Pres hsr mar5_pintor


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Pres hsr mar5_pintor

  1. 1. Putting Out the Welcome Mat: TargetingOutreach Under the Affordable Care ActProfile of Minnesota’s UninsuredJessie Kemmick Pintor, MPHMN Health Services Research ConferenceMarch 5th, 2013 Funded by a grant from the Robert Wood Johnson Foundation
  2. 2. Purpose/Overview• To provide an in-depth profile of the uninsured in Minnesota in order to inform targeted outreach to non-elderly adults who will be newly eligible for Medicaid coverage or subsidies through the exchange: – Overall uninsured – Potentially Medicaid-eligible non-elderly adults: <138% FPG – Potentially subsidy-eligible non-elderly adults : 139-400% FPG 2
  3. 3. 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
  4. 4. 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
  5. 5. Nearly half of Medicaid-eligible already have public coverage, most subsidy-eligible have ESI Insurance coverage among non-elderly adults at or below 138% and 139-400% FPG, 2011 Public Uninsured 15% Uninsured 17% 23% Individual Public 6%Individual 45% 5% Group Group 27% 62% Source: 2011 Minnesota Health Access Survey 5
  6. 6. Uninsured Medicaid- and subsidy-eligiblemuch younger than non-elderly adults overall Age distribution of non-elderly adults, 201150% 46%45% 41%40%35% 31% 29%* 30%*30% 26%25% 19% 19%20% 18% 16%15% 13% 11%10%5%0% 18-25 26-34 35-54 55-64 Uninsured Medicaid-eligible Uninsured subsidy-eligible Overall *Indicates statistically significant difference (95% level) from overall non-elderly population Source: 2011 Minnesota Health Access Survey 6
  7. 7. Latinos greatly overrepresented among Medicaid-eligible; Blacks overrepresented among subsidy-eligible Race/ethnicity among non-elderly adults, 2011100% 90% 84% 80% 75% 70% 59% 60% 50% 40% 30% 20% 17%* 12%* 10% 10% 5% 6% 4% 4% 7% 5% 4% 1% 1% 4% ƚ 2% 0% White Black Asian American Hispanic/Latino Other Indian Uninsured Medicaid-eligible Uninsured subsidy-eligible Overall *Indicates statistically significant difference (95% level) from overall non-elderly population ƚ Less than 1% Source: 2011 Minnesota Health Access Survey 7
  8. 8. Three in ten Medicaid-eligible have less thana high school education Level of education among non-elderly adults, 2011100% 8%90% 19%80% 34% 29%70% 32%60% College grad50% 34% Some college 33%40% HS grad30% 37% Less than HS20% 25% 30%*10% 13% 8% 0% Uninsured Medicaid- Uninsured subsidy- Overall eligible eligible *Indicates statistically significant difference (95% level) from overall non-elderly population Source: 2011 Minnesota Health Access Survey 8
  9. 9. What else do we know about Medicaid- andsubsidy-eligible non-elderly adults?• 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
  10. 10. Interaction of uninsured non-elderly adults withMinnesota Public Health Care Programs, 2011100%90%80%70%60%50%40% Uninsured Medicaid-elgible30% Uninsured subsidy-eligble20%10% 0% Asked/given Would enroll if Of those who say Would information eligible no: would enroll participate in a about public if coverage was premium programs free assistance program Source: 2011 Minnesota Health Access Survey 10
  11. 11. Main reason for not enrolling in MN Health Care Programs among uninsured non-elderly adults, 2011 Dont think the care/benefits are good 3% Other Other 11% Dont think the Too much 14% hassle/paperworkcare/benefits are 3% good Applied but not Too expensive Dont think eligible 4% 23% government should 23% pay for my health care Dont need or 4% want insurance Will get insurance right now/rarely soon sick 6% 10% Dont think Im eligible Do not know Dont need or want 14% Will get insurance insurance right now what to do/where soon 11% to go/how to 8% enroll Do not know Too much 21% what to hassle/paperwork do/where to Too expensive 9% go/how to 14% Applied but not enroll eligible 11% 11% Medicaid-eligible Subsidy-eligible Source: 2011 Minnesota Health Access Survey 11
  12. 12. Next steps/Potential analyses for MN HealthInsurance 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
  13. 13. Percent uninsured nonelderly US citizens, <=138%FPL and 139-400% FPL, 2008-2010, by PUMA 13
  14. 14. Conclusions/Implications for outreach toMedicaid-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
  15. 15. Conclusions/Implications for outreach tosubsidy-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
  16. 16. Jessie Kemmick Pintor 612.624.2083Sign up to receive our newsletter and updates at @shadac