Upload
soder145
View
219
Download
0
Embed Size (px)
Citation preview
Funded by a grant from the Robert Wood Johnson Foundation
Putting Out the Welcome Mat: Targeting
Outreach Under the Affordable Care Act
Profile of Minnesota’s Uninsured Jessie Kemmick Pintor, MPH
MN Health Services Research Conference
March 5th, 2013
Purpose/Overview
• To provide an in-depth profile of the
uninsured in Minnesota in order to inform
targeted outreach to individuals who will
be newly eligible for Medicaid coverage or
subsidies through the exchange:
– Overall uninsured
– Medicaid-eligible: <138% FPG
– Subsidy-eligible: 139-400% FPG
2
2011 MN Health Access Survey
• Conducted by MDH and SHADAC (Sep to Dec 2011)
• Purpose:
– Document trends in health insurance coverage and access to
insurance and health care
– Describe characteristics of the uninsured, and economic and
demographic factors associated with lack of coverage
– Establish baseline data for evaluating health reform
• Dual frame survey targeting 11,000 completes
– 62% landline, 38% cell
• Stratified sampling to produce reliable estimates for: – Regions of the state
– Most populous racial/ethnic groups
3
Uninsured Minnesotans, 2011
• 489,000, or 9.1% of, Minnesotans uninsured
– 675,000, or 12.6% uninsured at some time in 2011
• Uninsurance rates highest among: – 26-34 year olds, individuals with lower education/income
levels, Hispanics/Latinos, and foreign-born
• Uninsured as likely to be employed as overall – However, more likely to be self employed or work for
smaller employers, work part-time, hold more than one job,
and hold temporary or seasonal jobs
• Most report lack of coverage due to cost, and
loss of coverage due to job termination
4
Nearly half of Medicaid-eligible already have
public coverage, most subsidy-eligible have ESI
5
Public
45%
Group
27%
Individual
5%
Uninsured
23%
Public
15%
Group
62%
Individual
6%
Uninsured
17%
Source: 2011 Minnesota Health Access Survey
Insurance coverage among non-elderly adults at 138% and
139-400% FPG, 2011
Uninsured Medicaid- and subsidy-eligible
much younger than non-elderly adults overall
6
Source: 2011 Minnesota Health Access Survey
29%* 26%
31%
13%
18%
30%**
41%
11%
16% 19%
46%
19%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
18-25 26-34 35-54 55-64
Uninsured Medicaid-eligible Uninsured subsidy-eligible Overall
Latinos greatly overrepresented among Medicaid-
eligible; Blacks overrepresented among subsidy-eligible
7
59%
10% 6% 4%
17%**
5%
75%
12%*
4% 1%
7%
*
84%
5% 4% 1%
4% 2% 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
White Black Asian American
Indian
Hispanic/Latino Other
Uninsured Medicaid-eligible Uninsured subsidy-eligible Overall
*Less than 1%
Source: 2011 Minnesota Health Access Survey
Three in ten Medicaid-eligible have less than
a high school education
8
Source: 2011 Minnesota Health Access Survey
30%***
13% 8%
33%
37%
25%
29%
32%
34%
8% 19%
34%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Uninsured Medicaid-
eligible
Uninsured subsidy-
eligible
Overall
College grad
Some college
HS grad
Less than HS
What else do we know about Medicaid- and
subsidy-eligible? • Males slightly overrepresented
• Less likely to be in excellent/very good health
• Similar distribution across TC metro/Greater MN
• Just over half of Medicaid-eligible employed,
compared to 76% of nonelderly overall
• 11% of Medicaid-eligible and 19% of subsidy-eligible
have access to ESI
• Over half of Medicaid-eligible and 1/3 of subsidy-
eligible have children under 21 in household
9
Interaction of the uninsured Medicaid-eligible with
Minnesota Public Health Care Programs, 2011
10
Source: 2011 Minnesota Health Access Survey
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Asked/given
information
about public
programs
Would enroll if
eligible
Of those who say
no: would enroll
if coverage was
free
Would
participate in a
premium
assistance
program
Uninsured Medicaid-elgible
Uninsured subsidy-eligble
Main reason for not enrolling in Public Health
Care Programs, 2011
11
Source: Minnesota Health Access Survey, 2011
Too expensive
23%
Do not know
what to do/where
to go/how to
enroll
21%
Applied but not
eligible
11%
Too much
hassle/paperwork
9%
Will get insurance
soon
8%
Don't need or
want insurance
right now/rarely
sick
10%
Don't think the
care or benefits
through these
programs are
good
4%
Other
14%
Applied but not
eligible
23%
Don't think I'm eligible
14%
Too expensive
14%
Do not know
what to
do/where to
go/how to
enroll
11%
Don't need or want
insurance right now
11%
Will get insurance
soon
6%
Don't think
government should
pay for my health care
4%
Too much
hassle/paperwork
3%
Don't think the
care/benefits are good
3% Other
11%
Next steps/Potential analyses for MN Health
Insurance Exchange • 3-year (2008-2010) pooled sample of the American
Community Survey (ACS) allows for geographic
specificity (PUMA) in answering a number of questions
• Characteristics of uninsured across PUMAs:
– Education levels across PUMAs
– Individuals in linguistically-isolated households across PUMAs
– Individuals in households where someone receives
TANF/SNAP benefits across PUMAs
• Potential to generate regions designed by the state
• Adding layer information such as location of schools,
community centers, libraries, etc.
12
Conclusions/Implications for outreach to
Medicaid-eligible
• Medicaid outreach will need to target younger
Minnesotans with lower levels of education
• Over half of uninsured Medicaid-eligible have
inquired about MHCP and 4 in 5 report they
would enroll in Medicaid if they were eligible
– Still, many report that they do not know where to
go, how to apply and/or that the process is too
much of a hassle/too much paperwork
• Many live in households with children under 21,
which may be a potential avenue for outreach
14
Conclusions/Implications for outreach to
subsidy-eligible
• Slightly younger and lower levels of education
compared to nonelderly overall
• Only 1 in 5 of the uninsured who are potentially
eligible for subsidies under the exchange have
access to employer-sponsored insurance
• Over half have inquired about MHCP and most
report they would enroll in a premium
assistance program if eligible
– Still, again, they report problems accessing MHCP
15
Sign up to receive our newsletter and updates at
www.shadac.org
@shadac
Jessie Kemmick Pintor
612.624.2083