This document summarizes a presentation on changes in health care access and affordability in Minnesota following health care reforms. It analyzes data from Minnesota health surveys from 2007-2015. Key findings include: most Minnesotans have a usual source of care, though the uninsured report less access; while access has improved for many, some face issues getting appointments or with provider acceptance; forgone care due to costs has decreased for routine and mental care but remains an issue for low-income residents; and the percentage of people with medical bill or basic needs payment problems has declined since 2013 reforms.

1. POST-REFORM CHANGES IN
HEALTH CARE ACCESS AND
AFFORDABILITY IN MINNESOTA
Giovann Alarcón
MN Health Services Research Conference
March 1st, 2016

2. Purpose and overview
Provide an up-to-date and State specific overview
of two important outcomes to monitor: health
care access and affordability
• How accessible and affordable is care in MN?
• Has the situation changed post-ACA?
• Does this depend on insurance type or income?
2

3. Analytic sample
• MNHA 2007, 2009, 2011, 2013, and 2015
• Sample size
• 2007: 9,728
• 2009: 12,031
• 2011: 11,355
• 2013: 11,778
• 2015: 11,178
3

4. Indicators on Health Care
Access
Access indicators in the Minnesota Health Access
Survey include:
• reports of having a usual source of care (2007-2015),
• the ability –and confidence– in getting care when
needed (2013-2015), and
• provider supply issues where potential patients are
told by a doctor’s office or clinic that they do not
accept their health care coverage or they are not
accepting new patients (2013-2015).
Other indicators available are: visit to a doctor’s office
(2011-2015) and use of the emergency department
(2009-2015).
4

5. Indicators on Health Care
Affordability
Affordability indicators in the Minnesota Health Access
Survey include:
• forgone care due to costs (2011-2015),
• having problems paying medical bills (2013-2015),
• needing to establish a payment plan with a hospital
or doctor’s office (2013-2015),
• having trouble paying other basic bills (e.g. food,
heat, or rent) due to care costs (2013-2015), and
• being satisfied with the protection against high
medical bills provided by their insurance coverage
(2015).
5

6. ACCESS

7. Highlights
• Most Minnesotans have a (private) usual source of
care and are confident in getting care when needed,
but only about half of the uninsured report the same
characteristics.
• One in ten Minnesotans could not get a doctor’s
appointment as soon as needed, increasing for
people with private coverage.
• Minnesotans with public coverage were more likely
to face problems with providers than people with
other types of insurance.
7

8. Usual Source of Care by Insurance
Type, 2007 - 2015
8
* Indicates statistically significant difference (p≤.05) from previous year shown
89.4%
88.3%
86.4% 85.5% 85.7%
40%
60%
80%
100%
2007 2009 2011 2013 2015
Total Public Group Non-group Uninsured

9. Confidence in Getting Care When
Needed by Insurance Type, 2013 - 2015
9
* Indicates statistically significant difference (p≤.05) from 2013 estimates
91.7% 92.8% 96.1%
90.0%
58.2%
93.2%* 91.7% 96.3%
89.8%
67.2%
0%
20%
40%
60%
80%
100%
Total Public Group Non-group Uninsured
2013 2015

10. Level of Confidence in Getting Care
When Needed by Insurance Type, 2015
10
^ Indicates statistically significant difference (p≤.05) from Total estimates
Total
Very confident 75.8% 82.0% ^ 64.6% ^ 70.6% ^ 48.3% ^
Somewhat confident 17.4% 14.3% ^ 25.1% ^ 21.1% ^ 18.9%
A little confident 3.9% 2.3% ^ 5.2% 5.7% ^ 10.9% ^
Not confident at all 2.9% 1.5% ^ 5.0% 2.6% 21.9% ^
Group Non-group Public Uninsured

11. Could Not Get an Appointment When
Needed by Insurance Type, 2013 - 2015
11
* Indicates statistically significant difference (p≤.05) from 2013 estimates
9.7%
12.2%
8.9%
5.6%
7.9%
12.1%*
13.2%
11.5%*
12.3%*
11.5%
0%
2%
4%
6%
8%
10%
12%
14%
Total Public Group Non-group Uninsured
2013 2015

12. Doctor Did Not Accept Their Health
Coverage by Insurance Type, 2013-2015
12
* Indicates statistically significant difference (p≤.05) from 2013 estimates
2.7%
4.8%
1.3%
2.1%
5.4%
3.7%*
6.2%
2.1%*
3.7%
6.6%
0%
2%
4%
6%
8%
Total Public Group Non-group Uninsured
2013 2015

13. Doctor Was Not Accepting New
Patients by Insurance Type, 2013 - 2015
13
* Indicates statistically significant difference (p≤.05) from 2013 estimates
2.9%
4.1%
2.2% 2.0%
3.9%3.7%*
5.4%
2.3%
6.6%*
5.6%
0%
2%
4%
6%
8%
10%
Total Public Group Non-group Uninsured
2013 2015

14. AFFORDABILITY

15. Highlights
• About one in five people were likely to forgo care due
to costs, although this has decreased for patients
seeking routine or mental care.
• One in five insured Minnesotans who used some
form of care reported having financial burdens
related to these services. This doubles for uninsured
Minnesotans.
• Financial Burden affects 1 in 3 Minnesotans with
income between 138-250% FPG.
• Four in five people reported being satisfied with the
protection against high medical bills provided by
their insurance.
15

16. Forgone Care Due to Cost, 2013 - 2015
16
* Indicates statistically significant difference (p≤.05) from 2013 estimates
18.6%
7.0%
12.4%
6.3%
3.7%
4.4%
18.4%
6.2%
12.4%
4.6%*
2.7%*
4.4%
0%
4%
8%
12%
16%
20%
Any forgone
care
Prescription
drugs
Dental care Routine care Mental care Specialist care
2013 2015

17. Forgone Care Due to Cost by Income
Group, 2015
17
Any forgone
care
Prescription
drugs
Dental care
Routine
care
Mental care
Specialist
care
Total 18.4% 6.2% 12.4% 4.6% 2.7% 4.4%
0 to <138%/275 FPG 22.5% 7.9% 14.8% 5.6% 3.2% 4.6%
138-250% FPG 29.8% 9.3% 24.2% 7.3% 3.5% 8.3%
<250-400% FPG 19.0% 6.2% 14.1% 4.5% 2.2% 4.4%
<400% FPG 11.9% 4.0% 6.9% 3.2% 2.3% 3.0%

18. Forgone Care Due to Cost by Insurance
Type, 2015
18
Any forgone
care
Prescription
drugs
Dental care
Routine
care
Mental care
Specialist
care
Total 18.4% 6.2% 12.4% 4.6% 2.7% 4.4%
Public 20.1% 6.3% 16.5% 4.1% 2.0% 4.0%
Group 14.7% 5.1% 9.0% 3.7% 2.3% 3.5%
Non-group 29.4% 8.7% 21.8% 7.6% 5.1% 8.9%
Uninsured 40.0% 16.4% 24.4% 17.4% 9.9% 14.0%

19. Type of Medical Financial Burden,
2013 - 2015
19
* Indicates statistically significant difference (p≤.05) from 2013 estimates
23.0%
14.8%
17.0%
8.7%
20.8%*
12.1%*
16.0%
6.5%*
0%
5%
10%
15%
20%
25%
Financial Burden Medical bills Payment Plan Basic Bills
2013 2015

20. Financial Burden by Income Group,
2013 - 2015
20
* Indicates statistically significant difference (p≤.05) from 2013 estimates
23.0%
31.3% 32.1%
24.7%
14.0%
20.8%*
22.8%*
31.7%
24.3%
14.4%
0%
5%
10%
15%
20%
25%
30%
35%
Total 0 to <138%/275
FPG
138-250% FPG <250-400% FPG <400% FPG
2013 2015

21. Financial Protection by Insurance
Type, 2015
21
82.3%
87.7%
80.9%
66.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Total Public Coverage Group Coverage Individual Coverage

22. Financial Protection by Insurance
Type, 2015
22
0%
10%
20%
30%
40%
50%
60%
70%
Very
satisfied
Somewhat
satisfied
Neutral Somewhat
dissatisfied
Very
dissatisfied
Public Group Non-group

23. Financial Protection by Insurance
Type, 2015
23
^ Indicates statistically significant difference (p≤.05) from Total estimates
Total
Very satisfied 50.6% 62.0% ^ 46.1% ^ 31.7% ^
Somewhat satisfied 31.7% 25.8% ^ 34.8% ^ 35.3%
Neither satisfied or dissatisfied 8.0% 5.9% ^ 8.9% 11.1%
Somewhat dissatisfied 6.0% 4.0% ^ 6.6% 10.4% ^
Very dissatisfied 3.7% 2.4% ^ 3.6% 11.6% ^
Public Group Non-group

24. CLOSING REMARKS

25. • Some access indicators show a clear improvement,
including gains in coverage.
• Some issues related to providers have worsened,
including the rate of people who reported not getting
an appointment when they needed it.
• Forgone routine and mental care are less frequent.
• Fewer Minnesotans had problems paying medical
bills or other basic bills due to medical costs.
• Only low-income Minnesotans have experienced a
reduction in the financial burden they experience
due to their health care costs.
25

26. Acknowledgements
• Stefan Gildemeister
• Alisha Simon
• Sarah Hagge
• Kendal Orgera
• Kathleen Call
• Karen Turner
• Jessie Kemmick-Pintor
• Giovann Alarcon
26

27. THANK YOU
Giovann Alarcón
alar0013@umn.edu