Pres hsr mar5_hartman

316 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
316
On SlideShare
0
From Embeds
0
Number of Embeds
93
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Pres hsr mar5_hartman

  1. 1. High Burden Out-of-Pocket Spending forHealth Care: State Variation andPotential Impacts of ACALacey HartmanGilbert GonzalesState Health Access Data Assistance Center/SHADACUniversity of MinnesotaSharon LongSr. Fellow, Urban InstituteMN Health Services Research ConferenceMarch 5, 2013 Funded by a grant from the Robert Wood Johnson Foundation
  2. 2. Background• Health care costs outpacing growth in income• Key goal of ACA is to address affordability – Medicaid expansion – Premium and cost-sharing subsidies in the Exchange• State variation in ACA implementation and health care costs/markets 2
  3. 3. Goals• Assess variation in high burden spending across states• Estimate potential for ACA to alleviate high burden spending 3
  4. 4. Data: Current Population Survey• Annual Social and Economic Supplement (ASEC)• New questions related to OOP spending added to the CPS in 2010 (reference year 2009)• CPS is a monthly labor survey – ASEC fielded in Feb-April – Questions on work, income, migration and health insurance – Combine 2 years to produce state estimates 4
  5. 5. OOP Spending in the CPS• Spending related to: medical, dental, vision, medical supplies, and prescription drugs – Reported net of reimbursements• Includes: – Premiums (except Medicare Part B) – Non-premium • Co-pays, deductibles, other cost sharing• Data quality: compares well to other reliable sources of information on OOP spending (MEPS and SIPP) 5
  6. 6. Measures & Methods• OOP spending as a share of income – High burden: >10% of income – Very high burden: >20% of income• Unit of analysis=individuals in health insurance units (HIUs) 6
  7. 7. Methods: Potential Impacts of ACA Maximum potential gainsPotentially Medicaid eligible – Non-elderly citizens <=138% FPGPotentially subsidy eligible – Non-elderly citizens >I38 & <400% FPG – Uninsured or with nongroup coverage• Assign potential savings at individual level, recalculate HIU spending and burden 7
  8. 8. Methods: Potential Impacts of ACAFamily Income as Premium Cap as Out-of-Pocket Maximum % of FPG % of Income Individuals Families <=138 0% ------------5% of income------------- 138-149 3-4% $1,983 $3,967 150-199 4-6.3% $1,983 $3,967 200-249 6.3-8.05% $2,975 $5,950 250-299 8.05-9.5% $2,975 $5,950 300-399 9.5% $3,967 $7,933 8
  9. 9. Baseline Results, 2010-2011• Median spending $1275• High burden spending impacts many Americans – Nearly 20% or 58 million high burden (>10% income) – 8% very high burden (>20% income)• Variation across states 9
  10. 10. Median OOP SpendingSource 2010-2011 CPS ASEC 10
  11. 11. Percent of Individuals in HIUs with High Burden(>10% income) OOP SpendingSource 2010-2011 CPS ASEC 11
  12. 12. Estimated Impacts of ACA on OOP Spending:Nationally • Decrease in median OOP – $1275 to $1000 • Decrease in share with high burden – 19.2% to 13.8% • 16.8 million no longer high burden • 42 million continue to experience high burden spendingSource 2011 CPS ASEC 12
  13. 13. Characteristics of individuals with baselinehigh burden spending No longer Still high Total high burden burden population Female 53% 46% 51% Race White 63% 73% 63% Black 16% 8% 12% Asian 4% 5% 5% Hispanic 13% 2% 3% Other 4% 12% 17% Family income (% FPG) 0-138 94% 17% 30% 139-250 5% 34% 20% 250-400 2% 28% 19% 400+ 0% 21% 32% 13
  14. 14. Characteristics of individuals with baselinehigh burden spending, cont. No longer Still high Total high burden burden population Health Status Excellent or Good 82% 81% 88% Fair or Poor 18% 19% 12% Has employer based 39% 60% 55% coverage Has non-group coverage 15% 23% 9% Child present in family 44% 40% 46% Elderly person present 1% 35% 15% in family 14
  15. 15. Estimated Impacts of ACA on OOPSpending: State Level• Median levels and share with high burden decrease in all states• Variation across states persists – In potential impact of ACA: 16% to 40% reductions in high burden spending – In share with high burden spending: 7% to 19% still high burden, rankings fairly stable 15
  16. 16. Estimated percent change in share with highburden spendingSource 2010-2011 CPS ASEC 16
  17. 17. Share with high burden OOP spending,baseline and after estimated ACA impacts 20 WY ID MN NE SD UT ND OR ME WI TN MT KS NHCT NC KY IACO MS 15 WA IL NV IN VT FLOK MO AR RI AZ PA MA OH WV SC TX MD VA LA NM MI GA CA NJ AL DE AK 10 NY HI DC 5 10 15 20 25 30 % Baseline high burden spending 17
  18. 18. Limitations• Analysis of spending, not foregone care or risk of high OOP spending burdens• Increases in spending related to ACA• Upper bound estimate of ACA impacts – Take-up – State decisions about Medicaid expansions 18
  19. 19. Conclusions & Policy Implications• CPS useful new data source for – Monitoring – Informing policy solutions• High burden spending issue for many Americans and varies across states• Estimate ACA will help many but 40 million remain high burden• State decisions on Medicaid expansion 19
  20. 20. Lacey Hartman, MPP Senior Research Fellow hartm042@umn.eduState Health Access Data Assistance Center (SHADAC) University of Minnesota Sign up to receive our newsletter and updates at www.shadac.org @shadac

×