The document summarizes results from the 2017 Minnesota Health Access Survey. Key findings include: - Minnesota's uninsured rate rose significantly to 9.0% in 2017, reversing gains made after the ACA. - Coverage through employers and individual markets declined while public coverage increases did not make up the difference. - The uninsured profile did not significantly change, with young adults, lower-income individuals, and people of color most affected. - Uninsurance rates increased the most for Hispanics, Blacks, Asians and those with incomes over 300% FPG.

1. Results from the 2017 Minnesota Health Access Survey
SHADAC Webinar | April 19, 2018
Slides available at www.shadac.org/2017MNHAWebinar

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• Slides available at www.shadac.org/2017MNHAWebinar
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3. Speakers
Alisha Baines Simon
Supervisor, Access and Cost
Containment Unit
Health Economics Program
Minnesota Department of Health
3
Stefan Gildemeister
State Health Economist
and Director
Health Economics Program
Minnesota Department of Health
Kathleen Call
Investigator, State Health Access
Data Assistance Center (SHADAC)
and Professor, Division of Health
Policy and Management

4. Agenda
• Overview of the Minnesota Health Access Survey
• Main findings from the survey
• Who are the uninsured in 2017
• Reflections
• Questions
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5. What is the Minnesota Health Access Survey (MNHA)?
• Biennial survey of health insurance coverage and access in
Minnesota
• The definitive source for MN estimates on uninsurance and a tool
for policy simulation on coverage and access
• Funded by MN Legislature with matching funds from DHS and
operational funding support from HEP
• Partnership with the University of Minnesota School of Public
Health State Health Access Data Assistance Center
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6. Minnesota Health Access Survey methods
• General population telephone survey (English and Spanish)
• Comparable data back to 2001, conducted biennially since 2007
2017 Stats:
• 12,436 completed interviews
• Fielding period: June through early October 2017
• Sample design:
• 75% cell phone/25% landline
• Screening for age
• Oversampled pre-paid cell phones
• Response rate: Overall: 28.8%
• Weighted to MN population using 2016 American Community Survey (ACS)
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7. What changed in Minnesota between 2015 and 2017?
2015
Unemployment Rate: 3.8%
Average Weekly Wages
State Economy: $328.4B
0 to 65 Population Growth
65+ Population Growth
2017
Unemployment Rate: 3.6%
Average Weekly Wages
State Economy: $352.0B
0 to 65 Population Growth
65+ Population Growth
No change
7.2%
1.2%
4.6%
0.2 pp
6

8. Volatility and uncertainty in the health policy space
• Uncertainty throughout the year
• Will the ACA be repealed after election?
• Wait for state response to high individual market premiums
• ACA repeal votes in Congress
• Ending Cost Sharing Reduction (CSR) subsidies
• Individual Mandate penalty set to $0 for 2019
• Consecutive year increases in costs and cost sharing, with narrower networks
• Fewer options of policies across the state in the individual market
8

9. 2017 Results
4/18/2018 9

10. Minnesota Uninsurance Rate Rose Significantly in 2017
6.1%
7.7%*
7.2%
9.0%* 9.0%
8.2%
4.3%*
6.3%*
0%
2%
4%
6%
8%
10%
2001 2004 2007 2009 2011 2013 2015 2017
Percent Uninsured in Minnesota, 2001 to 2017
10
* Indicates statistically significant difference from previous year shown at the 95% level
Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013 , 2015 and 2017 Minnesota Health Access Survey.
Recession
Lagged Increase in
Uninsurance Rate
Recession
Lagged Increase in
Uninsurance Rate
?
MajorACAReforms
Why is 2017 different?

11. Coverage through individual market and employers fell
• Fewer people connected to
employers offering coverage
• Declining take-up among
children
• High costs (both group and
individual markets)
• Uncertainty around coverage
11
* Indicates statistically significant difference from previous year shown at the 95% level
Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013 , 2015 and 2017 Minnesota Health Access Survey.
68.1%
62.6%* 62.5%
57.6%* 56.6% 55.2% 55.9%
52.9%*
4.8% 4.6% 5.1% 5.1% 5.2% 5.4% 6.2%
4.4%*
0%
10%
20%
30%
40%
50%
60%
70%
2001 2004 2007 2009 2011 2013 2015 2017
Private Coverage in Minnesota, 2001 to 2017
Group Individual

12. Public coverage increases did not make up for private
coverage decreases
• More people aging into
Medicare (responsible for 40%
of the increase)
• Fewer people losing public
coverage and becoming
uninsured
• Eligible people have more
options to enroll, better
support than in the past and
more exposure to the issue
12
* Indicates statistically significant difference from previous year shown at the 95% level
Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013 , 2015 and 2017 Minnesota Health Access Survey.
68.1%
62.6%* 62.5%
57.6%* 56.6% 55.2% 55.9%
52.9%*
4.8% 4.6% 5.1% 5.1% 5.2% 5.4% 6.2%
4.4%*
21.1%
25.1%* 25.2%
28.3%* 29.2%
31.1%*
33.6%*
36.5%*
0%
10%
20%
30%
40%
50%
60%
70%
2001 2004 2007 2009 2011 2013 2015 2017
Sources of Insurance Coverage, 2001 to 2017
Group Individual Public

13. Potential sources of coverage for the uninsured
13
36.7%
19.6%
67.4%
17.7%
33.4%
23.1%
59.4%
23.5%
7.8%~
30.8%
18.6%
51.1%~
22.7%
12.5%~*
0%
20%
40%
60%
80%
Connection to Employer that
offers coverage
Eligible for employer coverage Potentially eligible for public
coverage
Potentially eligible for APTC Not eligible for employer
coverage, public coverage or
APTC (2013 does not include
APTC eligibility)
2013 2015 2017
* Statistically significant difference from 2015 at the 95% level
~ Statistically significant difference from 2013 at the 95% level
Source: Minnesota Department of Health, Health Economics Program, 2013 , 2015 and 2017 Minnesota Health Access Survey.

14. Why don’t eligible people enroll in coverage?
• People without health insurance tend to have less awareness of coverage
options
• They are worried or assume they cannot afford coverage, or that they aren’t
eligible
• In a recent Commonwealth Fund survey, 39% of uninsured people who had
heard of the marketplaces didn’t enroll because they thought the ACA would
be repealed or the individual mandate was no longer in effect
14

15. Who are the
Uninsured in
2017?
4/18/2018 15

16. The overall profile of the uninsured did not change in 2017
• In 2017, populations with the highest uninsurance rates were:
• Young adults, aged 18 to 34 (10.9%);
• People with lower incomes (under 200% Federal Poverty Guidelines) (11.3%);
• People with a high school education or less (11.9%); and
• People of color and American Indians (13.9%)
• These populations also tend to have less access to employer sponsored
(group) coverage
15

17. Uninsurance rate increases were not uniform
• Rates increased more for:
• Hispanic and Latino
• Black
• Asian
• People with incomes over 300% FPG
• Adults 18 to 25, 35 to 54 and 55 to 64
• People with a high school education or
less
• Rates stayed the same for:
• American Indians
• People with incomes at or below 100%
FPG
• Children
• Adults aged 26 to 34
• People with some college or technical
school
17

18. People with the lowest incomes maintained coverage gains
18Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013 , 2015 and 2017 Minnesota Health Access Survey.

19. Most adults saw a return to 2013 coverage levels
19Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013 , 2015 and 2017 Minnesota Health Access Survey.

20. People with lower educational attainment saw a return to
2013 coverage levels
20Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013 , 2015 and 2017 Minnesota Health Access Survey.

21. Variation in maintenance of 2015 coverage gains
by race and ethnicity
* Statistically significant difference from previous year shown at the 95% level
# Statistically significant difference from previous year shown at the 90% level
Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013 , 2015 and 2017 Minnesota Health Access Survey. 21
*
*
*
**
*
*
*
* * *
*
#

22. Uninsurance rates by region
22
*Indicates statistically significant difference from 2015 (95% level)
^ Indicates statistically significant difference (95% level) from statewide level in 2017
Source: Minnesota Health Access Survey, 2015 and 2017

23. The uninsured are also more likely to…
• Report fair or poor health (21.6% compared to 12.7% total population)
• Experience more unhealthy days related to their mental health per month
(4.6 days compared to 2.9 days)
• Lack confidence in getting needed health care (38.2% compared to 9.9%)
• Report forgoing health care due to costs at twice the rate of the general
population (46.0% compared to 21.0%)
23

24. Employment among the uninsured
• The uninsured are employed at similar rates to the state at a whole.
The differences are:
• Uninsured are more likely to be seasonal or temporary workers
• They are more likely to be self-employed
• They are more likely to work for smaller businesses (50 or fewer employees)
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25. Where do the uninsured get health care?
25
14.8%
5.3% 8.2% 11.9% 9.3%
74.6%
81.1% 71.0%
33.1%
75.5%
2.6%
1.5%
3.5%
5.5%
2.2%
7.9% 12.0% 17.1%
47.4%
13.0%
0%
20%
40%
60%
80%
100%
Public Coverage Group Coverage Individual Coverage Uninsured Overall
Type of Usual Source of Care by Health Insurance Coverage, 2017
Public Clinic Private clinic or Dr's office Other Emergency Room/Urgent Care No usual source of care
Source: Minnesota Department of Health, Health Economics Program, 2017 Minnesota Health Access Survey.

26. People without health insurance use less health care
26
83.2%
9.5%
20.3%
88.0%
15.0%
29.5%
85.2%
6.2%
14.3%
78.3%
6.0%
16.0%
51.4%
8.1%
21.4%
0%
20%
40%
60%
80%
100%
Doc Visit Inpatient ED Visit
Health Care Utilization by Health Insurance Coverage, 2017
Overall Public Coverage Group Coverage Individual Coverage Uninsured
Less likely to
See a Doctor Equally likely
to have an
inpatient stay
as privately
insured
More likely to use
the ED than
privately insured,
but less likely than
publically insured
Source: Minnesota Department of Health, Health Economics Program, 2017 Minnesota Health Access Survey.

27. Closing thoughts
• The ongoing decline in employer-sponsored coverage is of concern … that it happens
in strong economic times is even more worrisome
• Public coverage is covering more people, and they are maintaining that coverage
• Health care costs are still going up, regardless of how many people have insurance
coverage
• Disparities in access still persist – and may impact the disparities we see in health
outcomes
• We still need a deeper understanding:
• What drives people to drop, maintain, or enroll in coverage
• Why people eligible for public coverage or subsidies don’t enroll or take advantage of them
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28. Questions?
Alisha Baines Simon
Supervisor, Access and Cost
Containment Unit
Health Economics Program
Minnesota Department of Health
28
Stefan Gildemeister
State Health Economist
and Director
Health Economics Program
Minnesota Department of Health
Kathleen Call
Investigator, State Health Access
Data Assistance Center (SHADAC)
and Professor, Division of Health
Policy and Management
Please send any follow-up questions you may have to shadac@umn.edu

29. Kathleen Call, Alisha Simon & Stefan Gildemeister
THANK YOU!