0.
HRP: AR;
Average age (years): [Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 47.7;
Average length of enrollment (in months): 42;
Percent who are HIPAA-eligible[D]: 45.1;
Percent who are HCTC-eligible[E]: 0.6.
HRP: CA;
Average age (years): [Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 43.7;
Average length of enrollment (in months): 36;
Percent who are HIPAA-eligible[D]: [Empty];
Percent who are HCTC-eligible[E]: [Empty].
HRP: CO;
Average age (years): 45;
Employment status[A,B], Percentage Of Enrollees Who Are Employed: 29.8;
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
63.4;
Employment status[A,B], Percentage Of Enrollees Who Are Retired: 2.1;
Average household income of new enrollees[C]: [Empty];
Percent male: 46.9;
Average length of enrollment (in months): 26;
Percent who are HIPAA-eligible[D]: 9.4;
Percent who are HCTC-eligible[E]: 0.1.
HRP: CT;
Average age (years): 47;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 48.4;
Average length of enrollment (in months): 53;
Percent who are HIPAA-eligible[D]: 49.4;
Percent who are HCTC-eligible[E]: 0.8.
HRP: FL;
Average age (years): 50;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 50.3;
Average length of enrollment (in months): N/A[G];
Percent who are HIPAA-eligible[D]: 0.0;
Percent who are HCTC-eligible[E]: 0.0.
HRP: ID;
Average age (years): 47;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 45.0;
Average length of enrollment (in months): 31;
Percent who are HIPAA-eligible[D]: [Empty];
Percent who are HCTC-eligible[E]: [Empty].
HRP: IL;
Average age (years): 50;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 44.6;
Average length of enrollment (in months): 47;
Percent who are HIPAA-eligible[D]: 64.3;
Percent who are HCTC-eligible[E]: 1.4.
HRP: IN;
Average age (years): 48;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: $27,500;
Percent male: 54.9;
Average length of enrollment (in months): 31;
Percent who are HIPAA-eligible[D]: 37.8;
Percent who are HCTC-eligible[E]: 0.1.
HRP: IA;
Average age (years): 49;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 50.3;
Average length of enrollment (in months): 22;
Percent who are HIPAA-eligible[D]: 43.0;
Percent who are HCTC-eligible[E]: 0.0.
HRP: KS;
Average age (years): 51;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 44.2;
Average length of enrollment (in months): 42;
Percent who are HIPAA-eligible[D]: 17.9;
Percent who are HCTC-eligible[E]: 0.2.
HRP: KY;
Average age (years): 48;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 51.1;
Average length of enrollment (in months): 29;
Percent who are HIPAA-eligible[D]: 40.3;
Percent who are HCTC-eligible[E]: 0.0.
HRP: LA;
Average age (years): 50;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 52.8;
Average length of enrollment (in months): 41;
Percent who are HIPAA-eligible[D]: 60.6;
Percent who are HCTC-eligible[E]: 0.2.
HRP: MD;
Average age (years): 49;
Employment status[A,B], Percentage Of Enrollees Who Are Employed: 57.8;
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
29.1;
Employment status[A,B], Percentage Of Enrollees Who Are Retired: 12.1;
Average household income of new enrollees[C]: $35,000;
Percent male: 45.6;
Average length of enrollment (in months): 16;
Percent who are HIPAA-eligible[D]: 30.2;
Percent who are HCTC-eligible[E]: 1.5.
HRP: MN;
Average age (years): [Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: [Empty];
Average length of enrollment (in months): [Empty];
Percent who are HIPAA-eligible[D]: 5.2;
Percent who are HCTC-eligible[E]: 0.1.
HRP: MS;
Average age (years): 51;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 45.0;
Average length of enrollment (in months): 43;
Percent who are HIPAA-eligible[D]: 36.6;
Percent who are HCTC-eligible[E]: [Empty].
HRP: MO;
Average age (years): 48;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 50.8;
Average length of enrollment (in months): 25;
Percent who are HIPAA-eligible[D]: 40.1;
Percent who are HCTC-eligible[E]: [Empty].
HRP: MT;
Average age (years): 50;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 45.0;
Average length of enrollment (in months): 42;
Percent who are HIPAA-eligible[D]: 46.3;
Percent who are HCTC-eligible[E]: 0.1.
HRP: NE;
Average age (years): 47;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 52.6;
Average length of enrollment (in months): 59;
Percent who are HIPAA-eligible[D]: 45.2;
Percent who are HCTC-eligible[E]: 0.0.
HRP: NH;
Average age (years): 47;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 47.3;
Average length of enrollment (in months): 19;
Percent who are HIPAA-eligible[D]: 25.4;
Percent who are HCTC-eligible[E]: 1.4.
HRP: NM;
Average age (years): 48;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 45.9;
Average length of enrollment (in months): 24;
Percent who are HIPAA-eligible[D]: 17.7;
Percent who are HCTC-eligible[E]: 0.0.
HRP: ND;
Average age (years): [Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: [Empty];
Average length of enrollment (in months): [Empty];
Percent who are HIPAA-eligible[D]: 2.6;
Percent who are HCTC-eligible[E]: 0.2.
HRP: OK;
Average age (years): [Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: [Empty];
Average length of enrollment (in months): [Empty];
Percent who are HIPAA-eligible[D]: 43.6;
Percent who are HCTC-eligible[E]: 0.0.
HRP: OR;
Average age (years): 46;
Employment status[A,B], Percentage Of Enrollees Who Are Employed: 42.5;
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
29.5;
Employment status[A,B], Percentage Of Enrollees Who Are Retired: 13.0;
Average household income of new enrollees[C]: $29,366;
Percent male: 41.2;
Average length of enrollment (in months): 31;
Percent who are HIPAA-eligible[D]: 13.7;
Percent who are HCTC-eligible[E]: 0.2.
HRP: SC;
Average age (years): 50;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 48.0;
Average length of enrollment (in months): 36;
Percent who are HIPAA-eligible[D]: 66.7;
Percent who are HCTC-eligible[E]: 1.2.
HRP: SD;
Average age (years): 47;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 49.6;
Average length of enrollment (in months): 31;
Percent who are HIPAA-eligible[D]: 100.0[F];
Percent who are HCTC-eligible[E]: 0.0.
HRP: TN;
Average age (years): 51;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 40.3;
Average length of enrollment (in months): 6;
Percent who are HIPAA-eligible[D]: 12.1;
Percent who are HCTC-eligible[E]: [Empty].
HRP: TX;
Average age (years): 51;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 46.6;
Average length of enrollment (in months): 42;
Percent who are HIPAA-eligible[D]: 43.1;
Percent who are HCTC-eligible[E]: 0.1.
HRP: UT;
Average age (years): 46;
Employment status[A,B], Percentage Of Enrollees Who Are Employed: 47.9;
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
5.4;
Employment status[A,B], Percentage Of Enrollees Who Are Retired: 3.0;
Average household income of new enrollees[C]: $70,573;
Percent male: 40.5;
Average length of enrollment (in months): 60;
Percent who are HIPAA-eligible[D]: 35.0;
Percent who are HCTC-eligible[E]: 0.0.
HRP: WA;
Average age (years): 49;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 57.1;
Average length of enrollment (in months): 45;
Percent who are HIPAA-eligible[D]: 0.0;
Percent who are HCTC-eligible[E]: 0.0.
HRP: WV;
Average age (years): 49;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 42.1;
Average length of enrollment (in months): 13;
Percent who are HIPAA-eligible[D]: [Empty];
Percent who are HCTC-eligible[E]: [Empty].
HRP: WI;
Average age (years): 51;
Employment status[A,B], Percentage Of Enrollees Who Are Employed: 51.1;
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
37.0;
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: $54,200[H];
Percent male: 54.5;
Average length of enrollment (in months): 40;
Percent who are HIPAA-eligible[D]: [Empty];
Percent who are HCTC-eligible[E]: [Empty].
HRP: WY;
Average age (years): 51;
Employment status[A,B], Percentage Of Enrollees Who Are Employed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed:
[Empty];
Employment status[A,B], Percentage Of Enrollees Who Are Retired:
[Empty];
Average household income of new enrollees[C]: [Empty];
Percent male: 48.0;
Average length of enrollment (in months): [Empty];
Percent who are HIPAA-eligible[D]: 0.8;
Percent who are HCTC-eligible[E]: [Empty].
HRP: Across all HRPs;
Average age (years): 49[I];
Employment status[A,B], Percentage Of Enrollees Who Are Employed: 47;
Employment status[A,B], Percentage Of Enrollees Who Are Unemployed: 32;
Employment status[A,B], Percentage Of Enrollees Who Are Retired: 9;
Average household income of new enrollees[C]: $41,136[I];
Percent male: 47;
Average length of enrollment (in months): 36[I];
Percent who are HIPAA-eligible[D]: 28;
Percent who are HCTC-eligible[E]: 0.3.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
Legend: [Empty] = response not provided:
N/A: Not applicable.
Note: Information presented for enrollees only--not dependents, with
the exception of Texas where dependents are counted as enrollees
because they hold their own policies.
[A] Employment status was provided by five states--Colorado and
Wisconsin collected these data from new enrollees only, and Maryland,
Oregon, and Utah collected it from all enrollees.
[B] Percentages may not add to 100 because some enrollees may fall into
other or unknown employment status categories.
[C] Average income was provided by the five HRPs that collected income
data for new enrollees in 2008.
[D] HIPAA-eligible refers to those individuals who qualify for HRP
enrollment because of the Health Insurance Portability and
Accountability Act of 1996, which allows for portability of health
coverage for those with prior group coverage.
[E] HCTC-eligible refers to those individuals who qualify for HRP
enrollment because of the Health Coverage Tax Credit, which provides
tax credits for health insurance premiums for certain eligible
displaced workers and retirees.
[F] Pool is open to HIPAA-eligibles only.
[G] The Florida HRP has been closed to new enrollment since 1991 and,
in 2008, had 292 enrollees.
[H] Income data were provided on a voluntary basis by 77 percent of new
enrollees in Wisconsin.
[I] Averages are weighted based on HRP enrollment.
[End of table]
[End of section]
Enclosure II: HRP Plan Cost-sharing Provisions, Benefits, Coverage
Restrictions, and Premiums:
Table 4: Average Annual Deductible of Most Popular HRP Plans Compared
to Employer-sponsored Plans, 2008:
Average annual deductible:
Most popular HRP plans[A]: $1,593[C];
Employer-sponsored plans[B]: $560.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008 and Kaiser Family Foundation and Health Research &
Educational Trust, Employer Health Benefits: 2008 Annual Survey (Menlo
Park, Calif., and Chicago, Ill.: 2008).
Note: Deductibles are for self-only coverage and in-network services.
[A] This includes the most popular HRP plan--the plan with the most
enrollees--in each of the 34 HRPs. The most popular plans had a total
of 76,846 enrollees, accounting for 41 percent of total HRP enrollees
in 2008.
[B] Preferred provider organization plan types.
[C] Average was weighted by the number of HRP enrollees in the 33 most
popular plans that had deductibles greater than zero.
[End of table]
Table 5: Distribution of Enrollees by Annual Deductible Level in All
HRP Plans and Most Popular HRP Plans, Compared to Employer-sponsored
Plans, 2008:
Annual deductible: No deductible;
All HRP plans: Percentage of total enrollees[C]: 1.8;
Most popular HRP plans[A]: Percentage of total enrollees[C]: 1.0;
Employer-sponsored plans[B]: Percentage of covered workers in employer-
sponsored plans[D]: 32.0.
Annual deductible: $1-$499;
All HRP plans: Percentage of total enrollees[C]: 6.0;
Most popular HRP plans[A]: Percentage of total enrollees[C]: 4.1;
Employer-sponsored plans[B]: Percentage of covered workers in employer-
sponsored plans[D]: 35.4.
Annual deductible: $500-$999;
All HRP plans: Percentage of total enrollees[C]: 17.1;
Most popular HRP plans[A]: Percentage of total enrollees[C]: 32.2;
Employer-sponsored plans[B]: Percentage of covered workers in employer-
sponsored plans[D]: 20.4.
Annual deductible: $1,000-$1,999;
All HRP plans: Percentage of total enrollees[C]: 27.1;
Most popular HRP plans[A]: Percentage of total enrollees[C]: 17.8;
Employer-sponsored plans[B]: Percentage of covered workers in employer-
sponsored plans[D]: 8.8.
Annual deductible: $2,000-$2,999;
All HRP plans: Percentage of total enrollees[C]: 24.5;
Most popular HRP plans[A]: Percentage of total enrollees[C]: 39.1;
Employer-sponsored plans[B]: Percentage of covered workers in employer-
sponsored plans[D]: [Empty].
Annual deductible: $3,000-$4,999;
All HRP plans: Percentage of total enrollees[C]: 4.6;
Most popular HRP plans[A]: Percentage of total enrollees[C]: 1.7;
Employer-sponsored plans[B]: Percentage of covered workers in employer-
sponsored plans[D]: [Empty].
Annual deductible: $5,000 or more;
All HRP plans: Percentage of total enrollees[C]: 17.8;
Most popular HRP plans[A]: Percentage of total enrollees[C]: 4.1;
Employer-sponsored plans[B]: Percentage of covered workers in employer-
sponsored plans[D]: 2.7[E].
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008 and Kaiser Family Foundation and Health Research &
Educational Trust, Employer Health Benefits: 2008 Annual Survey (Menlo
Park, Calif., and Chicago, Ill.: 2008).
Note: Deductibles are for self-only coverage and in-network services.
Information presented for enrollees only--not dependents, with the
exception of Texas where dependents are counted as enrollees because
they hold their own policies.
[A] This includes the most popular HRP plan--the plan with the most
enrollees--in each of the 34 HRPs. The most popular plans had a total
of 76,846 enrollees, accounting for 41 percent of total HRP enrollees
in 2008.
[B] Preferred provider organization plan types.
[C] Percentages do not add to 100 because HRP enrollees in supplemental
insurance plans were excluded.
[D] Percentages do not add to 100 due to rounding.
[E] Data for employer-sponsored plans were only available for
deductibles of $2,000 or more.
[End of table]
Table 6: Distribution of Enrollees in Most Popular HRP Plans, by Annual
Out-of-pocket Spending Limits, 2008:
Annual out-of-pocket spending limits in most popular HRP plans: Less
than $2,000;
Percentage of all enrollees in most popular HRP plans: 29.3.
Annual out-of-pocket spending limits in most popular HRP plans: $2,001-
$5,000;
Percentage of all enrollees in most popular HRP plans: 48.5.
Annual out-of-pocket spending limits in most popular HRP plans: $5,001-
$7,000;
Percentage of all enrollees in most popular HRP plans: 15.5.
Annual out-of-pocket spending limits in most popular HRP plans: $7,001-
$10,000;
Percentage of all enrollees in most popular HRP plans: 6.6.
Annual out-of-pocket spending limits in most popular HRP plans: More
than $10,000;
Percentage of all enrollees in most popular HRP plans: 0.
Annual out-of-pocket spending limits in most popular HRP plans: Total;
Percentage of all enrollees in most popular HRP plans: 100.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
Notes: Analysis includes the most popular HRP plan--the plan with the
most enrollees--in each of the 34 HRPs. The most popular plans had a
total of 76,846 enrollees, accounting for 41 percent of total HRP
enrollees in 2008.
Information on out-of-pocket spending limits was provided for self-only
coverage and in-network services.
Information presented for enrollees only--not dependents, with the
exception of Texas where dependents are counted as enrollees because
they hold their own policies.
Percentages do not add to 100 due to rounding.
[End of table]
Table 7: Annual Out-of-pocket Spending Limit in Each State HRP's Most
Popular Plan, and Costs that Could Exceed the Limit, 2008:
HRP: AL;
Annual out-of-pocket spending limit: N/A;
Cost-sharing feature: Overall annual deductible: [Empty];
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: [Empty];
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: AK;
Annual out-of-pocket spending limit: $10,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: AR;
Annual out-of-pocket spending limit: $2,000;
Cost-sharing feature: Overall annual deductible: [Empty];
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum.
HRP: CA;
Annual out-of-pocket spending limit: $2,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is
subject to the annual out-of-pocket maximum.
HRP: CO;
Annual out-of-pocket spending limit: $2,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum.
HRP: CT;
Annual out-of-pocket spending limit: $7,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: Cost is not
subject to the annual out-of-pocket maximum;
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum.
HRP: FL;
Annual out-of-pocket spending limit: NR;
Cost-sharing feature: Overall annual deductible: [Empty];
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: [Empty];
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: ID;
Annual out-of-pocket spending limit: $10,000;
Cost-sharing feature: Overall annual deductible: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: IL;
Annual out-of-pocket spending limit: $1,500;
Cost-sharing feature: Overall annual deductible: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: IN;
Annual out-of-pocket spending limit: $1,500;
Cost-sharing feature: Overall annual deductible: [Empty];
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: IA;
Annual out-of-pocket spending limit: $5,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum.
HRP: KS;
Annual out-of-pocket spending limit: $3,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: KY;
Annual out-of-pocket spending limit: $4,000;
Cost-sharing feature: Overall annual deductible: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum.
HRP: LA;
Annual out-of-pocket spending limit: $9.500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: MD;
Annual out-of-pocket spending limit: $3,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is
subject to the annual out-of-pocket maximum.
HRP: MN;
Annual out-of-pocket spending limit: $3,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: MS[A];
Annual out-of-pocket spending limit: N/A;
Cost-sharing feature: Overall annual deductible: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: MO;
Annual out-of-pocket spending limit: $5,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: MT;
Annual out-of-pocket spending limit: $7,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: NE;
Annual out-of-pocket spending limit: $3,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum;
HRP: NH;
Annual out-of-pocket spending limit: $3,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: NM;
Annual out-of-pocket spending limit: $2,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is
subject to the annual out-of-pocket maximum.
HRP: ND;
Annual out-of-pocket spending limit: $3,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: OK;
Annual out-of-pocket spending limit: $10,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: Cost is not
subject to the annual out-of-pocket maximum;
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: OR;
Annual out-of-pocket spending limit: $1,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is
subject to the annual out-of-pocket maximum.
HRP: SC;
Annual out-of-pocket spending limit: $5,000;
Cost-sharing feature: Overall annual deductible:
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance:
Cost-sharing feature: Copay for prescription drugs: [Empty];
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: SD;
Annual out-of-pocket spending limit: $3,250;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: TN;
Annual out-of-pocket spending limit: $5,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: TX;
Annual out-of-pocket spending limit: $5,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum.
HRP: UT;
Annual out-of-pocket spending limit: $2,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is
subject to the annual out-of-pocket maximum.
HRP: WA;
Annual out-of-pocket spending limit: $1,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: Cost is not
subject to the annual out-of-pocket maximum;
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum.
HRP: WV;
Annual out-of-pocket spending limit: $3,000;
Cost-sharing feature: Overall annual deductible: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Separate prescription drug deductible: Cost is
not subject to the annual out-of-pocket maximum;
Cost-sharing feature: Separate mental health deductible: Cost is not
subject to the annual out-of-pocket maximum;
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: Cost is not subject to
the annual out-of-pocket maximum;
Cost-sharing feature: Copay for physician office visits: Cost is not
subject to the annual out-of-pocket maximum.
HRP: WI;
Annual out-of-pocket spending limit: $3,500;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible: [Empty];
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
HRP: WY;
Annual out-of-pocket spending limit: $2,000;
Cost-sharing feature: Overall annual deductible: Cost is subject to the
annual out-of-pocket maximum;
Cost-sharing feature: Separate hospital deductible: [Empty];
Cost-sharing feature: Separate prescription drug deductible:
Cost-sharing feature: Separate mental health deductible: [Empty];
Cost-sharing feature: Coinsurance: Cost is subject to the annual out-of-
pocket maximum;
Cost-sharing feature: Copay for prescription drugs: Cost is not subject
to the annual out-of-pocket maximum;
Cost-sharing feature: Copay for mental health: [Empty];
Cost-sharing feature: Copay for physician office visits: [Empty].
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008:
Legend:
N/A = Not applicable because the most popular plan did not have an
annual out-of-pocket maximum.
NR = Response not provided.
Notes: [Empty] cells indicate that the cost was not a feature of the
plan's cost-sharing structure.
Analysis includes the most popular HRP plan--the plan with the most
enrollees--in each of the 34 HRPs. The most popular plans had a total
of 76,846 enrollees, accounting for 41 percent of total HRP enrollees
in 2008.
Information on out-of-pocket spending limits was provided for self-only
coverage and in-network services.
[A] Mississippi does not have an overall policy regarding the out-of-
pocket maximum, but it has a $5,000 out-of-pocket maximum on allowable
hospital charges, after which the policy pays allowable hospital
charges at 100 percent.
[End of table]
Table 8: Coverage of Selected Benefits Among Most Popular HRP Plans
Compared to Employer-sponsored Plans, 2008:
Benefit: Maternity care;
Most popular HRP plans[A,B]: Number of plans that cover benefit: 30;
Most popular HRP plans[A,B]: Percentage of enrollees[C] in plans that
cover benefit: 82;
Employer-sponsored plans: Percentage of workers in plans that cover
benefit: NA.
Benefit: Maternity care covered as a rider[D];
Most popular HRP plans[A,B]: Number of plans that cover benefit: 4;
Most popular HRP plans[A,B]: Percentage of enrollees[C] in plans that
cover benefit: 10;
Employer-sponsored plans: Percentage of workers in plans that cover
benefit: NA.
Benefit: Transplants;
Most popular HRP plans[A,B]: Number of plans that cover benefit: 33;
Most popular HRP plans[A,B]: Percentage of enrollees[C] in plans that
cover benefit: 100[E];
Employer-sponsored plans: Percentage of workers in plans that cover
benefit: NA.
Benefit: Mental health services;
Most popular HRP plans[A,B]: Number of plans that cover benefit: 31;
Most popular HRP plans[A,B]: Percentage of enrollees[C] in plans that
cover benefit: 97;
Employer-sponsored plans: Percentage of workers in plans that cover
benefit: 98.
Benefit: Prescription drugs;
Most popular HRP plans[A,B]: Number of plans that cover benefit: 34;
Most popular HRP plans[A,B]: Percentage of enrollees[C] in plans that
cover benefit: 100;
Employer-sponsored plans: Percentage of workers in plans that cover
benefit: 98.
Source: GAO survey of 34 HRPs operational in 2008 and Kaiser Family
Foundation and Health Research & Educational Trust, Employer Health
Benefits: 2008 Annual Survey (Menlo Park, Calif., and Chicago, Ill.:
2008).
Legend: NA = Not available:
[A] This includes the most popular HRP plan--the plan with the most
enrollees--in each of the 34 HRPs. The most popular plans had a total
of 76,846 enrollees, accounting for 41 percent of total HRP enrollees
in 2008.
[B] Information is for in-network services and individual (not family)
coverage only. Supplemental insurance policies are excluded.
[C] Information presented for enrollees only--not dependents, with the
exception of Texas where dependents are counted as enrollees because
they hold their own policies.
[D] Private individual health insurance plans may offer optional
coverage of additional services, such as maternity care. This extra
coverage is referred to as an optional rider.
[E] The percentage of enrollees with coverage of transplants was 99.7,
which rounds to 100.
[End of table]
Table 9: Selected Cost-sharing Features and Coverage Limits Among Most
Popular HRP Plans Compared to Employer-sponsored Plans, 2008:
Cost-sharing features and limits on coverage: Separate cost sharing for
inpatient hospital care, in addition to the overall plan deductible;
Most popular HRP plans[A,B]: Number of plans: 21;
Most popular HRP plans[A,B]: Percentage of enrollees in plans with
feature and/or limit[C]: 56;
Employer-sponsored plans: Percentage of covered workers in plans with
feature and/or limit[D]: 79.
Cost-sharing features and limits on coverage: Preventive services
exempt from plan deductible;
Most popular HRP plans[A,B]: Number of plans: 15;
Most popular HRP plans[A,B]: Percentage of enrollees in plans with
feature and/or limit[C]: 57;
Employer-sponsored plans: Percentage of covered workers in plans with
feature and/or limit[D]: 89.
Cost-sharing features and limits on coverage: Separate prescription
drug deductible for plans that cover prescription drugs;
Most popular HRP plans[A,B]: Number of plans: 13;
Most popular HRP plans[A,B]: Percentage of enrollees in plans with
feature and/or limit[C]: 41;
Employer-sponsored plans: Percentage of covered workers in plans with
feature and/or limit[D]: 11.
Cost-sharing features and limits on coverage: Required coinsurance for
prescription drugs for plans that cover prescription drugs;
Most popular HRP plans[A,B]: Number of plans: 26;
Most popular HRP plans[A,B]: Percentage of enrollees in plans with
feature and/or limit[C]: 76;
Employer-sponsored plans: Percentage of covered workers in plans with
feature and/or limit[D]: NA.
Cost-sharing features and limits on coverage: Out-of-pocket annual
maximums that apply to cost sharing for prescription drugs for plans
that cover prescription drugs;
Most popular HRP plans[A,B]: Number of plans: 9;
Most popular HRP plans[A,B]: Percentage of enrollees in plans with
feature and/or limit[C]: 18;
Employer-sponsored plans: Percentage of covered workers in plans with
feature and/or limit[D]: 11.
Cost-sharing features and limits on coverage: Thirty or less mental
health outpatient visits covered in a year by plans that cover mental
health benefits;
Most popular HRP plans[A,B]: Number of plans: 13[E];
Most popular HRP plans[A,B]: Percentage of enrollees in plans with
feature and/or limit[C]: 19;
Employer-sponsored plans: Percentage of covered workers in plans with
feature and/or limit[D]: 59[F].
Cost-sharing features and limits on coverage: Additional cost sharing
for emergency room care;
Most popular HRP plans[A,B]: Number of plans: 12;
Most popular HRP plans[A,B]: Percentage of enrollees in plans with
feature and/or limit[C]: 49;
Employer-sponsored plans: Percentage of covered workers in plans with
feature and/or limit[D]: NA.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008 and Kaiser Family Foundation and Health Research &
Educational Trust, Employer Health Benefits: 2008 Annual Survey (Menlo
Park, Calif., and Chicago, Ill.: 2008).
Legend: NA = Not available.
[A] This includes the most popular HRP plan--the plan with the most
enrollees--in each of the 34 HRPs. The most popular plans had a total
of 76,846 enrollees, accounting for 41 percent of total HRP enrollees
in 2008.
[B] Information is for in-network services and individual (not family)
coverage only. Supplemental insurance policies are excluded.
[C] Information presented for HRP enrollees only--not dependents, with
the exception of Texas where dependents are counted as enrollees
because they hold their own policies.
[D] Preferred provider organization plan types.
[E] Such limits may apply to some mental health services only. For
example, the New Mexico HRP reported that its mental health limits
apply only to chemical dependency services.
[F] Information for mental health outpatient visits is for covered
workers with outpatient mental health coverage and not specified for in-
or out-of-network coverage.
[End of table]
Table 10: Annual and Lifetime Dollar Limits Among Most Popular HRP
Plans Compared to Employer-sponsored Plans, 2008:
Type of Limit: Annual dollar limit;
Most popular HRP plans[A,B]: Average limit: $175,000;
Most popular HRP plans[A,B]: Range in limits: $75,000-300,000;
Most popular HRP plans[A,B]: Number of enrollees[C] who met limit: 10;
Most popular HRP plans[A,B]: Number of plans with limit: 5[E];
Most popular HRP plans[A,B]: Percentage of plans with limit: 15;
Employer-sponsored plans: Percentage of employer-sponsored plans with
limit[D]: 10.
Type of Limit: Lifetime dollar limit;
Most popular HRP plans[A,B]: Average limit: $1.6 million;
Most popular HRP plans[A,B]: Range in limits: $500,000-5 million;
Most popular HRP plans[A,B]: Number of enrollees[C] who met limit: 16;
Most popular HRP plans[A,B]: Number of plans with limit: 30[F];
Most popular HRP plans[A,B]: Percentage of plans with limit: 88;
Employer-sponsored plans: Percentage of employer-sponsored plans with
limit[D]: 56[G].
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008 and Mercer, National Survey of Employer-Sponsored
Health Plans, 2008.
[A] This includes the most popular HRP plan--the plan with the most
enrollees--in each of the 34 HRPs. The most popular plans had a total
of 76,846 enrollees, accounting for 41 percent of total HRP enrollees
in 2008.
[B] Information is for in-network services and individual (not family)
coverage only. Supplemental insurance policies are excluded.
[C] Information presented for enrollees only--not dependents, with the
exception of Texas where dependents are counted as enrollees because
they hold their own policies.
[D] Among preferred provider organization and point-of-service plans
offered by employers with 10 or more employees.
[E] The five HRPs that had annual limits were: California, Louisiana,
Tennessee, Utah, and West Virginia. In addition, while some HRPs may
not have had overall annual limits, they may have had annual limits on
specific services. For example, Mississippi told us that while it did
not have an overall annual limit in 2008, it had an annual pharmacy
limit of $100,000 in 2008. Similarly, New Mexico had annual limits on
acupuncture, diabetic education services, therapy/rehabilitation, and
annual wellness preventive benefits.
[F] HRPs may have had lifetime limits on individual services. For
example, New Mexico reported that while it did not have an overall
lifetime limit, it had a $5 million lifetime limit on transplants and a
$2,500 limit on diabetic education services.
[G] Median lifetime limit was $2,000,000.
[End of table]
Table 11a: HRP Average Monthly Premiums, by State HRP, 2004-2006:
HRP: AL;
2004: HRP premium rate as a percent of standard market rate[A]: 98;
2004: Average monthly HRP premium[B]: $448;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$358;
2005: HRP premium rate as a percent of standard market rate[A]: 104;
2005: Average monthly HRP premium[B]: $486;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$412;
2006: HRP premium rate as a percent of standard market rate[A]: 127;
2006: Average monthly HRP premium[B]: $539;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$478.
HRP: AK;
2004: HRP premium rate as a percent of standard market rate[A]: 137;
2004: Average monthly HRP premium[B]: $462;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$580;
2005: HRP premium rate as a percent of standard market rate[A]: 142;
2005: Average monthly HRP premium[B]: $494;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$580;
2006: HRP premium rate as a percent of standard market rate[A]: 145;
2006: Average monthly HRP premium[B]: $511;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$614.
HRP: AR;
2004: HRP premium rate as a percent of standard market rate[A]: 140;
2004: Average monthly HRP premium[B]: $463;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$622;
2005: HRP premium rate as a percent of standard market rate[A]: 140;
2005: Average monthly HRP premium[B]: $395;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$389;
2006: HRP premium rate as a percent of standard market rate[A]: 150;
2006: Average monthly HRP premium[B]: $419;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$416.
HRP: CA;
2004: HRP premium rate as a percent of standard market rate[A]: 125;
2004: Average monthly HRP premium[B]: $519;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$666;
2005: HRP premium rate as a percent of standard market rate[A]: 125;
2005: Average monthly HRP premium[B]: $444;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$683;
2006: HRP premium rate as a percent of standard market rate[A]: 125;
2006: Average monthly HRP premium[B]: $435;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$736.
HRP: CO;
2004: HRP premium rate as a percent of standard market rate[A]: 144;
2004: Average monthly HRP premium[B]: $379;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$689;
2005: HRP premium rate as a percent of standard market rate[A]: 144;
2005: Average monthly HRP premium[B]: $376;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$571;
2006: HRP premium rate as a percent of standard market rate[A]: 134;
2006: Average monthly HRP premium[B]: $405;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$622.
HRP: CT;
2004: HRP premium rate as a percent of standard market rate[A]: 150;
2004: Average monthly HRP premium[B]: $651;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$658;
2005: HRP premium rate as a percent of standard market rate[A]: 150;
2005: Average monthly HRP premium[B]: $712;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$567;
2006: HRP premium rate as a percent of standard market rate[A]: 150;
2006: Average monthly HRP premium[B]: $623;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$651.
HRP: FL;
2004: HRP premium rate as a percent of standard market rate[A]: 200;
2004: Average monthly HRP premium[B]: [Empty];
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty];
2005: HRP premium rate as a percent of standard market rate[A]: 200;
2005: Average monthly HRP premium[B]: [Empty];
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty];
2006: HRP premium rate as a percent of standard market rate[A]: 200;
2006: Average monthly HRP premium[B]: [Empty];
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty].
HRP: ID;
2004: HRP premium rate as a percent of standard market rate[A]: 125;
2004: Average monthly HRP premium[B]: $303;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$250;
2005: HRP premium rate as a percent of standard market rate[A]: 125;
2005: Average monthly HRP premium[B]: $330;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$260;
2006: HRP premium rate as a percent of standard market rate[A]: 131;
2006: Average monthly HRP premium[B]: $349;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$252.
HRP: IL;
2004: HRP premium rate as a percent of standard market rate[A]: 138;
2004: Average monthly HRP premium[B]: $496;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$610;
2005: HRP premium rate as a percent of standard market rate[A]: 138;
2005: Average monthly HRP premium[B]: $517;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$623;
2006: HRP premium rate as a percent of standard market rate[A]: 137;
2006: Average monthly HRP premium[B]: $523;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$660.
HRP: IN;
2004: HRP premium rate as a percent of standard market rate[A]: 138;
2004: Average monthly HRP premium[B]: $496;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$515;
2005: HRP premium rate as a percent of standard market rate[A]: 134;
2005: Average monthly HRP premium[B]: $528;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$546;
2006: HRP premium rate as a percent of standard market rate[A]: 133;
2006: Average monthly HRP premium[B]: $575;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$590.
HRP: IA;
2004: HRP premium rate as a percent of standard market rate[A]: 150;
2004: Average monthly HRP premium[B]: $681;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$860;
2005: HRP premium rate as a percent of standard market rate[A]: 150;
2005: Average monthly HRP premium[B]: $457;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$329;
2006: HRP premium rate as a percent of standard market rate[A]: 150;
2006: Average monthly HRP premium[B]: $471;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$360.
HRP: KS;
2004: HRP premium rate as a percent of standard market rate[A]: 130;
2004: Average monthly HRP premium[B]: $475;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$621;
2005: HRP premium rate as a percent of standard market rate[A]: 134;
2005: Average monthly HRP premium[B]: $483;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$640;
2006: HRP premium rate as a percent of standard market rate[A]: 134;
2006: Average monthly HRP premium[B]: $494;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$656.
HRP: KY;
2004: HRP premium rate as a percent of standard market rate[A]: 130;
2004: Average monthly HRP premium[B]: $400;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$324;
2005: HRP premium rate as a percent of standard market rate[A]: 130;
2005: Average monthly HRP premium[B]: $424;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$357;
2006: HRP premium rate as a percent of standard market rate[A]: 130;
2006: Average monthly HRP premium[B]: $480;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$369.
HRP: LA;
2004: HRP premium rate as a percent of standard market rate[A]: 184;
2004: Average monthly HRP premium[B]: $609;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$483;
2005: HRP premium rate as a percent of standard market rate[A]: 183;
2005: Average monthly HRP premium[B]: $535;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$529;
2006: HRP premium rate as a percent of standard market rate[A]: 183;
2006: Average monthly HRP premium[B]: $575;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$482.
HRP: MD;
2004: HRP premium rate as a percent of standard market rate[A]: 147;
2004: Average monthly HRP premium[B]: $272;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$267;
2005: HRP premium rate as a percent of standard market rate[A]: 131;
2005: Average monthly HRP premium[B]: $306;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$273;
2006: HRP premium rate as a percent of standard market rate[A]: 121;
2006: Average monthly HRP premium[B]: $283;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$273.
HRP: MN;
2004: HRP premium rate as a percent of standard market rate[A]: 112;
2004: Average monthly HRP premium[B]: $308;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$382;
2005: HRP premium rate as a percent of standard market rate[A]: 120;
2005: Average monthly HRP premium[B]: $342;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$359;
2006: HRP premium rate as a percent of standard market rate[A]: 123;
2006: Average monthly HRP premium[B]: $380;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$315.
HRP: MS;
2004: HRP premium rate as a percent of standard market rate[A]: 150;
2004: Average monthly HRP premium[B]: $356;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$316;
2005: HRP premium rate as a percent of standard market rate[A]: 150;
2005: Average monthly HRP premium[B]: $375;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$322;
2006: HRP premium rate as a percent of standard market rate[A]: 150;
2006: Average monthly HRP premium[B]: $400;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$366.
HRP: MO;
2004: HRP premium rate as a percent of standard market rate[A]: 175;
2004: Average monthly HRP premium[B]: $382;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$338;
2005: HRP premium rate as a percent of standard market rate[A]: 168;
2005: Average monthly HRP premium[B]: $251;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$355;
2006: HRP premium rate as a percent of standard market rate[A]: 168;
2006: Average monthly HRP premium[B]: $417;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$396.
HRP: MT;
2004: HRP premium rate as a percent of standard market rate[A]: 117;
2004: Average monthly HRP premium[B]: $349;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$311;
2005: HRP premium rate as a percent of standard market rate[A]: 134;
2005: Average monthly HRP premium[B]: $395;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$358;
2006: HRP premium rate as a percent of standard market rate[A]: 138;
2006: Average monthly HRP premium[B]: $426;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$383.
HRP: NE;
2004: HRP premium rate as a percent of standard market rate[A]: 135;
2004: Average monthly HRP premium[B]: $488;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$401;
2005: HRP premium rate as a percent of standard market rate[A]: 135;
2005: Average monthly HRP premium[B]: $510;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$435;
2006: HRP premium rate as a percent of standard market rate[A]: 135;
2006: Average monthly HRP premium[B]: $510;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$434.
HRP: NH;
2004: HRP premium rate as a percent of standard market rate[A]: 140;
2004: Average monthly HRP premium[B]: $459;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$458;
2005: HRP premium rate as a percent of standard market rate[A]: 136;
2005: Average monthly HRP premium[B]: $477;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$505;
2006: HRP premium rate as a percent of standard market rate[A]: 125;
2006: Average monthly HRP premium[B]: $424;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$498.
HRP: NM;
2004: HRP premium rate as a percent of standard market rate[A]:
[Empty];
2004: Average monthly HRP premium[B]: $420;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$625;
2005: HRP premium rate as a percent of standard market rate[A]:
[Empty];
2005: Average monthly HRP premium[B]: $374;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$407;
2006: HRP premium rate as a percent of standard market rate[A]: 147;
2006: Average monthly HRP premium[B]: $250;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$407.
HRP: ND;
2004: HRP premium rate as a percent of standard market rate[A]: 135;
2004: Average monthly HRP premium[B]: $304;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$378;
2005: HRP premium rate as a percent of standard market rate[A]: 135;
2005: Average monthly HRP premium[B]: $336;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$402;
2006: HRP premium rate as a percent of standard market rate[A]: 135;
2006: Average monthly HRP premium[B]: $363;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$420.
HRP: OK;
2004: HRP premium rate as a percent of standard market rate[A]: 150;
2004: Average monthly HRP premium[B]: $497;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$674;
2005: HRP premium rate as a percent of standard market rate[A]: 150;
2005: Average monthly HRP premium[B]: $418;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$674;
2006: HRP premium rate as a percent of standard market rate[A]: 150;
2006: Average monthly HRP premium[B]: $545;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$848.
HRP: OR;
2004: HRP premium rate as a percent of standard market rate[A]: 102;
2004: Average monthly HRP premium[B]: $391;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$482;
2005: HRP premium rate as a percent of standard market rate[A]: 111;
2005: Average monthly HRP premium[B]: $344;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$434;
2006: HRP premium rate as a percent of standard market rate[A]: 110;
2006: Average monthly HRP premium[B]: $376;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$506.
HRP: SC;
2004: HRP premium rate as a percent of standard market rate[A]: 200;
2004: Average monthly HRP premium[B]: $734;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty];
2005: HRP premium rate as a percent of standard market rate[A]: 200;
2005: Average monthly HRP premium[B]: $835;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$665;
2006: HRP premium rate as a percent of standard market rate[A]: 200;
2006: Average monthly HRP premium[B]: $878;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$737.
HRP: SD;
2004: HRP premium rate as a percent of standard market rate[A]: 150;
2004: Average monthly HRP premium[B]: $139;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$377;
2005: HRP premium rate as a percent of standard market rate[A]: 150;
2005: Average monthly HRP premium[B]: $380;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$429;
2006: HRP premium rate as a percent of standard market rate[A]: 150;
2006: Average monthly HRP premium[B]: $404;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$471.
HRP: TN;
2004: HRP premium rate as a percent of standard market rate[A]:
[Empty];
2004: Average monthly HRP premium[B]: [Empty];
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty];
2005: HRP premium rate as a percent of standard market rate[A]:
[Empty];
2005: Average monthly HRP premium[B]: [Empty];
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty];
2006: HRP premium rate as a percent of standard market rate[A]:
[Empty];
2006: Average monthly HRP premium[B]: [Empty];
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty].
HRP: TX;
2004: HRP premium rate as a percent of standard market rate[A]: 200;
2004: Average monthly HRP premium[B]: $479;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$397;
2005: HRP premium rate as a percent of standard market rate[A]: 200;
2005: Average monthly HRP premium[B]: $489;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$420;
2006: HRP premium rate as a percent of standard market rate[A]: 200;
2006: Average monthly HRP premium[B]: $510;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$456.
HRP: UT;
2004: HRP premium rate as a percent of standard market rate[A]: 125;
2004: Average monthly HRP premium[B]: $355;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$369;
2005: HRP premium rate as a percent of standard market rate[A]: 141;
2005: Average monthly HRP premium[B]: $404;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$434;
2006: HRP premium rate as a percent of standard market rate[A]: 142;
2006: Average monthly HRP premium[B]: $443;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$497.
HRP: WA;
2004: HRP premium rate as a percent of standard market rate[A]: 120;
2004: Average monthly HRP premium[B]: $416;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$582;
2005: HRP premium rate as a percent of standard market rate[A]: 120;
2005: Average monthly HRP premium[B]: $524;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$777;
2006: HRP premium rate as a percent of standard market rate[A]: 113;
2006: Average monthly HRP premium[B]: $514;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$791.
HRP: WV;
2004: HRP premium rate as a percent of standard market rate[A]:
[Empty];
2004: Average monthly HRP premium[B]: [Empty];
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty];
2005: HRP premium rate as a percent of standard market rate[A]: 148;
2005: Average monthly HRP premium[B]: $830;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$474;
2006: HRP premium rate as a percent of standard market rate[A]: 140;
2006: Average monthly HRP premium[B]: $595;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$512.
HRP: WI[D];
2004: HRP premium rate as a percent of standard market rate[A]: 140;
2004: Average monthly HRP premium[B]: [Empty];
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$360;
2005: HRP premium rate as a percent of standard market rate[A]: 140;
2005: Average monthly HRP premium[B]: $442;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$417;
2006: HRP premium rate as a percent of standard market rate[A]: 144;
2006: Average monthly HRP premium[B]: $474;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$437.
HRP: WY;
2004: HRP premium rate as a percent of standard market rate[A]: 150;
2004: Average monthly HRP premium[B]: $669;
2004: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$711;
2005: HRP premium rate as a percent of standard market rate[A]: 174;
2005: Average monthly HRP premium[B]: $675;
2005: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$782;
2006: HRP premium rate as a percent of standard market rate[A]: 179;
2006: Average monthly HRP premium[B]: $801;
2006: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$899.
HRP: Average monthly premium across all HRPs[E];
2004: Average monthly HRP premium[B]: $424;
2005: Average monthly HRP premium[B]: $431;
2006: Average monthly HRP premium[B]: $450.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
Legend: [Empty] = response not provided:
[A] In general, each HRP sets premiums as a percentage of a standard
market rate, which is based on the premium rates charged by other
private individual market health insurance carriers offering coverage
in its state.
[B] HRPs calculated average premiums by dividing the total premium
revenue in each year by the average number of enrollees for the year,
with the exception of Texas which also included dependents in its
calculation because they hold their own policies. The calculation
excludes supplemental plans.
[C] Average premium is for a 50-year-old nonsmoking male with self-only
coverage who is enrolled in that state's most popular plan--the one
with the most enrollees.
[D] Wisconsin does not set its premiums as a percent of the standard
rate.
[E] Averages are weighted based on HRP enrollment.
[End of table]
Table 11b: HRP Average Monthly Premiums, by State HRP, Continued, 2007-
2008:
HRP: AL;
2007: HRP premium rate as a percent of standard market rate[A]: 126;
2007: Average monthly HRP premium[B]: $556;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$502;
2008: HRP premium rate as a percent of standard market rate[A]: 123;
2008: Average monthly HRP premium[B]: $571;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
$540.
HRP: AK;
2007: HRP premium rate as a percent of standard market rate[A]: 145;
2007: Average monthly HRP premium[B]: 563;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
689;
2008: HRP premium rate as a percent of standard market rate[A]: 140;
2008: Average monthly HRP premium[B]: 596;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
761.
HRP: AR;
2007: HRP premium rate as a percent of standard market rate[A]: 150;
2007: Average monthly HRP premium[B]: 445;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
450;
2008: HRP premium rate as a percent of standard market rate[A]: 150;
2008: Average monthly HRP premium[B]: 447;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
462.
HRP: CA;
2007: HRP premium rate as a percent of standard market rate[A]: 125;
2007: Average monthly HRP premium[B]: 410;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
717;
2008: HRP premium rate as a percent of standard market rate[A]: 125;
2008: Average monthly HRP premium[B]: 471;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
772.
HRP: CO;
2007: HRP premium rate as a percent of standard market rate[A]: 130;
2007: Average monthly HRP premium[B]: 329;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
478;
2008: HRP premium rate as a percent of standard market rate[A]: 128;
2008: Average monthly HRP premium[B]: 351;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
524.
HRP: CT;
2007: HRP premium rate as a percent of standard market rate[A]: 150;
2007: Average monthly HRP premium[B]: 628;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
717;
2008: HRP premium rate as a percent of standard market rate[A]: 150;
2008: Average monthly HRP premium[B]: 709;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
802.
HRP: FL;
2007: HRP premium rate as a percent of standard market rate[A]: 200;
2007: Average monthly HRP premium[B]: 455;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty];
2008: HRP premium rate as a percent of standard market rate[A]: 200;
2008: Average monthly HRP premium[B]: [Empty];
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
[Empty].
HRP: ID;
2007: HRP premium rate as a percent of standard market rate[A]: 125;
2007: Average monthly HRP premium[B]: 350;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
247;
2008: HRP premium rate as a percent of standard market rate[A]: 125;
2008: Average monthly HRP premium[B]: 367;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
275.
HRP: IL;
2007: HRP premium rate as a percent of standard market rate[A]: 137;
2007: Average monthly HRP premium[B]: 551;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
693;
2008: HRP premium rate as a percent of standard market rate[A]: 137;
2008: Average monthly HRP premium[B]: 608;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
721.
HRP: IN;
2007: HRP premium rate as a percent of standard market rate[A]: 130;
2007: Average monthly HRP premium[B]: 598;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
613;
2008: HRP premium rate as a percent of standard market rate[A]: 129;
2008: Average monthly HRP premium[B]: 629;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
613.
HRP: IA;
2007: HRP premium rate as a percent of standard market rate[A]: 150;
2007: Average monthly HRP premium[B]: 461;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
375;
2008: HRP premium rate as a percent of standard market rate[A]: 150;
2008: Average monthly HRP premium[B]: 472;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
384.
HRP: KS;
2007: HRP premium rate as a percent of standard market rate[A]: 134;
2007: Average monthly HRP premium[B]: 531;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
681;
2008: HRP premium rate as a percent of standard market rate[A]: 134;
2008: Average monthly HRP premium[B]: 589;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
521.
HRP: KY;
2007: HRP premium rate as a percent of standard market rate[A]: 130;
2007: Average monthly HRP premium[B]: 499;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
384;
2008: HRP premium rate as a percent of standard market rate[A]: 130;
2008: Average monthly HRP premium[B]: 502;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
388.
HRP: LA;
2007: HRP premium rate as a percent of standard market rate[A]: 182;
2007: Average monthly HRP premium[B]: 527;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
441;
2008: HRP premium rate as a percent of standard market rate[A]: 180;
2008: Average monthly HRP premium[B]: 562;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
482.
HRP: MD;
2007: HRP premium rate as a percent of standard market rate[A]: 117;
2007: Average monthly HRP premium[B]: 278;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
280;
2008: HRP premium rate as a percent of standard market rate[A]: 105;
2008: Average monthly HRP premium[B]: 270;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
431.
HRP: MN;
2007: HRP premium rate as a percent of standard market rate[A]: 119;
2007: Average monthly HRP premium[B]: 385;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
325;
2008: HRP premium rate as a percent of standard market rate[A]: 120;
2008: Average monthly HRP premium[B]: 410;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
375.
HRP: MS;
2007: HRP premium rate as a percent of standard market rate[A]: 150;
2007: Average monthly HRP premium[B]: 432;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
383;
2008: HRP premium rate as a percent of standard market rate[A]: 146;
2008: Average monthly HRP premium[B]: 428;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
383.
HRP: MO;
2007: HRP premium rate as a percent of standard market rate[A]: 170;
2007: Average monthly HRP premium[B]: 453;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
437;
2008: HRP premium rate as a percent of standard market rate[A]: 150;
2008: Average monthly HRP premium[B]: 474;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
450.
HRP: MT;
2007: HRP premium rate as a percent of standard market rate[A]: 130;
2007: Average monthly HRP premium[B]: 411;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
394;
2008: HRP premium rate as a percent of standard market rate[A]: 135;
2008: Average monthly HRP premium[B]: 486;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
397.
HRP: NE;
2007: HRP premium rate as a percent of standard market rate[A]: 135;
2007: Average monthly HRP premium[B]: 539;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
564;
2008: HRP premium rate as a percent of standard market rate[A]: 135;
2008: Average monthly HRP premium[B]: 502;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
546.
HRP: NH;
2007: HRP premium rate as a percent of standard market rate[A]: 125;
2007: Average monthly HRP premium[B]: 438;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
538;
2008: HRP premium rate as a percent of standard market rate[A]: 125;
2008: Average monthly HRP premium[B]: 461;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
580.
HRP: NM;
2007: HRP premium rate as a percent of standard market rate[A]: 138;
2007: Average monthly HRP premium[B]: 245;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
407;
2008: HRP premium rate as a percent of standard market rate[A]: 137;
2008: Average monthly HRP premium[B]: 240;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
407.
HRP: ND;
2007: HRP premium rate as a percent of standard market rate[A]: 135;
2007: Average monthly HRP premium[B]: 394;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
478;
2008: HRP premium rate as a percent of standard market rate[A]: 135;
2008: Average monthly HRP premium[B]: 421;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
478.
HRP: OK;
2007: HRP premium rate as a percent of standard market rate[A]: 150;
2007: Average monthly HRP premium[B]: 534;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
848;
2008: HRP premium rate as a percent of standard market rate[A]: 150;
2008: Average monthly HRP premium[B]: 552;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
848.
HRP: OR;
2007: HRP premium rate as a percent of standard market rate[A]: 117;
2007: Average monthly HRP premium[B]: 344;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
419;
2008: HRP premium rate as a percent of standard market rate[A]: 113;
2008: Average monthly HRP premium[B]: 398;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
503.
HRP: SC;
2007: HRP premium rate as a percent of standard market rate[A]: 200;
2007: Average monthly HRP premium[B]: 836;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
693;
2008: HRP premium rate as a percent of standard market rate[A]: 200;
2008: Average monthly HRP premium[B]: 926;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
792.
HRP: SD;
2007: HRP premium rate as a percent of standard market rate[A]: 150;
2007: Average monthly HRP premium[B]: 466;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
502;
2008: HRP premium rate as a percent of standard market rate[A]: 150;
2008: Average monthly HRP premium[B]: 504;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
571.
HRP: TN;
2007: HRP premium rate as a percent of standard market rate[A]: 150;
2007: Average monthly HRP premium[B]: 670;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
649;
2008: HRP premium rate as a percent of standard market rate[A]: 150;
2008: Average monthly HRP premium[B]: 672;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
649.
HRP: TX;
2007: HRP premium rate as a percent of standard market rate[A]: 200;
2007: Average monthly HRP premium[B]: 540;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
493;
2008: HRP premium rate as a percent of standard market rate[A]: 200;
2008: Average monthly HRP premium[B]: 593;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
565.
HRP: UT;
2007: HRP premium rate as a percent of standard market rate[A]: 137;
2007: Average monthly HRP premium[B]: 448;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
542;
2008: HRP premium rate as a percent of standard market rate[A]: 134;
2008: Average monthly HRP premium[B]: 444;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
569.
HRP: WA;
2007: HRP premium rate as a percent of standard market rate[A]: 113;
2007: Average monthly HRP premium[B]: 505;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
777;
2008: HRP premium rate as a percent of standard market rate[A]: 113;
2008: Average monthly HRP premium[B]: 538;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
801.
HRP: WV;
2007: HRP premium rate as a percent of standard market rate[A]: 140;
2007: Average monthly HRP premium[B]: 608;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
538;
2008: HRP premium rate as a percent of standard market rate[A]: 130;
2008: Average monthly HRP premium[B]: 585;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
466.
HRP: WI[D];
2007: HRP premium rate as a percent of standard market rate[A]: 149;
2007: Average monthly HRP premium[B]: 492;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
429;
2008: HRP premium rate as a percent of standard market rate[A]: 120;
2008: Average monthly HRP premium[B]: 466;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
404.
HRP: WY;
2007: HRP premium rate as a percent of standard market rate[A]: 200;
2007: Average monthly HRP premium[B]: 855;
2007: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
811;
2008: HRP premium rate as a percent of standard market rate[A]: 166;
2008: Average monthly HRP premium[B]: 752;
2008: Average monthly HRP premium for 50-year-old nonsmoking male[C]:
811.
HRP: Average monthly premium across all HRPs[E];
2007: Average monthly HRP premium[B]: $460;
2008: Average monthly HRP premium[B]: $485.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
Legend: [Empty] = response not provided:
[A] In general, each HRP sets premiums as a percentage of a standard
market rate, which is based on the premium rates charged by other
private individual health insurance carriers offering coverage in its
state.
[B] HRPs calculated average premiums by dividing the total premium
revenue in each year by the average number of enrollees for the year,
with the exception of Texas which also included dependents in its
calculation because they hold their own policies. The calculation
excludes supplemental plans.
[C] Average premium is for a 50-year-old nonsmoking male with self-only
coverage who is enrolled in that state's most popular plan--the one
with the most enrollees.
[D] Wisconsin does not set its premiums as a percent of the standard
market rate.
[E] Averages are weighted based on HRP enrollment.
[End of table]
Table 12: Change in Average Monthly Premiums for all HRPs Compared to
Private Health Insurance Market Premiums, 2004 to 2008:
Employer-sponsored market;
2004 through 2006: 2004: $308;
2004 through 2006: 2006: $354;
2004 through 2006: Percentage change: 15;
2007 through 2008: 2007: $373;
2007 through 2008: 2008: $392;
2007 through 2008: Percentage change: 5;
2004 through 2008: Percentage change: 27.
Individual market[A];
2004 through 2006: 2004: $189;
2004 through 2006: 2006: $218[B];
2004 through 2006: Percentage change: 15;
2007 through 2008: 2007: NA;
2007 through 2008: 2008: NA;
2007 through 2008: Percentage change: NA;
2004 through 2008: Percentage change: NA.
HRP[C,D];
2004 through 2006: 2004: $424;
2004 through 2006: 2006: $450;
2004 through 2006: Percentage change: 6;
2007 through 2008: 2007: $460;
2007 through 2008: 2008: $485;
2007 through 2008: Percentage change: 6;
2004 through 2008: Percentage change: 14.
Sources: GAO data collection instrument administered to all 34 HRPs
operational in 2008; America's Health Insurance Plans (AHIP) Center for
Policy and Research, Individual Health Insurance: A Comprehensive
Survey of Affordability, Access, and Benefits, August 2005,
(Washington, D.C.: 2005), and Individual Health Insurance 2006-2007: A
Comprehensive Survey of Premiums, Availability, and Benefits
(Washington, D.C.: 2007); Kaiser Family Foundation and Health Research
& Educational Trust, Employer Health Benefits: 2004, 2006, 2007, and
2008 Annual Surveys (Menlo Park, Calif., and Chicago, Ill.: 2004, 2006,
2007, and 2008 respectively).
Legend: NA = Not available:
[A] According to model legislation prescribed by the National
Association of Insurance Commissioners, an HRP should consider basing
premiums on the standard market rates charged in the individual market
in its state.
[B] AHIP individual market premium data are mostly as of December 2006
and January 2007.
[C] HRPs calculated average premiums by dividing the total premium
revenue in each year by the average number of enrollees for the year,
with the exception of Texas which also included dependents in its
calculation because they hold their own policies. The calculation
excludes supplemental plans. In addition, monthly averages were
weighted by the number of enrollees across all plans that responded.
[D] Table shows rounded numbers for average monthly HRP premiums.
However, percentage change numbers were calculated using non-rounded
numbers.
[End of table]
Table 13: Income-based Premium Subsidies Offered by HRPs, 2008:
HRP: CO;
Subsidy recipients: 3,232;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 481;
Average discount as a percentage of monthly premium: 30;
Average monthly discount: $111;
Maximum discount available as a percentage of monthly premium: 31.
HRP: IN;
Subsidy recipients: 238;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 200;
Average discount as a percentage of monthly premium: 40;
Average monthly discount: $348;
Maximum discount available as a percentage of monthly premium: 45.
HRP: MD;
Subsidy recipients: 4,614;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 300;
Average discount as a percentage of monthly premium: 55;
Average monthly discount: $191;
Maximum discount available as a percentage of monthly premium: 63.
HRP: MN[B];
Subsidy recipients: 2,390;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 220;
Average discount as a percentage of monthly premium: [Empty];
Average monthly discount: [Empty];
Maximum discount available as a percentage of monthly premium: [Empty].
HRP: MT;
Subsidy recipients: 336;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 150;
Average discount as a percentage of monthly premium: 45;
Average monthly discount: $266;
Maximum discount available as a percentage of monthly premium: 45.
HRP: NM;
Subsidy recipients: 2,637;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 399;
Average discount as a percentage of monthly premium: 67;
Average monthly discount: $239;
Maximum discount available as a percentage of monthly premium: 75.
HRP: OR;
Subsidy recipients: 4,729;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 185;
Average discount as a percentage of monthly premium: [Empty];
Average monthly discount: $397;
Maximum discount available as a percentage of monthly premium: 95.
HRP: TN;
Subsidy recipients: 3,342;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 350;
Average discount as a percentage of monthly premium: 63;
Average monthly discount: $436;
Maximum discount available as a percentage of monthly premium: 90.
HRP: UT;
Subsidy recipients: 795;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 300;
Average discount as a percentage of monthly premium: 37;
Average monthly discount: $168;
Maximum discount available as a percentage of monthly premium: 50.
HRP: WA;
Subsidy recipients: 11;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 300;
Average discount as a percentage of monthly premium: 18;
Average monthly discount: $168;
Maximum discount available as a percentage of monthly premium: 21.
HRP: WI[C];
Subsidy recipients: 3,299;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: [Empty];
Average discount as a percentage of monthly premium: 33;
Average monthly discount: $169;
Maximum discount available as a percentage of monthly premium: 43.
HRP: WY;
Subsidy recipients: 92;
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 250;
Average discount as a percentage of monthly premium: 30;
Average monthly discount: [Empty];
Maximum discount available as a percentage of monthly premium: 33.
HRP: Across all HRPs;
Subsidy recipients: 25,715[D];
Maximum household income eligible for a subsidy as percentage of
FPL[A]: 285%;
Average discount as a percentage of monthly premium: 49%[E];
Average monthly discount: $261[E];
Maximum discount available as a percentage of monthly premium: 66[E].
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
Legend: [Empty] = response not provided:
Note: Information presented for the 12 HRPs that reported that they
provided income-based premium subsidies. Other HRPs may also offer
income-based subsidies that are not related to premiums.
[A] Federal Poverty Level (FPL).
[B] Minnesota's subsidy program is not tied directly to the amount of
premium or percent of premium an enrollee pays; rather, it is a program
that provides a subsidy once a year. If enrollees qualify at 220
percent of the FPL based on household size, they receive one check per
enrollee and dependent. They are not required to use these funds toward
premium payment. For example, funds can be used for other purposes such
as paying coinsurance, or deductible amounts due to providers. The
program includes enrollees and dependents on all plans including
Medicare.
[C] The income limit for Wisconsin's subsidy program was not expressed
relative to the FPL, but to a level of household income. In calendar
year 2008, the maximum income eligible was $25,000.
[D] Fourteen percent of all HRP enrollees were receiving income-based
premium subsidies.
[E] Average is weighted by number of subsidy recipients.
[End of table]
Table 14: Income-based Premium Subsidy Recipients by Deductible Level,
2008:
Deductible level: No deductible;
Number of subsidy recipients enrolled: 229.
Deductible level: $1 - $499;
Number of subsidy recipients enrolled: 2,218.
Deductible level: $500 - $999;
Number of subsidy recipients enrolled: 9,186.
Deductible level: $1,000 - $1,999;
Number of subsidy recipients enrolled: 5,851.
Deductible level: $2,000 - $2,999;
Number of subsidy recipients enrolled: 3,348.
Deductible level: $3,000 - $4,999;
Number of subsidy recipients enrolled: 909.
Deductible level: $5,000 or more;
Number of subsidy recipients enrolled: 1,538.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
Note: Information presented for the 12 HRPs that reported that they
provided income-based premium subsidies. Deductible information was not
provided for all subsidy recipients.
[End of table]
Enclosure III: HRP Governance, Expenditures, and Funding:
Table 15: Composition of HRP Boards of Directors Across All 34 HRPs,
2008:
Group: Employers;
Voting members as a percentage of total: 3;
Nonvoting members as a percentage of total: 5.
Group: Enrollees;
Voting members as a percentage of total: 7;
Nonvoting members as a percentage of total: 0.
Group: Insurance carriers;
Voting members as a percentage of total: 41;
Nonvoting members as a percentage of total: 2.
Group: Medical providers;
Voting members as a percentage of total: 9;
Nonvoting members as a percentage of total: 15.
Group: State government;
Voting members as a percentage of total: 13;
Nonvoting members as a percentage of total: 54.
Group: Other[A];
Voting members as a percentage of total: 27;
Nonvoting members as a percentage of total: 24.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
[A] Other members of HRP boards of directors include members of
insurance and medical representative associations, the general public,
and disability agents, among others.
[End of table]
Table 16: Composition of Boards of Directors by State HRP, 2008:
HRP: AL;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 2;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 3;
State government: Nonvoting: [Empty];
Other[A]: Voting: 1;
Other[A]: Nonvoting: [Empty].
HRP: AK;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 5;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 2;
Other[A]: Nonvoting: [Empty].
HRP: AR;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 1;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 4;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 1;
Other[A]: Nonvoting: [Empty].
HRP: CA;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: [Empty];
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 5;
Other[A]: Nonvoting: 3.
HRP: CO;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 2;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 4;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: 3;
Other[A]: Voting: [Empty];
Other[A]: Nonvoting: [Empty].
HRP: CT;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 9;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: [Empty];
Other[A]: Nonvoting: [Empty].
HRP: FL;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 1;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 1;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 1;
State government: Nonvoting: [Empty];
Other[A]: Voting: [Empty];
Other[A]: Nonvoting: [Empty].
HRP: ID;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 4;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 3;
State government: Nonvoting: [Empty];
Other[A]: Voting: 4;
Other[A]: Nonvoting: [Empty].
HRP: IL;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: [Empty];
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 3;
State government: Nonvoting: 4;
Other[A]: Voting: 10;
Other[A]: Nonvoting: [Empty].
HRP: IN;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 2;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 4;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: 2;
State government: Nonvoting: [Empty];
Other[A]: Voting: [Empty];
Other[A]: Nonvoting: [Empty].
HRP: IA;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 7;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 1;
State government: Nonvoting: [Empty];
Other[A]: Voting: 3;
Other[A]: Nonvoting: 3.
HRP: KS;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 1;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 6;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 3;
Other[A]: Nonvoting: [Empty].
HRP: KY;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: [Empty];
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 1;
State government: Nonvoting: 1;
Other[A]: Voting: [Empty];
Other[A]: Nonvoting: [Empty].
HRP: LA;
Employers: Voting: 1;
Employers: Nonvoting: [Empty];
Enrollees: Voting: 1;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 1;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 2;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: 3;
Other[A]: Voting: 5;
Other[A]: Nonvoting: [Empty].
HRP: MD;
Employers: Voting: 1;
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 1;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 4;
State government: Nonvoting: [Empty];
Other[A]: Voting: 3;
Other[A]: Nonvoting: [Empty].
HRP: MN;
Employers: Voting: 1;
Employers: Nonvoting: [Empty];
Enrollees: Voting: 2;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 6;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 2;
Other[A]: Nonvoting: [Empty].
HRP: MS;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 3;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: 2;
Other[A]: Voting: 3;
Other[A]: Nonvoting: [Empty].
HRP: MO;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 3;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 2;
Medical providers: Nonvoting: [Empty];
State government: Voting: 1;
State government: Nonvoting: 4;
Other[A]: Voting: 3;
Other[A]: Nonvoting: [Empty].
HRP: MT;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 1;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 7;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: [Empty];
Other[A]: Nonvoting: [Empty].
HRP: NE;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 1;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 4;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 2;
Other[A]: Nonvoting: [Empty].
HRP: NH;
Employers: Voting: 1;
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 6;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: 1;
Other[A]: Voting: 2;
Other[A]: Nonvoting: [Empty].
HRP: NM;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 4;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: 1;
State government: Nonvoting: [Empty];
Other[A]: Voting: 5;
Other[A]: Nonvoting: [Empty].
HRP: ND;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 3;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 5;
State government: Nonvoting: [Empty];
Other[A]: Voting: [Empty];
Other[A]: Nonvoting: [Empty].
HRP: OK;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 1;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 5;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 2;
Other[A]: Nonvoting: [Empty].
HRP: OR;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 5;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: 1;
State government: Nonvoting: [Empty];
Other[A]: Voting: 2;
Other[A]: Nonvoting: 1.
HRP: SC;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 5;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 3;
Other[A]: Nonvoting: [Empty].
HRP: SD;
Employers: Voting: [Empty];
Employers: Nonvoting: 2;
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 1;
Insurance carriers: Nonvoting: 1;
Medical providers: Voting: 1;
Medical providers: Nonvoting: 6;
State government: Voting: 5;
State government: Nonvoting: 2;
Other[A]: Voting: [Empty];
Other[A]: Nonvoting: 3.
HRP: TN;
Employers: Voting: 2;
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 2;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 2;
Medical providers: Nonvoting: [Empty];
State government: Voting: 5;
State government: Nonvoting: [Empty];
Other[A]: Voting: 2;
Other[A]: Nonvoting: [Empty].
HRP: TX;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: 2;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 2;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 2;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 3;
Other[A]: Nonvoting: [Empty].
HRP: UT;
Employers: Voting: 1;
Employers: Nonvoting: [Empty];
Enrollees: Voting: 1;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 2;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: 2;
State government: Nonvoting: [Empty];
Other[A]: Voting: 5;
Other[A]: Nonvoting: [Empty].
HRP: WA;
Employers: Voting: 2;
Employers: Nonvoting: [Empty];
Enrollees: Voting: 2;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 4;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: 1;
Other[A]: Voting: 1;
Other[A]: Nonvoting: [Empty].
HRP: WV;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 2;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 1;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: [Empty];
Other[A]: Voting: 3;
Other[A]: Nonvoting: [Empty].
HRP: WI;
Employers: Voting: 1;
Employers: Nonvoting: [Empty];
Enrollees: Voting: 2;
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 4;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: 4;
Medical providers: Nonvoting: [Empty];
State government: Voting: [Empty];
State government: Nonvoting: 1;
Other[A]: Voting: 2;
Other[A]: Nonvoting: [Empty].
HRP: WY;
Employers: Voting: [Empty];
Employers: Nonvoting: [Empty];
Enrollees: Voting: [Empty];
Enrollees: Nonvoting: [Empty];
Insurance carriers: Voting: 3;
Insurance carriers: Nonvoting: [Empty];
Medical providers: Voting: [Empty];
Medical providers: Nonvoting: [Empty];
State government: Voting: 1;
State government: Nonvoting: [Empty];
Other[A]: Voting: 3;
Other[A]: Nonvoting: [Empty].
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
[A] Other members of HRP boards of directors include members of
insurance and medical representative associations, the general public,
and disability agents, among others.
[End of table]
Table 17: Expenditures by State HRP, 2003 and 2008 (dollars in
thousands):
HRP: AL;
Year: 2003;
Paid claims: Medical: $23,991;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $23,991;
Administrative expenses[B]: $263;
Other expenditures: $19;
Total expenditures[C]: $24,272.
HRP: AL;
Year: 2008;
Paid claims: Medical: $21,225;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $21,225;
Administrative expenses[B]: $363;
Other expenditures: $24;
Total expenditures[C]: $21,612.
HRP: AK;
Year: 2003;
Paid claims: Medical: $5,749;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $909;
Paid claims: Total claims: $6,658;
Administrative expenses[B]: $416;
Other expenditures: $95;
Total expenditures[C]: $7,168.
HRP: AK;
Year: 2008;
Paid claims: Medical: $4,558;
Paid claims: Mental health services[A]: $54;
Paid claims: Prescription drugs: $780;
Paid claims: Total claims: $5,392;
Administrative expenses[B]: $352;
Other expenditures: $163;
Total expenditures[C]: $5,906.
HRP: AR;
Year: 2003;
Paid claims: Medical: $21,375;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $21,375;
Administrative expenses[B]: $2,149;
Other expenditures: $27;
Total expenditures[C]: $23,551.
HRP: AR;
Year: 2008;
Paid claims: Medical: $19,635;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $19,635;
Administrative expenses[B]: $2,386;
Other expenditures: [Empty];
Total expenditures[C]: $22,021.
HRP: CA;
Year: 2003; Paid claims: Medical: $97,565;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $97,565;
Administrative expenses[B]: $4,850;
Other expenditures: [Empty];
Total expenditures[C]: $102,415.
HRP: CA;
Year: 2008;
Paid claims: Medical: $39,201;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $39,201;
Administrative expenses[B]: $2,507;
Other expenditures: [Empty];
Total expenditures[C]: $41,708.
HRP: CO;
Year: 2003;
Paid claims: Medical: $24,876;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $5,568;
Paid claims: Total claims: $30,444;
Administrative expenses[B]: $3,007;
Other expenditures: [Empty];
Total expenditures[C]: $33,451.
HRP: CO;
Year: 2008;
Paid claims: Medical: $51,401;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $11,227;
Paid claims: Total claims: $62,628;
Administrative expenses[B]: $5,302;
Other expenditures: [Empty];
Total expenditures[C]: $67,930.
HRP: CT;
Year: 2003;
Paid claims: Medical: $22,391;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $22,391;
Administrative expenses[B]: $725;
Other expenditures: $1,164;
Total expenditures[C]: $24,281.
HRP: CT;
Year: 2008;
Paid claims: Medical: $28,108;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $7,543;
Paid claims: Total claims: $35,651;
Administrative expenses[B]: $521;
Other expenditures: $1,098;
Total expenditures[C]: $37,270.
HRP: FL;
Year: 2003;
Paid claims: Medical: $4,371;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: 0;
Paid claims: Total claims: $4,371;
Administrative expenses[B]: $552;
Other expenditures: [Empty];
Total expenditures[C]: $4,923.
HRP: FL;
Year: 2008;
Paid claims: Medical: $2,812;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $865;
Paid claims: Total claims: $3,676;
Administrative expenses[B]: $630;
Other expenditures: [Empty];
Total expenditures[C]: $4,306.
HRP: ID;
Year: 2003;
Paid claims: Medical: $5,715;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: 0;
Paid claims: Total claims: $5,715;
Administrative expenses[B]: $143;
Other expenditures: $32;
Total expenditures[C]: $5,889.
HRP: ID;
Year: 2008;
Paid claims: Medical: $12,578;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: 0;
Paid claims: Total claims: $12,578;
Administrative expenses[B]: $1,360;
Other expenditures: $141;
Total expenditures[C]: $14,079.
HRP: IL;
Year: 2003;
Paid claims: Medical: $81,814;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $25,245;
Paid claims: Total claims: $107,059;
Administrative expenses[B]: $6,131;
Other expenditures: [Empty];
Total expenditures[C]: $113,191.
HRP: IL;
Year: 2008;
Paid claims: Medical: $115,607;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $40,521;
Paid claims: Total claims: $156,128;
Administrative expenses[B]: $8,883;
Other expenditures: [Empty];
Total expenditures[C]: $165,011.
HRP: IN;
Year: 2003;
Paid claims: Medical: $90,429;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $18,617;
Paid claims: Total claims: $109,046;
Administrative expenses[B]: $4,538;
Other expenditures: $596;
Total expenditures[C]: $114,180.
HRP: IN;
Year: 2008;
Paid claims: Medical: $57,100;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $39,810;
Paid claims: Total claims: $96,910;
Administrative expenses[B]: $3,991;
Other expenditures: $587;
Total expenditures[C]: $101,488.
HRP: IA;
Year: 2003;
Paid claims: Medical: [Empty];
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $1,795;
Administrative expenses[B]: $365;
Other expenditures: [Empty];
Total expenditures[C]: $2,160.
HRP: IA;
Year: 2008;
Paid claims: Medical: $25,760;
Paid claims: Mental health services[A]: $307;
Paid claims: Prescription drugs: $5,392;
Paid claims: Total claims: $31,459;
Administrative expenses[B]: $1,442;
Other expenditures: $201;
Total expenditures[C]: $33,101.
HRP: KS;
Year: 2003;
Paid claims: Medical: $11,488;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $1,485;
Paid claims: Total claims: $12,974;
Administrative expenses[B]: $318;
Other expenditures: $137;
Total expenditures[C]: $13,429.
HRP: KS;
Year: 2008;
Paid claims: Medical: $19,334;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $2,930;
Paid claims: Total claims: $22,264;
Administrative expenses[B]: $322;
Other expenditures: $852;
Total expenditures[C]: $23,438.
HRP: KY;
Year: 2003;
Paid claims: Medical: $10,697;
Paid claims: Mental health services[A]: $91;
Paid claims: Prescription drugs: $3,802;
Paid claims: Total claims: $14,591;
Administrative expenses[B]: $1,281;
Other expenditures: $41;
Total expenditures[C]: $15,914.
HRP: KY;
Year: 2008;
Paid claims: Medical: $31,091;
Paid claims: Mental health services[A]: $527;
Paid claims: Prescription drugs: $15,654;
Paid claims: Total claims: $47,272;
Administrative expenses[B]: $3,122;
Other expenditures: $39;
Total expenditures[C]: $50,433.
HRP: LA;
Year: 2003;
Paid claims: Medical: $12,174;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $1,570;
Paid claims: Total claims: $13,744;
Administrative expenses[B]: $746;
Other expenditures: $338;
Total expenditures[C]: $14,828.
HRP: LA;
Year: 2008;
Paid claims: Medical: $7,785;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $1,791;
Paid claims: Total claims: $9,576;
Administrative expenses[B]: $1,137;
Other expenditures: $381;
Total expenditures[C]: $11,094.
HRP: MD;
Year: 2003[D];
Paid claims: Medical: 0;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: 0;
Paid claims: Total claims: 0;
Administrative expenses[B]: $96;
Other expenditures: $169;
Total expenditures[C]: $266.
HRP: MD;
Year: 2008;
Paid claims: Medical: $75,829;
Paid claims: Mental health services[A]: $1,817;
Paid claims: Prescription drugs: $28,866;
Paid claims: Total claims: $106,511;
Administrative expenses[B]: $6,568;
Other expenditures: $800;
Total expenditures[C]: $113,880.
HRP: MN;
Year: 2003;
Paid claims: Medical: [Empty];
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $175,049;
Administrative expenses[B]: $9,079;
Other expenditures: 0;
Total expenditures[C]: $184,128.
HRP: MN;
Year: 2008;
Paid claims: Medical: $195,904;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $49,869;
Paid claims: Total claims: $245,773;
Administrative expenses[B]: $10,207;
Other expenditures: $1,559;
Total expenditures[C]: $257,540.
HRP: MS;
Year: 2003;
Paid claims: Medical: $17,956;
Paid claims: Mental health services[A]: $277;
Paid claims: Prescription drugs: $5,524;
Paid claims: Total claims: $23,757;
Administrative expenses[B]: $1,371;
Other expenditures: 0;
Total expenditures[C]: $25,129.
HRP: MS;
Year: 2008;
Paid claims: Medical: $16,260;
Paid claims: Mental health services[A]: $132;
Paid claims: Prescription drugs: $6,625;
Paid claims: Total claims: $23,018;
Administrative expenses[B]: $1,597;
Other expenditures: 0;
Total expenditures[C]: $24,615.
HRP: MO;
Year: 2003;
Paid claims: Medical: $11,666;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $5,062;
Paid claims: Total claims: $16,728;
Administrative expenses[B]: $2,114;
Other expenditures: 0;
Total expenditures[C]: $18,842.
HRP: MO;
Year: 2008;
Paid claims: Medical: $16,407;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $8,387;
Paid claims: Total claims: $24,794;
Administrative expenses[B]: $2,849;
Other expenditures: 0;
Total expenditures[C]: $27,644.
HRP: MT;
Year: 2003;
Paid claims: Medical: $10,369;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $3,481;
Paid claims: Total claims: $13,850;
Administrative expenses[B]: $1,085;
Other expenditures: $112;
Total expenditures[C]: $15,047.
HRP: MT;
Year: 2008;
Paid claims: Medical: $20,968;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $4,539;
Paid claims: Total claims: $25,507;
Administrative expenses[B]: $1,165;
Other expenditures: $209;
Total expenditures[C]: $26,882.
HRP: NE;
Year: 2003;
Paid claims: Medical: $32,214;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $12,657;
Paid claims: Total claims: $44,871;
Administrative expenses[B]: $2,891;
Other expenditures: $93;
Total expenditures[C]: $47,856.
HRP: NE;
Year: 2008;
Paid claims: Medical: $39,092;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $15,827;
Paid claims: Total claims: $54,920;
Administrative expenses[B]: $2,982;
Other expenditures: $675;
Total expenditures[C]: $58,576.
HRP: NH;
Year: 2003;
Paid claims: Medical: $1,499;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $60;
Paid claims: Total claims: $1,559;
Administrative expenses[B]: $323;
Other expenditures: $42;
Total expenditures[C]: $1,925.
HRP: NH;
Year: 2008;
Paid claims: Medical: $10,997;
Paid claims: Mental health services[A]: $83;
Paid claims: Prescription drugs: $1,103;
Paid claims: Total claims: $12,183;
Administrative expenses[B]: $702;
Other expenditures: $142;
Total expenditures[C]: $13,027.
HRP: NM;
Year: 2003;
Paid claims: Medical: $7,136;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $2,924;
Paid claims: Total claims: $10,060;
Administrative expenses[B]: $425;
Other expenditures: $225;
Total expenditures[C]: $10,710.
HRP: NM;
Year: 2008;
Paid claims: Medical: $46,283;
Paid claims: Mental health services[A]: $381;
Paid claims: Prescription drugs: $14,189;
Paid claims: Total claims: $60,853;
Administrative expenses[B]: $2,454;
Other expenditures: $975;
Total expenditures[C]: $64,282.
HRP: ND;
Year: 2003;
Paid claims: Medical: [Empty];
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $8,090;
Administrative expenses[B]: $281;
Other expenditures: [Empty];
Total expenditures[C]: $8,370.
HRP: ND;
Year: 2008;
Paid claims: Medical: [Empty];
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $10,343;
Administrative expenses[B]: $379;
Other expenditures: [Empty];
Total expenditures[C]: $10,722.
HRP: OK;
Year: 2003;
Paid claims: Medical: $16,368;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $6,993;
Paid claims: Total claims: $23,361;
Administrative expenses[B]: $1,227;
Other expenditures: 0;
Total expenditures[C]: $24,587.
HRP: OK;
Year: 2008;
Paid claims: Medical: $16,013;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $8,320;
Paid claims: Total claims: $24,333;
Administrative expenses[B]: $1,239;
Other expenditures: 0;
Total expenditures[C]: $25,571.
HRP: OR;
Year: 2003;
Paid claims: Medical: $45,624;
Paid claims: Mental health services[A]: $1,508;
Paid claims: Prescription drugs: $13,961;
Paid claims: Total claims: $61,092;
Administrative expenses[B]: $3,976;
Other expenditures: 0;
Total expenditures[C]: $65,069.
HRP: OR;
Year: 2008;
Paid claims: Medical: $125,324;
Paid claims: Mental health services[A]: $7,252;
Paid claims: Prescription drugs: $30,453;
Paid claims: Total claims: $163,029;
Administrative expenses[B]: $7,982;
Other expenditures: 0;
Total expenditures[C]: $171,011.
HRP: SC;
Year: 2003;
Paid claims: Medical: $18,973;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $18,973;
Administrative expenses[B]: $1,405;
Other expenditures: $275;
Total expenditures[C]: $20,652.
HRP: SC;
Year: 2008;
Paid claims: Medical: $26,630;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $26,630;
Administrative expenses[B]: $1,737;
Other expenditures: $66;
Total expenditures[C]: $28,433.
HRP: SD;
Year: 2003;
Paid claims: Medical: [Empty];
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
aid claims: Total claims: [Empty];
Administrative expenses[B]: [Empty];
Other expenditures: [Empty];
Total expenditures[C]: v.
HRP: SD;
Year: 2008;
Paid claims: Medical: $3,707;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $1,518;
Paid claims: Total claims: $5,225;
Administrative expenses[B]: $389;
Other expenditures: 0;
Total expenditures[C]: $5,614.
HRP: TN;
Year: 2003;
Paid claims: Medical: 0;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: 0;
Paid claims: Total claims: 0;
Administrative expenses[B]: 0;
Other expenditures: 0;
Total expenditures[C]: 0.
HRP: TN;
Year: 2008;
Paid claims: Medical: $20,443;
Paid claims: Mental health services[A]: 0;
Paid claims: Prescription drugs: $4,675;
Paid claims: Total claims: $25,118;
Administrative expenses[B]: $2,359;
Other expenditures: 0;
Total expenditures[C]: $27,477.
HRP: TX;
Year: 2003;
Paid claims: Medical: $124,682;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $52,696;
Paid claims: Total claims: $177,378;
Administrative expenses[B]: $14,284;
Other expenditures: 0;
Total expenditures[C]: $191,662.
HRP: TX;
Year: 2008;
Paid claims: Medical: $182,337;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $80,210;
Paid claims: Total claims: $262,547;
Administrative expenses[B]: $13,715;
Other expenditures: 0;
Total expenditures[C]: $276,262.
HRP: UT;
Year: 2003;
Paid claims: Medical: $12,275;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $3,808;
Paid claims: Total claims: $16,083;
Administrative expenses[B]: $1,340;
Other expenditures: [Empty];
Total expenditures[C]: $17,424.
HRP: UT;
Year: 2008;
Paid claims: Medical: $21,021;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $4,975;
Paid claims: Total claims: $25,996;
Administrative expenses[B]: $1,782;
Other expenditures: [Empty];
Total expenditures[C]: $27,778.
HRP: WA;
Year: 2003;
Paid claims: Medical: [Empty];
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $37,493;
Administrative expenses[B]: $1,746;
Other expenditures: 0;
Total expenditures[C]: $39,239.
HRP: WA;
Year: 2008;
Paid claims: Medical: $30,880;
Paid claims: Mental health services[A]: $838;
Paid claims: Prescription drugs: $23,490;
Paid claims: Total claims: $55,208;
Administrative expenses[B]: $3,567;
Other expenditures: 0;
Total expenditures[C]: $58,775.
HRP: WV;
Year: 2003;
Paid claims: Medical: 0;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: 0;
Paid claims: Total claims: 0;
Administrative expenses[B]: 0;
Other expenditures: 0;
Total expenditures[C]: 0.
HRP: WV;
Year: 2008;
Paid claims: Medical: $1,957;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $722;
Paid claims: Total claims: $2,679;
Administrative expenses[B]: $387;
Other expenditures: 0;
Total expenditures[C]: $3,066.
HRP: WI;
Year: 2003;
Paid claims: Medical: [Empty];
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $110,444;
Administrative expenses[B]: $4,574;
Other expenditures: 0;
Total expenditures[C]: $115,018.
HRP: WI;
Year: 2008;
Paid claims: Medical: $123,458;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: $33,364;
Paid claims: Total claims: $156,822;
Administrative expenses[B]: $6,530;
Other expenditures: 0;
Total expenditures[C]: $163,352.
HRP: WY;
Year: 2003;
Paid claims: Medical: $4,568;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $4,568;
Administrative expenses[B]: $51;
Other expenditures: $112;
Total expenditures[C]: $4,731.
HRP: WY;
Year: 2008;
Paid claims: Medical: $7,511;
Paid claims: Mental health services[A]: [Empty];
Paid claims: Prescription drugs: [Empty];
Paid claims: Total claims: $7,511;
Administrative expenses[B]: $74;
Other expenditures: $314;
Total expenditures[C]: $7,899.
Total;
Year: 2003;
Paid claims: Medical: $715,965;
Paid claims: Mental health services[A]: $1,876;
Paid claims: Prescription drugs: $164,364;
Paid claims: Total claims: $1,215,075;
Administrative expenses[B]: $71,752;
Other expenditures: $3,479;
Total expenditures[C]: $1,290,306.
Total;
Year: 2008;
Paid claims: Medical: $1,417,216;
Paid claims: Mental health services[A]: $11,391;
Paid claims: Prescription drugs: $443,646;
Paid claims: Total claims: $1,882,595;
Administrative expenses[B]: $100,982;
Other expenditures: $8,226;
Total expenditures[C]: $1,991,803.
Percent change[E]:
Paid claims: Medical: +99;
Paid claims: Prescription drugs: +170;
Paid claims: Total claims: +55;
Administrative expenses[B]: +41;
Other expenditures: +136;
Total expenditures[C]: +54.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
Legend: [Empty] = response not provided:
[A] Where mental health services claims are not provided, they are
included in the medical claims.
[B] May include third-party administrative fees, actuarial fees, legal
fees, agent fees, etc.
[C] Totals may not add due to rounding.
[D] The Maryland HRP did not begin providing health insurance coverage
until fiscal year 2004.
[E] While this table presents expenditure figures in rounded numbers
(thousands), the percentage change numbers were calculated based on non-
rounded expenditure numbers.
[End of table]
Table 18: Average Claims per Enrolled Individual, by State HRP, 2003
and 2008:
HRP: AL;
2003: $6,114;
2008: $8,807.
HRP: AK;
2003: $13,755;
2008: $11,496.
HRP: AR;
2003: $6,485;
2008: $6,377.
HRP: CA;
2003: $12,609;
2008: $5,572.
HRP: CO;
2003: $6,251;
2008: $7,323.
HRP: CT;
2003: $9,778;
2008: $15,262.
HRP: FL;
2003: $8,406;
2008: $12,590.
HRP: ID;
2003: $4,369;
2008: $9,407.
HRP: IL;
2003: $6,668;
2008: $9,720.
HRP: IN;
2003: $11,355;
2008: $13,864.
HRP: IA;
2003: $13,806;
2008: $11,515.
HRP: KS;
2003: $7,618;
2008: $11,951.
HRP: KY;
2003: $5,939;
2008: $10,857.
HRP: LA;
2003: $10,047;
2008: $8,573.
HRP: MD;
2003: 0[A];
2008: $7,250.
HRP: MN;
2003: $5,194;
2008: $8,974.
HRP: MS;
2003: $5,603;
2008: $6,637.
HRP: MO;
2003: $6,856;
2008: $8,224.
HRP: MT;
2003: $4,553;
2008: $8,457.
HRP: NE;
2003: $7,274;
2008: $10,714.
HRP: NH;
2003: $9,868;
2008: $11,137.
HRP: NM;
2003: $8,383;
2008: $10,108.
HRP: ND;
2003: $4,479;
2008: $7,070.
HRP: OK;
2003: $8,211;
2008: $10,691.
HRP: OR;
2003: $6,180;
2008: $10,643.
HRP: SC;
2003: $10,546;
2008: $11,434.
HRP: SD;
2003: [Empty][B];
2008: $7,810.
HRP: TN;
2003: [Empty][C];
2008: $6,666.
HRP: TX;
2003: $7,189;
2008:$9,757.
HRP: UT;
2003: $5,661;
2008: $7,179.
HRP: WA;
2003: $14,138;
2008: $16,252.
HRP: WV;
2003: [Empty][D];
2008: $4,109.
HRP: WI;
2003: $6,330;
2008: $9,630.
HRP: WY;
2003: $7,016;
2008: $10,490.
HRP: Across all HRPs;
2003: $6,795[E];
2008: $9,437[E].
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008 and GAO analysis of data from the National
Association of State Comprehensive Health Insurance Plans,
Comprehensive Health Insurance for High-Risk Individuals: A State-by-
State Analysis, 2008/2009.
Legend: --= response not provided:
Note: GAO calculated average claims based on an analysis of total
claims and total enrollment--including dependents--for all state HRPs
except for Indiana, which directly provided us average claims data.
[A] Maryland's HRP was first established in 2003.
[B] South Dakota's HRP was first established in 2003.
[C] Tennessee's HRP did not exist in 2003.
[D] West Virginia's HRP did not exist in 2003.
[E] Averages weighted by total enrollment.
[End of table]
Table 19: Sources of HRP Funding Nationwide, 2003 and 2008 (in
thousands):
Type of funding: Premiums;
2003: ($): 763,850;
2003: Percentage of total funding: 57.4;
2008: ($): 981,882;
2008: Percentage of total funding: 54.0.
Type of funding: Assessments on health insurance carriers;
2003: ($): 428,288;
2003: Percentage of total funding: 32.2;
2008: ($): 422,815;
2008: Percentage of total funding: 23.2.
Type of funding: Other assessments;
2003: ($): 28,137;
2003: Percentage of total funding: 2.1;
2008: ($): 135,073;
2008: Percentage of total funding: 7.4.
Type of funding: State general revenues;
2003: ($): 16,683;
2003: Percentage of total funding: 1.3;
2008: ($): 93,426;
2008: Percentage of total funding: 5.1.
Type of funding: State tobacco tax;
2003: ($): 40,000;
2003: Percentage of total funding: 3.0;
2008: ($): 39,771;
2008: Percentage of total funding: 2.2.
Type of funding: Federal grants[A];
2003: ($): 1,844;
2003: Percentage of total funding: 0.1;
2008: ($): 31,487; 2008:
Percentage of total funding: 1.7.
Type of funding: Other;
2003: ($): 52,248;
2003: Percentage of total funding: 3.9;
2008: ($): 115,063;
2008: Percentage of total funding: 6.3.
Type of funding: Total;
2003: ($): 1,331,050;
2003: Percentage of total funding: 100;
2008: ($): 1,819,517;
2008: Percentage of total funding: 100[B].
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
[A] Federal grants were awarded by the Centers for Medicare & Medicaid
Services.
[B] Totals do not sum to 100 percent due to rounding.
[End of table]
Table 20: Sources of Funding by State HRP, 2003 and 2008:
HRP: AL;
Year: 2003;
Percentage of total funding: Premiums: 65.5;
Percentage of total funding: Assessments on carriers: 33.9;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.6;
Total funding for state HRP (in thousands): $28,683.
HRP: AL;
Year: 2008;
Percentage of total funding: Premiums: 72.4;
Percentage of total funding: Assessments on carriers: 20.3;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 6.3;
Percentage of total funding: Other: 1.0;
Total funding for state HRP (in thousands): $23,071.
HRP: AK;
Year: 2003;
Percentage of total funding: Premiums: 43.5;
Percentage of total funding: Assessments on carriers: 56.4;
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: [Empty];
Percentage of total funding: Other: 0.1;
Total funding for state HRP (in thousands): $5,939.
HRP: AK;
Year: 2008;
Percentage of total funding: Premiums: 52.3;
Percentage of total funding: Assessments on carriers: 38.9;
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: 8;
Percentage of total funding: Other: 0.7;
Total funding for state HRP (in thousands): $6,420.
HRP: AR;
Year: 2003;
Percentage of total funding: Premiums: 61.9;
Percentage of total funding: Assessments on carriers: 38.1;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.1;
Total funding for state HRP (in thousands): $26,462.
HRP: AR;
Year: 2008;
Percentage of total funding: Premiums: 76.7;
Percentage of total funding: Assessments on carriers: 21.6;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0.1;
Percentage of total funding: Other: 1.6;
Total funding for state HRP (in thousands): $20,963.
HRP: CA;
Year: 2003;
Percentage of total funding: Premiums: 63.4;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 36.6;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $109,285.
HRP: CA;
Year: 2008;
Percentage of total funding: Premiums: 45.0;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 11.2;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 43.8;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $88,927.
HRP: CO;
Year: 2003;
Percentage of total funding: Premiums: 67.1;
Percentage of total funding: Assessments on carriers: 11.9;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 21.0;
Total funding for state HRP (in thousands): $30,640.
HRP: CO;
Year: 2008;
Percentage of total funding: Premiums: 44.8;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 2.5;
Percentage of total funding: Other: 52.7;
Total funding for state HRP (in thousands): $73,399.
HRP: CT;
Year: 2003;
Percentage of total funding: Premiums: 62.8;
Percentage of total funding: Assessments on carriers: 31.3;
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: 5.9;
Percentage of total funding: Other: [Empty];
Total funding for state HRP (in thousands): $25,489.
HRP: CT;
Year: 2008;
Percentage of total funding: Premiums: FL: 59.5;
Percentage of total funding: Assessments on carriers: 37.3;
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: 3.3;
Percentage of total funding: Other: [Empty];
Total funding for state HRP (in thousands): $36,205.
HRP: FL;
Year: 2003;
Percentage of total funding: Premiums: 44.1;
Percentage of total funding: Assessments on carriers: 55.9;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $4,909.
HRP: FL;
Year: 2008;
Percentage of total funding: Premiums: 51.4;
Percentage of total funding: Assessments on carriers: 44.0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 4.6;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $3,273.
HRP: ID;
Year: 2003;
Percentage of total funding: Premiums: 73.4;
Percentage of total funding: Assessments on carriers: [Empty];
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: 26.0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.6;
Total funding for state HRP (in thousands): $5,889.
HRP: ID;
Year: 2008;
Percentage of total funding: Premiums: 43.2;
Percentage of total funding: Assessments on carriers: [Empty];
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: 43.5;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 6.9;
Percentage of total funding: Other: 6.5;
Total funding for state HRP (in thousands): $14,079.
HRP: IL;
Year: 2003;
Percentage of total funding: Premiums: 77.2;
Percentage of total funding: Assessments on carriers: 20.6;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 2.2;
Total funding for state HRP (in thousands): $95,167.
HRP: IL;
Year: 2008;
Percentage of total funding: Premiums: 3.3;
Percentage of total funding: Assessments on carriers: 12.9;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 12.5;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 1.3;
Total funding for state HRP (in thousands): $154,297.
HRP: IN;
Year: 2003;
Percentage of total funding: Premiums: 39.2;
Percentage of total funding: Assessments on carriers: 60.7;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.1;
Total funding for state HRP (in thousands): $129,245.
HRP: IN;
Year: 2008;
Percentage of total funding: Premiums: 53.3;
Percentage of total funding: Assessments on carriers: 11.1;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 33.5;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 1.8;
Percentage of total funding: Other: 0.4;
Total funding for state HRP (in thousands): $94,616.
HRP: IA;
Year: 2003;
Percentage of total funding: Premiums: 27.5;
Percentage of total funding: Assessments on carriers: 72.3;
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: [Empty];
Percentage of total funding: Other: 0.2;
Total funding for state HRP (in thousands): $4,135.
HRP: IA;
Year: 2008;
Percentage of total funding: Premiums: 57.1;
Percentage of total funding: Assessments on carriers: 38.8;
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: 2.6;
Percentage of total funding: Other: 1.4;
Total funding for state HRP (in thousands): $27,031.
HRP: KS;
Year: 2003;
Percentage of total funding: Premiums: 76.0;
Percentage of total funding: Assessments on carriers: 23.3;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.6;
Total funding for state HRP (in thousands): $13,049.
HRP: KS;
Year: 2008;
Percentage of total funding: Premiums: 49.5;
Percentage of total funding: Assessments on carriers: 43.7;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 4.2;
Percentage of total funding: Other: 2.6;
Total funding for state HRP (in thousands): $23,754.
HRP: KY;
Year: 2003;
Percentage of total funding: Premiums: 23.9;
Percentage of total funding: Assessments on carriers: 21.6;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 54.4;
Total funding for state HRP (in thousands): $40,249.
HRP: KY;
Year: 2008;
Percentage of total funding: Premiums: 42.1;
Percentage of total funding: Assessments on carriers: 21.2;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 2.7;
Percentage of total funding: Other: 34.1;
Total funding for state HRP (in thousands): $60,431.
HRP: LA;
Year: 2003;
Percentage of total funding: Premiums: 50.6;
Percentage of total funding: Assessments on carriers: 31.4;
Percentage of total funding: Other assessments: 4.2;
Percentage of total funding: State general revenue: 11.6;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 2.3;
Total funding for state HRP (in thousands): $17,219.
HRP: LA;
Year: 2008;
Percentage of total funding: Premiums: 48.7;
Percentage of total funding: Assessments on carriers: 10.6;
Percentage of total funding: Other assessments: 3.6;
Percentage of total funding: State general revenue: 12.9;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 5.6;
Percentage of total funding: Other: 18.6;
Total funding for state HRP (in thousands): $15,512.
HRP: MD;
Year: 2003;
Percentage of total funding: Premiums: 0;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 72.3;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 27.7;
Total funding for state HRP (in thousands): $1,723.
HRP: MD;
Year: 2008;
Percentage of total funding: Premiums: 31.4;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 61.6;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 1.1;
Percentage of total funding: Other: 5.9;
Total funding for state HRP (in thousands): $133,878.
HRP: MN;
Year: 2003;
Percentage of total funding: Premiums: 50.7;
Percentage of total funding: Assessments on carriers: 48.9;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.3;
Total funding for state HRP (in thousands): $184,128.
HRP: MN;
Year: 2008;
Percentage of total funding: Premiums: [Empty];
Percentage of total funding: Assessments on carriers: [Empty];
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 74.0;
Percentage of total funding: Other: 26.0;
Total funding for state HRP (in thousands): $4,651.
HRP: MS;
Year: 2003;
Percentage of total funding: Premiums: 75.1;
Percentage of total funding: Assessments on carriers: 24.1;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.8;
Total funding for state HRP (in thousands): $21,623.
HRP: MS;
Year: 2008;
Percentage of total funding: Premiums: 63.8;
Percentage of total funding: Assessments on carriers: 29.5;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 3.2;
Percentage of total funding: Other: 3.5;
Total funding for state HRP (in thousands): $28,573.
HRP: MO;
Year: 2003;
Percentage of total funding: Premiums: 77.2;
Percentage of total funding: Assessments on carriers: 22.7;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.1;
Total funding for state HRP (in thousands): $15,809.
HRP: MO;
Year: 2008;
Percentage of total funding: Premiums: 82.1;
Percentage of total funding: Assessments on carriers: 12.6;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]:3.6;
Percentage of total funding: Other:1.6;
Total funding for state HRP (in thousands): $25,848.
HRP: MT;
Year: 2003;
Percentage of total funding: Premiums: 65.6;
Percentage of total funding: Assessments on carriers: 31.6;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 2.0;
Percentage of total funding: Other: 0.8;
Total funding for state HRP (in thousands): $16,756.
HRP: MT;
Year: 2008;
Percentage of total funding: Premiums: 65.0;
Percentage of total funding: Assessments on carriers: 29.7;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 3.3;
Percentage of total funding: Federal grants[A]: 0.6;
Percentage of total funding: Other: 1.3;
Total funding for state HRP (in thousands): $25,035.
HRP: NE;
Year: 2003;
Percentage of total funding: Premiums: 64.7;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 35.3;
Total funding for state HRP (in thousands): $48,900.
HRP: NE;
Year: 2008;
Percentage of total funding: Premiums: 52.6;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 2.0;
Percentage of total funding: Other: 45.4;
Total funding for state HRP (in thousands): $58,781.
HRP: NH;
Year: 2003;
Percentage of total funding: Premiums: 10.2;
Percentage of total funding: Assessments on carriers: 88.4;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 1.4;
Total funding for state HRP (in thousands): $4,794.
HRP: NH;
Year: 2008;
Percentage of total funding: Premiums: 46.1;
Percentage of total funding: Assessments on carriers: 47.4;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 4.5;
Percentage of total funding: Other: 2.0;
Total funding for state HRP (in thousands): $13,298.
HRP: NM;
Year: 2003;
Percentage of total funding: Premiums: 50.6;
Percentage of total funding: Assessments on carriers: 49.1;
Percentage of total funding: Other assessments: 0.1;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.2;
Total funding for state HRP (in thousands): $11,144.
HRP: NM;
Year: 2008;
Percentage of total funding: Premiums: 23.7;
Percentage of total funding: Assessments on carriers: 74.1;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 1.4;
Percentage of total funding: Other: 0.8;
Total funding for state HRP (in thousands): $66,210.
HRP: ND;
Year: 2003;
Percentage of total funding: Premiums: 66.9;
Percentage of total funding: Assessments on carriers: 33.1;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $9,050.
HRP: ND;
Year: 2008;
Percentage of total funding: Premiums: 62.7;
Percentage of total funding: Assessments on carriers: 33.9;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 3.4;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $11,797.
HRP: OK;
Year: 2003;
Percentage of total funding: Premiums: 56.1;
Percentage of total funding: Assessments on carriers: 43.9;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $27,759.
HRP: OK;
Year: 2008;
Percentage of total funding: Premiums: 59.8;
Percentage of total funding: Assessments on carriers: 40.2;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $25,202.
HRP: OR;
Year: 2003;
Percentage of total funding: Premiums: 60.0;
Percentage of total funding: Assessments on carriers: 38.5;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 1.5;
Total funding for state HRP (in thousands): $66,864.
HRP: OR;
Year: 2008;
Percentage of total funding: Premiums: 48.9;
Percentage of total funding: Assessments on carriers: 47.2;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 1.5;
Percentage of total funding: Other: 2.4;
Total funding for state HRP (in thousands): $167,452.
HRP: SC;
Year: 2003;
Percentage of total funding: Premiums: 81.4;
Percentage of total funding: Assessments on carriers: 18.5;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.1;
Total funding for state HRP (in thousands): $16,929.
HRP: SC;
Year: 2008;
Percentage of total funding: Premiums: 84.5;
Percentage of total funding: Assessments on carriers: 14.1;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 1.3;
Total funding for state HRP (in thousands): $29,719.
HRP: SD;
Year: 2003;
Percentage of total funding: Premiums: [Empty];
Percentage of total funding: Assessments on carriers: [Empty];
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: [Empty];
Percentage of total funding: Other: [Empty];
Total funding for state HRP (in thousands): [Empty].
HRP: SD;
Year: 2008;
Percentage of total funding: Premiums: 0.3;
Percentage of total funding: Assessments on carriers: 14.5;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 11.9;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 3.3;
Total funding for state HRP (in thousands): $5,930.
HRP: TN;
Year: 2003;
Percentage of total funding: Premiums: [Empty];
Percentage of total funding: Assessments on carriers: [Empty];
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: [Empty];
Percentage of total funding: Other: [Empty];
Total funding for state HRP (in thousands): 0.
HRP: TN;
Year: 2008;
Percentage of total funding: Premiums: 26.4;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue:72.5;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 1.1;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $30,255.
HRP: TX;
Year: 2003;
Percentage of total funding: Premiums: 63.8;
Percentage of total funding: Assessments on carriers: 36.0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.2;
Total funding for state HRP (in thousands): $191,662.
HRP: TX;
Year: 2008;
Percentage of total funding: Premiums: 70.5;
Percentage of total funding: Assessments on carriers: 27.7;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 1.3;
Percentage of total funding: Other: 0.6;
Total funding for state HRP (in thousands): $276,262.
HRP: UT;
Year: 2003;
Percentage of total funding: Premiums: 74.4;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 23.3;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 2.2;
Total funding for state HRP (in thousands): $12,498.
HRP: UT;
Year: 2008;
Percentage of total funding: Premiums: 55.6;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 34.9;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 4.9;
Percentage of total funding: Other: 4.7;
Total funding for state HRP (in thousands): $30,982.
HRP: WA;
Year: 2003;
Percentage of total funding: Premiums: 41.3;
Percentage of total funding: Assessments on carriers: 58.7;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0;
Total funding for state HRP (in thousands): $31,065.
HRP: WA;
Year: 2008;
Percentage of total funding: Premiums: 30.9;
Percentage of total funding: Assessments on carriers: 66.0;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 2.6;
Percentage of total funding: Other: 0.5;
Total funding for state HRP (in thousands): $61,664.
HRP: WV;
Year: 2003;
Percentage of total funding: Premiums: [Empty];
Percentage of total funding: Assessments on carriers: [Empty];
Percentage of total funding: Other assessments: [Empty];
Percentage of total funding: State general revenue: [Empty];
Percentage of total funding: State tobacco tax: [Empty];
Percentage of total funding: Federal grants[A]: [Empty];
Percentage of total funding: Other: v;
Total funding for state HRP (in thousands): 0.
HRP: WV;
Year: 2008;
Percentage of total funding: Premiums: 60.1;
Percentage of total funding: Assessments on carriers: 0;
Percentage of total funding: Other assessments: 35.3;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 4.6;
Total funding for state HRP (in thousands): $5,862.
HRP: WI;
Year: 2003;
Percentage of total funding: Premiums: 51.4;
Percentage of total funding: Assessments on carriers: 20.1;
Percentage of total funding: Other assessments: 20.3;
Percentage of total funding: State general revenue: 7.9;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.3;
Total funding for state HRP (in thousands): $129,118.
HRP: WI;
Year: 2008;
Percentage of total funding: Premiums: 52.5;
Percentage of total funding: Assessments on carriers: 23.1;
Percentage of total funding: Other assessments: 23.5;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 0.8;
Total funding for state HRP (in thousands): $169,766.
HRP: WY;
Year: 2003;
Percentage of total funding: Premiums: 66.9;
Percentage of total funding: Assessments on carriers: 30.8;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 0;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 2.3;
Total funding for state HRP (in thousands): $4,869.
HRP: WY;
Year: 2008;
Percentage of total funding: Premiums: 62.8;
Percentage of total funding: Assessments on carriers: 18.8;
Percentage of total funding: Other assessments: 0;
Percentage of total funding: State general revenue: 15.3;
Percentage of total funding: State tobacco tax: 0;
Percentage of total funding: Federal grants[A]: 0;
Percentage of total funding: Other: 3.1;
Total funding for state HRP (in thousands): $6,377.
Source: GAO data collection instrument administered to all 34 HRPs
operational in 2008.
Legend: [Empty] = response not provided:
[A] Federal grants were awarded by the Centers for Medicare & Medicaid
Services (CMS). Percentages are based on awards available but may not
reflect funds actually drawn down in that year. For example, according
to the Minnesota HRP, it was awarded $1,984,248 in federal grants in
2003; however, these funds were not drawn down until 2004.
[End of table]
Table 21: Total Federal HRP Grants Awarded, 2003-2008:
Type of federal grant: Operational;
2003: $38,538,311;
2004: $40,164,646;
2005: $74,989,091;
2006: $50,000,001;
2007[A]: $0;
2008: $32,669,455;
Total: $236,361,504.
Type of federal grant: Bonus[B];
2003: N/A;
2004: N/A;
2005: N/A;
2006: $25,000,000;
2007[A]: $0;
2008: $16,457,045;
Total: $41,457,045.
Type of federal grant: Seed[C];
2003: $4,202,618;
2004: 0;
2005: 0;
2006: $2,450,000;
2007[A]: $1,450,000;
2008: 0;
Total: $8,102,618.
Type of federal grant: Total;
2003: $42,740,929;
2004: $40,164,646;
2005: $74,989,091;
2006: $77,450,001;
2007[A]: $1,450,000;
2008: $49,126,500;
Total: $285,921,167.
Source: Centers for Medicare & Medicaid Services (CMS).
Legend: N/A = Not applicable:
[A] Only seed grants were awarded in 2007.
[B] Bonus grants were not available prior to 2006.
[C] Seed grants were awarded in 2003, 2006, and 2007.
[End of table]
Table 22: Cumulative Federal HRP Grants Awarded, by State HRP, 2003-
2008:
HRP: Alabama;
Type of federal grant: Operational: $6,571,156;
Type of federal grant: Bonus: $500,000;
Type of federal grant: Seed[A]: $0;
Total federal grants: $7,071,156.
HRP: Alaska;
Type of federal grant: Operational: $4,002,711;
Type of federal grant: Bonus: $1,065,640;
Type of federal grant: Seed[A]: 0;
Total federal grants: $5,068,351.
HRP: Arkansas;
Type of federal grant: Operational: $7,195,953;
Type of federal grant: Bonus: $145,420;
Type of federal grant: Seed[A]: 0;
Total federal grants: $7,341,373.
HRP: California;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $150,000;
Total federal grants: $150,000.
HRP: Colorado;
Type of federal grant: Operational: $12,288,357;
Type of federal grant: Bonus: $2,084,917;
Type of federal grant: Seed[A]: 0;
Total federal grants: $14,373,274.
HRP: Connecticut;
Type of federal grant: Operational: $6,828,693;
Type of federal grant: Bonus: $1,125,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $7,953,693.
HRP: District of Columbia;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $150,000;
Total federal grants: $150,000.
HRP: Idaho;
Type of federal grant: Operational: $2,520,108;
Type of federal grant: Bonus: $350,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $2,870,108.
HRP: Illinois;
Type of federal grant: Operational: $24,553,892;
Type of federal grant: Bonus: $2,397,444;
Type of federal grant: Seed[A]: 0;
Total federal grants: $26,951,336.
HRP: Indiana;
Type of federal grant: Operational: $12,597,329;
Type of federal grant: Bonus: $1,442,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $14,039,329.
HRP: Iowa;
Type of federal grant: Operational: $4,157,835;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: 0;
Total federal grants: $4,157,835.
HRP: Florida;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $150,000;
Total federal grants: $150,000.
HRP: Georgia;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $150,000;
Total federal grants: $150,000.
HRP: Kansas;
Type of federal grant: Operational: $4,475,963;
Type of federal grant: Bonus: $695,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $5,170,963.
HRP: Kentucky;
Type of federal grant: Operational: $9,505,610;
Type of federal grant: Bonus: $1,725,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $11,230,610.
HRP: Louisiana;
Type of federal grant: Operational: $4,562,054;
Type of federal grant: Bonus: $1,542,713;
Type of federal grant: Seed[A]: 0;
Total federal grants: $6,104,767.
HRP: Maryland;
Type of federal grant: Operational: $9,421,081;
Type of federal grant: Bonus: $2,025,000;
Type of federal grant: Seed[A]: $1,000,000;
Total federal grants: $12,446,081.
HRP: Massachusetts;
Type of federal grant: Operational: $1,704,415;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: 0;
Total federal grants: $1,704,415.
HRP: Minnesota;
Type of federal grant: Operational: $15,456,436;
Type of federal grant: Bonus: $3,250,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $18,706,436.
HRP: Mississippi;
Type of federal grant: Operational: $8,206,031;
Type of federal grant: Bonus: $974,202;
Type of federal grant: Seed[A]: 0;
Total federal grants: $9,180,233.
HRP: Missouri;
Type of federal grant: Operational: $4,735,438;
Type of federal grant: Bonus: $1,550,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $6,285,438.
HRP: Montana;
Type of federal grant: Operational: $4,860,622;
Type of federal grant: Bonus: $1,104,875;
Type of federal grant: Seed[A]: 0;
Total federal grants: $5,965,497.
HRP: Nebraska;
Type of federal grant: Operational: $5,911,145;
Type of federal grant: Bonus: $1,327,816;
Type of federal grant: Seed[A]: 0;
Total federal grants: $7,238,961.
HRP: New Hampshire;
Type of federal grant: Operational: $3,732,650;
Type of federal grant: Bonus: $1,107,644;
Type of federal grant: Seed[A]: $1,000,000;
Total federal grants: $5,840,294.
HRP: New Mexico;
Type of federal grant: Operational: $7,850,167;
Type of federal grant: Bonus: $1,500,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $9,350,167.
HRP: New York;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $150,000;
Total federal grants: $150,000.
HRP: North Carolina;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $1,000,000;
Total federal grants: $1,000,000.
HRP: North Dakota;
Type of federal grant: Operational: $2,894,342;
Type of federal grant: Bonus: $178,440;
Type of federal grant: Seed[A]: 0;
Total federal grants: $3,072,782.
HRP: Ohio;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $150,000;
Total federal grants: $150,000.
HRP: Oklahoma;
Type of federal grant: Operational: $10,282,089;
Type of federal grant: Bonus: $1,525,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $11,807,089.
HRP: Oregon;
Type of federal grant: Operational: $7,958,345;
Type of federal grant: Bonus: v2,450,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $10,408,345.
HRP: Rhode Island;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $150,000;
Total federal grants: $150,000.
HRP: South Carolina;
Type of federal grant: Operational: $4,128,780;
Type of federal grant: Bonus: $1,250,000;
Type of federal grant: Seed[A]: 0;
Total federal grants: $5,378,780.
HRP: South Dakota;
Type of federal grant: Operational: $2,384,720;
Type of federal grant: Bonus: $521,451;
Type of federal grant: Seed[A]: $1,000,000;
Total federal grants: $3,906,171.
HRP: Tennessee;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $1,000,000;
Total federal grants: $1,000,000.
HRP: Texas;
Type of federal grant: Operational: $21,023,993;
Type of federal grant: Bonus: $3,620,691;
Type of federal grant: Seed[A]: 0;
Total federal grants: $24,644,684.
HRP: Utah;
Type of federal grant: Operational: $5,769,821;
Type of federal grant: Bonus: $1,825,000;
Type of federal grant: Seed[A]: $52,618;
Total federal grants: $7,647,439.
HRP: Vermont;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $1,000,000;
Total federal grants: $1,000,000.
HRP: Washington;
Type of federal grant: Operational: $4,987,098;
Type of federal grant: Bonus: $1,466,892;
Type of federal grant: Seed[A]: 0;
Total federal grants: $6,453,990.
HRP: West Virginia;
Type of federal grant: Operational: 0;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: $1,000,000;
Total federal grants: $1,000,000.
HRP: Wisconsin;
Type of federal grant: Operational: $13,400,216;
Type of federal grant: Bonus: $2,706,900;
Type of federal grant: Seed[A]: 0;
Total federal grants: $16,107,116.
HRP: Wyoming;
Type of federal grant: Operational: $2,394,454;
Type of federal grant: Bonus: 0;
Type of federal grant: Seed[A]: 0;
Total federal grants: $2,394,454.
HRP: Total;
Type of federal grant: Operational: $236,361,504;
Type of federal grant: Bonus: $41,457,045;
Type of federal grant: Seed[A]: $8,102,618;
Total federal grants: $285,921,167.
Source: GAO analysis of Centers for Medicare & Medicaid Services (CMS)
data.
[A] Certain operating HRPs were awarded seed grants. For example,
Utah's HRP, which became operational in 1991, was awarded a seed grant
in 2003 for program modification.
[End of table]
Table 23: Use of Federal HRP Operational and Bonus Grants Awarded in
2006:
Grant use: Covering operational losses;
Type of federal grant: Operational: Number of HRPS: 30;
Type of federal grant: Operational: Amount: $41,300,050;
Type of federal grant: Bonus: Number of HRPS: N/A;
Type of federal grant: Bonus: Amount: N/A;
Total: $41,300,050;
Percentage of total operational and bonus federal grants: 55.1%.
Grant use: Reducing premiums[A];
Type of federal grant: Operational: Number of HRPS: 5;
Type of federal grant: Operational: Amount: $6,027,017;
Type of federal grant: Bonus: Number of HRPS: 7;
Type of federal grant: Bonus: Amount: $6,575,952;
Total: $12,602,969;
Percentage of total operational and bonus federal grants: 16.8%.
Grant use: Income-based premium subsidy[B,C];
Type of federal grant: Operational: Number of HRPS: 1;
Type of federal grant: Operational: Amount: $2,672,935;
Type of federal grant: Bonus: Number of HRPS: 6;
Type of federal grant: Bonus: Amount: $7,550,000;
Total: $10,222,935;
Percentage of total operational and bonus federal grants: 13.6%.
Grant use: Reduction in cost sharing;
Type of federal grant: Operational: Number of HRPS: N/A;
Type of federal grant: Operational: Amount: N/A;
Type of federal grant: Bonus: Number of HRPS: 1;
Type of federal grant: Bonus: Amount: $1,500,000;
Total: $1,500,000;
Percentage of total operational and bonus federal grants: 2.0%.
Grant use: Disease management[C]; 2006 Grants:
Type of federal grant: Operational: Number of HRPS: N/A;
Type of federal grant: Operational: Amount: N/A;
Type of federal grant: Bonus: Number of HRPS: 9;
Type of federal grant: Bonus: Amount: $5,015,126;
Total: $5,015,126;
Percentage of total operational and bonus federal grants: 6.7%.
Grant use: Other[C,D];
Type of federal grant: Operational: Number of HRPS: N/A;
Type of federal grant: Operational: Amount: N/A;
Type of federal grant: Bonus: Number of HRPS: 7;
Type of federal grant: Bonus: Amount: $4,358,923;
Total: $4,358,923;
Percentage of total operational and bonus federal grants: 5.8%.
Grant use: Totals[E];
Type of federal grant: Operational: Amount: $50,000,000;
Type of federal grant: Bonus: Amount: $25,000,000;
Total: $75,000,000.
Source: GAO analysis of Centers for Medicare & Medicaid Services (CMS)
data.
Legend: N/A = Not applicable:
HRPs may use a certain type of grant for more than one purpose. For
example, an HRP that was awarded a bonus grant may use it to reduce
premiums and to expand disease management programs.
[A] According to CMS, five states--Louisiana, Missouri, South Carolina,
Texas, and Wyoming--had a standard market rate for individual coverage
(SRR) over 150 percent; therefore, they were required to spend 50
percent of their operational grant to reduce premiums.
[B] Wisconsin spent all of its operational grants on income-based
subsidies.
[C] Oklahoma and Montana spent $1 million and $729,875 respectively on
premium subsidies and disease management programs. Because we could not
obtain dollar amounts separately for these two grant uses, we included
them in the "other" category.
[D] Other uses include increased benefit coverage, marketing, and
outreach, among others.
[E] Totals may not add due to rounding.
[End of table]
Table 24: Use of Federal HRP Operational and Bonus Grants, Awarded in
2006, by State HRP:
HRP: Alabama;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Alaska;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Check].
HRP: Arkansas;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Empty].
HRP: Colorado;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Empty].
HRP: Connecticut;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Idaho;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Illinois;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Indiana;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Empty].
HRP: Iowa;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Kansas;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Empty].
HRP: Kentucky;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Empty].
HRP: Louisiana;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Check].
HRP: Maryland;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Massachusetts;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Minnesota;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Mississippi;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Empty].
HRP: Missouri;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Montana;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Check].
HRP: Nebraska;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Empty].
HRP: New Hampshire;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Empty].
HRP: New Mexico;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Check].
HRP: North Dakota;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Oklahoma;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other[A]: [Check].
HRP: Oregon;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Check];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: South Carolina;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: South Dakota;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Check].
HRP: Texas;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Utah;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Washington;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Wisconsin[B];
Grant uses: Covering operational losses: [Empty];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Wyoming;
Grant uses: Covering operational losses: [Check];
Grant uses: Premium reduction: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other[A]: [Empty].
HRP: Total;
Grant uses: Covering operational losses: 30;
Grant uses: Premium reduction: 7;
Grant uses: Income-based premium subsidy: 6;
Grant uses: Reduction in cost sharing: 1;
Grant uses: Disease management: 11;
Grant uses: Other[A]: 7.
Source: GAO analysis of Centers for Medicare & Medicaid Services (CMS)
data.
Legend: [Check] = grant use:
Note: HRPs may use a certain type of grant for more than one purpose.
For example, an HRP that was awarded a bonus grant may use it to reduce
premiums and to expand disease management programs.
[A] Other uses included increased benefit coverage, marketing, and
outreach, among others.
[B] Wisconsin spent all of its operational grants on income-based
subsidies.
[End of table]
Table 25: Planned Use of Federal Operational and Bonus HRP Grants
Awarded in 2008, by State HRP:
HRP: Alabama;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Alaska;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Check].
HRP: Arkansas;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: Colorado;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: Connecticut;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Check].
HRP: Idaho;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Check].
HRP: Illinois;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Indiana[A];
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Iowa;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Kansas;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Check].
HRP: Kentucky;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: Louisiana;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Check].
HRP: Maryland;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Minnesota;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Mississippi;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: Missouri;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Montana;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: Nebraska;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: New Hampshire;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: New Mexico;
Grant uses: Covering operational losses: [Empty];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Check].
HRP: North Dakota;
Grant uses: Covering operational losses: [Empty];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Oklahoma;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: Oregon;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Check];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: South Carolina;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: South Dakota;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Check].
HRP: Texas;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Utah;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Empty];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Washington;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: Wisconsin[B];
Grant uses: Covering operational losses: [Empty];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Check];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Check];
Grant uses: Other: [Empty].
HRP: Wyoming;
Grant uses: Covering operational losses: [Check];
Grant uses: Reducing premiums: [Check];
Grant uses: Income-based premium subsidy: [Empty];
Grant uses: Reduction in cost sharing: [Empty];
Grant uses: Disease management: [Empty];
Grant uses: Other: [Empty].
HRP: Total;
Grant uses: Covering operational losses: 29;
Grant uses: Reducing premiums: 10;
Grant uses: Income-based premium subsidy: 10;
Grant uses: Reduction in cost sharing: 1;
Grant uses: Disease management: 13;
Grant uses: Other: 7.
Source: GAO analysis of Centers for Medicare & Medicaid Services (CMS)
data.
Legend: [Check] = grant use:
[A] According to an Indiana HRP official, Indiana also used 2008 grant
funds to reduce premiums and for disease management.
[B] Wisconsin planned to spend its operational grant on premium
reduction.
[End of table]
[End of section]
Enclosure IV: Comments from the Department of Health and Human
Services:
Department Of Health & Human Services:
Office Of The Secretary
Assistant Secretary of Legislation:
Washington, DC 20201:
June 26, 2009:
John E. Dicken:
Director, Health Care:
U.S. Government Accountability Office:
441 G Street, NW:
Washington, DC 20548:
Dear. Mr. Dicken:
Enclosed are the Department's comments on the U.S. Government
Accountability Office's draft report entitled, "Health Insurance:
Enrollment, Benefits, Funding, and Other Characteristics of State High-
Risk Health Insurance Pools" (GAO-09-730R).
The Department appreciates the opportunity to comment on this draft
report before its publication.
Sincerely,
Signed by:
Barbara Pisaro Clark:
Acting Assistant Secretary for Legislation:
Enclosure:
Comments Of The US Department Of Health And Human Services (HHS) To The
Government Accountability Office's (GAO) Draft Report Entitled "Health
Insurance: Enrollment, Benefits, Funding, And Other Characteristics Of
State High-Risk Health Insurance Pools" (GAO-09-730R)
The report contains a wealth of valuable information on State High-Risk
Health Insurance Pools. We note, that although 2008 data was not
available for use in this report, the survey recently switched from
asking questions retrospectively to asking current questions about
insurance benefits. Thus, the MEPS also has an employer-level survey
with information on insurance benefits and more current data will be
available in the future for further research.
[End of section]
Enclosure V: GAO Contact and Staff Acknowledgements:
GAO Contact:
John E. Dicken, Director, Health Care (202) 512-7114 or
dickenj@gao.gov:
Acknowledgements:
In addition to the contact named above, Randy Dirosa (Assistant
Director), Nick Bartine, Laura Brogan, Jawaria Gilani, Shirin Hormozi,
Martha Kelly, and Pauline Seretakis were major contributors to this
report.
[End of section]
Footnotes:
[1] Participants in the private individual market include self-employed
people; people whose employers do not offer health insurance coverage;
people not in the labor force; early retirees who no longer have
employment-based coverage and are not yet eligible for Medicare; and
people who lose their jobs and have exhausted or are ineligible for
continuation of employer-based coverage.
[2] Individuals who--due to a preexisting health condition--have been
rejected for coverage or charged higher premiums in the private
individual market are typically eligible for HRP coverage. Other groups
of individuals may also be eligible for HRP coverage. States may use
HRPs to implement the group market to individual market portability
provision of the Health Insurance Portability and Accountability Act
(HIPAA) of 1996. Pub. L. No. 104-191, title I, §111, 110 Stat. 1936,
1978. HIPAA requires that individuals with prior group coverage must
have continued access to nongroup coverage with any preexisting
condition waiting periods waived. In addition, states can designate
HRPs as qualified health coverage for displaced workers and retirees
eligible for the federal Health Coverage Tax Credit, under the Trade
Adjustment Assistance Reform Act of 2002. Pub. L. No. 107-210, Div. A,
§201 (a), 116 Stat. 935, 954.
[3] Most states offer waivers for the waiting period for coverage of
preexisting medical conditions. Examples of criteria to qualify for a
waiver often include involuntary termination of coverage by a previous
carrier or previous creditable coverage within the past 12 months,
among others. HIPAA-eligible enrollees are not subject to preexisting
condition restrictions.
[4] Where funding is limited, an HRP may need to restrict enrollment by
various means, such as by temporarily closing the pool to new enrollees
or maintaining a waiting list.
[5] Pub. L. 107-210, Div. A, § 201(b), 116 Stat. 935, 959.
[6] See, the Deficit Reduction Act of 2005, Pub. L. 109-171, § 6202,
120 Stat. 4, 134 (2006) and the State High Risk Pool Funding Extension
Act of 2006, Pub. L. 109-172, § 2, 120 Stat. 185. The State High Risk
Pool Funding Extension Act authorized a total of $75 million in
operational and bonus grants for each of fiscal years 2006 through 2010
and $15 million in seed grants for fiscal year 2006. Bonus grants are
to be used for supplemental consumer benefits such as premium
subsidies, disease management programs, and HRP expansion efforts.
[7] We did not include the North Carolina HRP in our DCI because it was
not operational until 2009.
[8] In this report, we refer to the primary policyholders as enrollees.
[9] The MEPS and CPS data we used were the most currently available at
the time we performed our work. We used the 2006 MEPS, which is a set
of large-scale surveys of families and individuals, their medical
providers, and employers across the United States administered by the
Agency for Healthcare Research and Quality. MEPS collects information
regarding individuals' demographics, health status, and insurance
status, among other characteristics. We also used data published in the
U.S. Census Bureau's report, Income, Poverty, and Health Insurance
Coverage in the United States: 2007, on the 3-year average (2005-2007)
of the uninsured populations by state. These data were based on the CPS
Annual Social and Economic Supplement, which is a household survey that
collects demographic information, such as employment and health
insurance status, among other characteristics.
[10] Our estimate of individuals potentially eligible for HRP
enrollment may be understated because we excluded from our MEPS
analysis individuals with conditions that are not always chronic in
nature or that were diagnosed or treated prior to 2006. Conversely, our
estimate could be overstated to the extent it includes uninsured
individuals who may not be eligible because they had access to other
private or public coverage but chose not to enroll. The CPS estimates
of the uninsured in each state are subject to sampling error of plus or
minus 1.3 percent at the 90 percent confidence level.
[11] We compared HRP benefits and coverage restrictions to those in
employer-sponsored plans because, according to model legislation
prescribed by the National Association of Insurance Commissioners
(NAIC), HRP plan benefit levels and deductibles should be comparable to
coverage provided by large employers in the state. NAIC model
legislation provides a basis for the uniform regulation of HRPs
throughout the states.
[12] GAO estimated the potentially eligible population, including
dependents, by (1) determining the percentage of uninsured individuals
with at least one chronic condition using 2006 MEPS data, and (2)
applying that percentage to CPS estimates of the 3-year average
uninsured population in each of the 34 states with an HRP (2005-2007).
The CPS estimates are subject to sampling error of plus or minus 1.3
percent at the 90 percent confidence level.
[13] Employment information was provided by Colorado, Maryland, Oregon,
Utah, and Wisconsin. Income information was provided by Indiana,
Maryland, Oregon, Utah, and Wisconsin for new enrollees only.
[14] Percentages provided are out of total voting board members. HRP
governing boards may also include nonvoting members.
[15] Such funds were next awarded in 2008. Annual reports on how HRPs
used these 2008 grants were not available at the time of this report,
so they were not included in our analysis.
[End of section]
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