Location, Location, Location: Leveraging Interactive Maps, Administrative and Census Data to Find and Describe the Remaining Eligible for coverage in the Health Insurance Marketplaces

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This document discusses using geographic data and interactive maps to identify populations remaining eligible for health insurance coverage. It finds that while smaller geographic areas like ZIP codes provide more neighborhood variation, larger areas like counties are more reliable. Combining census data on eligible populations with administrative enrollment records allows mapping the number and share of people still eligible by location. Interactive maps that include addresses of outreach sites, hospitals and other places can help target remaining eligible individuals. In sum, geographic data and interactive maps are useful tools to improve marketplace outreach when considering the tradeoffs of different geography levels.

TITLE: LOCATION, LOCATION, LOCATION:
LEVERAGING INTERACTIVE MAPS, ADMINISTRATIVE AND
CENSUS DATA TO FIND AND DESCRIBE THE REMAINING
ELIGIBLE FOR COVERAGE IN THE HEALTH INSURANCE
MARKETPLACES
Brett Fried
SHADAC, University of Minnesota
State Health Research and Policy Interest Group
Minneapolis, MN
June 13, 2015
1Funded by a grant from the Robert Wood Johnson Foundation’s State Health Reform Assistance Network.

Acknowledgments
Funding for this work is supported by the Robert
Wood Johnson Foundation State Reform Assistance
Network
• Collaborators:
• Elizabeth Lukanen (SHADAC)
• Karen Turner (SHADAC)
2

Research Questions
1) Can data be used to improve marketplace
outreach?
2) What geography is best?
3) What are some of the challenges with using low
level geographies?
4) Are there strategies to make this data more useful?
3

Where are we in terms of marketplace enrollment?
• 11.7 million at end of OEP2
• CBO (March 2015)—21 million by 2016
• 36% of Potentially Eligible (15% HI and 77% VT)
• People who were easy to enroll have enrolled
• http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf
• https://www.cbo.gov/publication/43900
• http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population-2015/
4

Availability of Survey Data - Geography
5
Nation, States, & DC
Congressional Districts
Counties
School Districts
Public Use Microdata Area (PUMA)
Metro & Micro Statistical
Areas
Zip Code
Tabulation Areas
(ZCTA)
Census
Tracts

PUMAs: Public Use Microdata
Areas
6
PUMAs are geographic areas created by the Census
Bureau to contain at least 100,000 people and nest within
states.

ZIP CodeTabulation Areas
• ZIP Code: Not created as an area based division but
instead is a collection of mail delivery routes
• ZIP Code Tabulation Area (ZCTA): Aligns ZIP codes with
census geography. Most frequently occurring ZIP code
within census blocks
7

Three Census Geographies: Advantages of each
PUMA County ZCTA
Included in PUMS (can create
custom variables from
publically available files)  X X
Data is timely
X (2014 data--
Sept. 2015)
X (2014 data for all
counties--March 2016)
X (2010-2014 data--
Dec. 2015)
Intuitive geography X  
Reliable for full area population   X
Neighborhood level estimates
X (
high density areas) X 
Nests within other geography   X
Data is annual   X
8

Using Administrative Data
Combining data
• Map ZIP Codes to ZCTAs (administrative data)
• Map ZCTAs to PUMAs (administrative data)
• Estimate PUMA levelTarget Population (census microdata)
• Remaining Eligible (target pop – enrolled)
Map any administrative data that includes an address
(e.g location of application assistors, hospitals, churches)
9

Example: Illinois Marketplace Enrollment
Target Pop. Enrolled Remaining
Eligible
10

Summary
Choosing the best geography
• Availability, timelines and reliability
• The research question
• Audience for the analysis
Advantage of ZIP Code level data
• Captures variation between neighborhoods
Disadvantages
• Less reliable
• Cannot trend
• Categories and variables are preset by census
• Not timely
13

Summary (2)
Interactive maps and admin data can help
• Interactive maps
• Can include anything that has an address
• Can include multiple geographies
• Can include underlying data
• Can include number and percent
• Can be accessed anywhere the internet is
available
• Administrative data
• Timeliness
• Usefulness
14

www.shadac.org
@shadac
Brett Fried
Senior Research Fellow
bfried@umn.edu
612.624.1406
Contact Information
15

This document discusses using data from the American Community Survey and health insurance marketplace administrative records to identify populations that remain eligible for health insurance coverage. It analyzes the advantages and disadvantages of different geographic levels for the data, including PUMAs, counties, and ZIP Code Tabulation Areas. Maps are presented as interactive tools to leverage these data sources and help target outreach efforts. The best geography depends on the research question, audience, and balancing availability, timeliness, and reliability of the data. Combining administrative enrollment data with census estimates of the target population can help identify areas with remaining eligible individuals.

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This document summarizes key findings from an analysis of trends in children's health insurance coverage between 2016 and 2017. Some key points: - The uninsured rate among children in the U.S. increased from 4.7% in 2016 to 5% in 2017, reversing over a decade of decline. This represented nearly 270,000 additional uninsured children. - The increase was driven by a decline in public coverage, particularly Medicaid. Uninsurance rose across most demographic groups. - There was considerable variation between states, from a low of 1.4% uninsured in Vermont to a high of 10.7% in Texas. - States with low uninsurance typically had high rates of employer-sponsored insurance or

Exploring Disparities Using New and Updated MEasures on SHADAC's State Health...

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Leveraging 1332 State Innovation Waivers to Stabilize Individual Health Insur...

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Modeling State-based Reinsurance: One Option for Stabilization of the Individ...

soder145

This document summarizes research on modeling state-based reinsurance programs to stabilize individual health insurance markets. Key findings include: - An estimated $60 billion is spent annually in the individual market, with 2.5% of enrollees accounting for 48.8% of expenditures. - State reinsurance programs with varying parameters could reduce insurer costs by $6-14 billion nationally per year. - Estimated reinsurance costs for four states range from $300,000 to $1.8 billion depending on the attachment point and coinsurance rate. - Federal transitional reinsurance and proposed legislation allocated $10 billion annually, consistent with these estimates.

2017 Health Insurance Coverage Estimates: SHADAC Webinar Featuring U.S. Censu...

soder145

Join us for an overview of the 2017 health insurance coverage estimates from two key, large-scale federal data sources: The American Community Survey (ACS) and the Current Population Survey (CPS). This webinar will examine the new estimates with technical insight from experts at the U.S. Census Bureau, which administers both the ACS and CPS, and from SHADAC researchers. Attendees will learn about: The new 2017 national and state coverage estimates When to use which estimates from which survey How to access the estimates via Census reports and American FactFinder How to access state-level estimates from the ACS using SHADAC tables SHADAC researchers and Census experts will answer questions from attendees after the presentation.

Exploring the New State-Level Opioid Data On SHADAC's State Health Compare

soder145

Between 2000 and 2016, the annual number of drug overdose deaths in the United States more than tripled, from 17,500 to 63,500, and most of these deaths involved opioids. Despite widespread increases in overdose death rates from natural and semi-synthetic opioids, synthetic opioids, and heroin, individual states’ death rates varied widely. For example, in 2016, Nebraska’s rate of 1.2 deaths per 100,000 people was the lowest in the U.S. for natural and semi-synthetic opioids, while West Virginia’s rate (the highest) was more than 15 times larger, at 18.5 deaths. These deaths are the most glaring indication of the growing crisis of opioid abuse and addiction that has been spreading unevenly throughout the country over the past two decades. On this SHADAC webinar, Research Fellow Colin Planalp will examine the United States opioid epidemic at the state level, analyzing trends in overdose deaths from heroin and other opioids, such as prescription painkillers. Using data available through SHADAC’s State Health Compare, he will look at which states have the highest rates of opioid-related deaths and which have experienced the largest increases in death rates. Mr. Planalp will be joined by SHADAC Research Fellow Robert Hest, who will discuss the data on opioid-related overdose deaths from the U.S. Centers from Disease Control and Prevention (CDC) that are available on SHADAC’s State Health Compare. He will also discuss State Health Compare data from the U.S. Drug Enforcement Administration (DEA) on sales of common prescription opioid painkillers. Mr. Hest will show users how to access and use the data for state-level analyses.

Ibd intersectionality

soder145

This document summarizes research on the intersection of structural risk factors and insurance-based discrimination on healthcare access inequities. The study analyzed data on over 3,800 non-elderly adults in Minnesota to examine how experiences of insurance-based discrimination vary across gender, race, income and insurance status, both independently and combined. It also assessed how the synergistic effects of structural risk factors and reported discrimination influence access to a usual source of care and confidence in getting needed healthcare services. The results show that structural factors like race, income and insurance status combine to produce greater reported discrimination, which then interacts with those factors to further reduce healthcare access. The implications are that reducing inequities requires attention to the convergence of these structural barriers

Who gets it right

soder145

This study analyzed characteristics associated with accurate reports of health insurance coverage in census surveys. It found that reporting of public insurance was most accurate among low-income, less educated individuals who likely needed care. Reporting varied by specific public program, with family characteristics impacting Medicaid accuracy and respondent characteristics impacting MinnesotaCare accuracy. Private insurance reporting in the ACS was more accurate among advantaged groups, while the CPS saw greater accuracy among older respondents with long-term coverage. The results provide insight into survey design, editing, and using survey data for policy analysis by identifying who reports coverage most reliably.

Mn ltss projection model

soder145

- The document presents preliminary results from the Minnesota Long-Term Services and Supports Projection Model (MN-LPM), which projects LTSS utilization and costs for Minnesota's Medicaid elderly population through 2030. - In 2015, over 54,000 Minnesotans received LTSS through Medicaid, costing $991 million total. The model projects these numbers will double by 2030, with LTSS costs reaching $1.7 billion as HCBS use grows significantly faster than nursing home use. - The model uses Minnesota-specific data on the characteristics of elderly residents and current LTSS spending patterns to generate projections. It is intended to help evaluate potential policy changes that could impact future LTSS needs and costs in

Modeling financial eligibility, ltss

soder145

Modeling Financial Eligibility for Medicaid Payment of LTSS 1) Medicaid long-term services and expenditures (LTSS) are a large and growing part of state budgets. States may restrict LTSS eligibility rules to control costs. 2) The researchers modeled LTSS eligibility rules to understand their impact and potential consequences of restricting access. 3) The model found that restricting income eligibility rules had a larger impact on reducing the number of eligible individuals than restricting asset rules. This is because income rules are more broadly applied and generous under current policies.

Poster, advancements in care coordination mn sim

soder145

The document summarizes findings from an evaluation of Minnesota's State Innovation Model (SIM) Initiative. It finds that Minnesota's SIM investments increased organizations' capacity for coordinated care in several ways: 1) It strengthened relationships and knowledge sharing between organizations. 2) It improved some care coordination processes like assessing social needs and accessing data. 3) It expanded access to health information exchange capabilities needed to coordinate care across settings.

Poster, section 1115 waivers

soder145

- Structured interviews were conducted with 33 current and former state agency and health plan staff across 4 states to understand challenges implementing Section 1115 Medicaid expansion waiver programs. - Key challenges included the significant administrative resources and coordination required across entities, educating enrollees, and reconciling complex program rules across systems. - While waiver programs allowed for innovative policy testing, the administrative complexity was substantial and ongoing. Implementation involved major efforts to develop new IT systems and operational protocols within tight timelines.

Modeling state based reinsurance

soder145

1. The document analyzes the potential impact and costs of state-based reinsurance programs using data from 2012-2015. 2. It estimates that reinsurance subsidies could range from $6.4 billion to $16 billion annually depending on the attachment point and coinsurance rate. 3. Reinsurance costs are estimated to range from close to $300,000 in Illinois to $2 billion in California under sample programs with an 80/20 coinsurance split.

Comparing Health Insurance Measurement Error (CHIME) in the ACS & CPS

soder145

This document summarizes a study that compared survey responses about health insurance from the American Community Survey (ACS) and Current Population Survey (CPS) to actual administrative insurance records to assess accuracy. The study found that both surveys produced reasonably accurate aggregated estimates but that some types of coverage, like direct purchase plans, were less accurately reported. Specifically: - Both surveys had high sensitivity in detecting those with any insurance but the ACS performed better for direct purchase plans. - The predictive power of reported coverage types varied, with direct purchase again less accurately predicted than employer-sponsored coverage. - Prevalence estimates based on surveys were generally within a few percentage points of administrative records, though CPS estimates were less accurate for

Who Gets It Right? Characteristics Associated with Accurate Reporting of Heal...

soder145

This document summarizes a study examining factors associated with accurate reporting of health insurance coverage type. The study used survey data matched to enrollment records from a health plan. It found: 1) Reporting accuracy was highest for those with employer-sponsored insurance and lowest for those with direct purchase or Medicaid coverage. 2) Among those with direct purchase insurance, reporting accuracy was higher for those who were white, non-Hispanic, fully employed, and from higher income households. 3) For Medicaid enrollees, reporting accuracy was higher for those who were unemployed, from lower income and education households.

Medicaid vs. Marketplace Coverage for Near-Poor Adults: Impact on Out-of-Pock...

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1) The document analyzes the impact of state Medicaid expansion decisions on out-of-pocket health expenses and insurance coverage for low-income adults making 100-138% of the federal poverty level. 2) It finds that Medicaid expansion was associated with lower total out-of-pocket spending (a reduction of $353), lower premium spending (a reduction of $118), and lower medical spending (a reduction of $235) compared to non-expansion states. 3) Medicaid expansion also increased Medicaid coverage by 11.1 percentage points and decreased the uninsured rate by 4.5 percentage points for this low-income group relative to non-expansion states.

The Impact of Medicaid Expansion on Employer Provision of Health Insurance

soder145

- The study examines the impact of Medicaid expansion under the ACA on employer-sponsored health insurance (ESI) offers, out-of-pocket premiums, and eligibility using data from 2010-2015. - The results show Medicaid expansion decreased worker eligibility for ESI offers by 4 percentage points but had no effect on ESI offers or out-of-pocket premiums. There was also no differential effect for low-wage establishments. - The authors note the short-term effects may differ from long-term effects, and ongoing uncertainty could impact employer behavior and outcomes over time as more states expand Medicaid.

Physician Participation in Medi-Cal: Is Supply Meeting Demand?

soder145

This document summarizes a webinar presentation on physician participation in California's Medicaid program, Medi-Cal. The presentation was given by Janet Coffman from UCSF and Alan McKay from the Central California Alliance for Health. Key findings from Coffman's presentation include: California physicians are less likely to accept new Medi-Cal patients than patients with private insurance or Medicare; acceptance rates vary by specialty, practice type, and region; and the most common reasons physicians limit Medi-Cal patients are delays in payment and administrative hassles. McKay discussed the Alliance's efforts to expand Medi-Cal provider capacity after expansion, including grant programs for recruitment, equipment, practice coaching,

Shadac acs cps-webinar 2016-final_sept21

soder145

The document summarizes key information from a webinar about 2015 health insurance coverage estimates from the American Community Survey (ACS) and Current Population Survey (CPS). It provides an overview of the surveys' methodologies, measures of health insurance coverage, changes in insurance rates from 2013 to 2015, and resources for accessing public data from the ACS and CPS. New products for analyzing health insurance coverage from both surveys were also announced.

2014 SAHIE: Overview with Census Experts

soder145

The document summarizes a webinar presented by experts from the U.S. Census Bureau on the Small Area Health Insurance Estimates (SAHIE). SAHIE provides county-level estimates of health insurance coverage across various demographic groups. The webinar discussed the 2014 SAHIE release, which incorporated more up-to-date Medicaid data and showed substantial changes in insurance rates from 2013 to 2014. The webinar also reviewed the data sources and methodology used to produce the SAHIE estimates.

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Location, Location, Location: Leveraging Interactive Maps, Administrative and Census Data to Find and Describe the Remaining Eligible for coverage in the Health Insurance Marketplaces

1. TITLE: LOCATION, LOCATION, LOCATION: LEVERAGING INTERACTIVE MAPS, ADMINISTRATIVE AND CENSUS DATA TO FIND AND DESCRIBE THE REMAINING ELIGIBLE FOR COVERAGE IN THE HEALTH INSURANCE MARKETPLACES Brett Fried SHADAC, University of Minnesota State Health Research and Policy Interest Group Minneapolis, MN June 13, 2015 1Funded by a grant from the Robert Wood Johnson Foundation’s State Health Reform Assistance Network.

2. Acknowledgments Funding for this work is supported by the Robert Wood Johnson Foundation State Reform Assistance Network • Collaborators: • Elizabeth Lukanen (SHADAC) • Karen Turner (SHADAC) 2

3. Research Questions 1) Can data be used to improve marketplace outreach? 2) What geography is best? 3) What are some of the challenges with using low level geographies? 4) Are there strategies to make this data more useful? 3

4. Where are we in terms of marketplace enrollment? • 11.7 million at end of OEP2 • CBO (March 2015)—21 million by 2016 • 36% of Potentially Eligible (15% HI and 77% VT) • People who were easy to enroll have enrolled • http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf • https://www.cbo.gov/publication/43900 • http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population-2015/ 4

5. Availability of Survey Data - Geography 5 Nation, States, & DC Congressional Districts Counties School Districts Public Use Microdata Area (PUMA) Metro & Micro Statistical Areas Zip Code Tabulation Areas (ZCTA) Census Tracts

6. PUMAs: Public Use Microdata Areas 6 PUMAs are geographic areas created by the Census Bureau to contain at least 100,000 people and nest within states.

7. ZIP CodeTabulation Areas • ZIP Code: Not created as an area based division but instead is a collection of mail delivery routes • ZIP Code Tabulation Area (ZCTA): Aligns ZIP codes with census geography. Most frequently occurring ZIP code within census blocks 7

8. Three Census Geographies: Advantages of each PUMA County ZCTA Included in PUMS (can create custom variables from publically available files)  X X Data is timely X (2014 data-- Sept. 2015) X (2014 data for all counties--March 2016) X (2010-2014 data-- Dec. 2015) Intuitive geography X   Reliable for full area population   X Neighborhood level estimates X ( high density areas) X  Nests within other geography   X Data is annual   X 8

9. Using Administrative Data Combining data • Map ZIP Codes to ZCTAs (administrative data) • Map ZCTAs to PUMAs (administrative data) • Estimate PUMA levelTarget Population (census microdata) • Remaining Eligible (target pop – enrolled) Map any administrative data that includes an address (e.g location of application assistors, hospitals, churches) 9

10. Example: Illinois Marketplace Enrollment Target Pop. Enrolled Remaining Eligible 10

11. Map 1 - Data intensive: Drill down 11

12. Map 2 - Outreach Intensive: Counties 12

13. Summary Choosing the best geography • Availability, timelines and reliability • The research question • Audience for the analysis Advantage of ZIP Code level data • Captures variation between neighborhoods Disadvantages • Less reliable • Cannot trend • Categories and variables are preset by census • Not timely 13

14. Summary (2) Interactive maps and admin data can help • Interactive maps • Can include anything that has an address • Can include multiple geographies • Can include underlying data • Can include number and percent • Can be accessed anywhere the internet is available • Administrative data • Timeliness • Usefulness 14

15. www.shadac.org @shadac Brett Fried Senior Research Fellow bfried@umn.edu 612.624.1406 Contact Information 15

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