Pres paa2012 may4_hartman

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Pres paa2012 may4_hartman

  1. 1. State Variation in High BurdenSpending for Health Care: Preliminaryfindings from new data in the CurrentPopulation SurveyLacey HartmanState Health Access Data Assistance Center/SHADACUniversity of Minnesotawww.shadac.orgMay 4, 2012Funded by a grant from the Robert Wood Johnson Foundation Funded by a grant from the Robert Wood Johnson Foundation
  2. 2. Acknowledgements• Co-Authors – Gilbert Gonzales, SHADAC – Sharon Long, Urban Institute & SHADAC• Funding – Robert Wood Johnson Foundation 2
  3. 3. 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 3
  4. 4. Goals• Assess variation in high burden spending across states• Estimate potential for ACA to alleviate high burden spending 4
  5. 5. Data: Annual Social and Economic Supplement to theCurrent Population Survey (CPS ASEC)• New questions related to OOP spending added to the CPS in 2010 (reference CY 2009)• CPS is a monthly labor survey – ASEC fielded in Feb-April – Questions on work, income, migration and health insurance – Supports state estimates 5
  6. 6. OOP Spending in the CPS• Spending related to: Medical, dental, vision, medical supplies, and prescription drugs• Includes: – Premiums (except Medicare Part B) – Non-premium • Co-pays, deductibles, other cost sharing • Over the counter expenses (separate in 2011)
  7. 7. Data Quality• Compares well to MEPS and SIPP (Caswell et. al 2011) – Compared statistics by age, race, income, etc. – Tested differences in distribution of OOP spending across data sources SKL1 – Small expenditures underreported in CPS• Overall, data performs well for capturing high burden spending
  8. 8. Slide 7SKL1 Highlight focus on high costs. Arent concerned exact estimate of OOP, but on whether OOP are high SKL, 2/27/2012
  9. 9. Measures & Methods• OOP spending as a share of family income – High burden: >10% of income – Very high burden: >20% of income• Unit of analysis=individuals in families• Premium and non-premium high burden spending (2011 only)
  10. 10. Methods, Potential Impacts of ACA• Potentially Medicaid eligible – Non-elderly citizens below 138% FPG• Potentially subsidy eligible – Non-elderly citizens I39-399% FPG – Uninsured or with nongroup coverage• Assign potential savings at individual level, recalculate family spending and burden 9
  11. 11. Methods, Potential Impacts of ACAFamily Income as Premium Cap as Out-of-Pocket Maximum % of FPG % of Income Individuals Families <=138 0% ---------- ------------- 138-149 3-4% $1,983 $3967 150-199 4-6.3% $1,983 $3967 200-249 6.3-8.05% $2,975 $5950 250-299 8.05-9.5% $2,975 $5950 300-399 9.5% $3,967 $7933 10
  12. 12. Limitations• Only 1 year of data for estimates of ACA impacts – Rerun results with 2012 data in the fall• Conservative estimates of ACA impacts – CPS coverage questions don’t assess full year coverage – Citizenship (some non-citizens would be eligible for Medicaid/subsidies) 11
  13. 13. High Burden Spending, National Results• Impacts many Americans – Nearly 20% or 56 million high burden (>10%) – 8% very high burden (>20%)• Compared to total population, more likely – Income below 250% FPG (59% vs. 42%) – Fair/poor health (19% vs. 12%) – Disabled person in family (25% vs. 17%) – Elderly (22% vs. 13%) – Nongroup coverage (21% vs. 9%) 12
  14. 14. Percent of Individuals in Families with High Burden(>10%) Out-of-Pocket Spending, by State Source 2010-2011 CPS ASEC 13
  15. 15. Percent of Individuals in Families with High Burden (>10%) Health CarePremium Spending, by State 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% South Dakota North Dakota Maine Nebraska Tennessee Montana Wisconsin Kansas Mississippi Indiana Louisiana Rhode Island Oregon Oklahoma Minnesota New Hampshire Arkansas Connecticut North Carolina Georgia Colorado Vermont Wyoming Florida Iowa Pennsylvania Washington Alabama Maryland Missouri Kentucky National Average Nevada Michigan Massachusetts New Mexico Virginia Delaware Idaho Arizona Utah West Virginia Ohio Illinois Texas South Carolina New Jersey New York California Hawaii Alaska District of ColumbiaSource 2011 CPS ASEC 14
  16. 16. Percent of Individuals in Families with High Burden (>10%) Health Care Non-Premium Spending, by State 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Montana Wyoming Mississippi Idaho Utah West Virginia Nevada North Dakota Washington Tennessee Kentucky Oregon Colorado Arkansas Indiana North Carolina Alaska Louisiana Michigan Arizona Oklahoma Georgia Ohio Florida Maine National Average Missouri South Dakota South Carolina Texas Alabama Nebraska Kansas Pennsylvania Delaware Iowa Illinois Wisconsin New Mexico Minnesota Maryland New Jersey California Vermont Virginia Rhode Island Connecticut New Hampshire Massachusetts Hawaii New York District of ColumbiaSource 2011 CPS ASEC 15
  17. 17. Potential Impact of ACA on High (>10%) BurdenSpending 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Montana Nebraska South Dakota Idaho Wyoming Utah Oregon Maine North Dakota Mississippi Tennessee Kentucky Colorado Arkansas Kansas Wisconsin Minnesota Alabama Indiana Louisiana Nevada Washington Missouri Post‐ACA Florida West Virginia Pre‐ACA North Carolina South Carolina Iowa Georgia Connecticut Arizona Vermont Illinois Pennsylvania Ohio New Hampshire Oklahoma New Mexico Rhode Island Michigan Texas Virginia Delaware Maryland Alaska Massachusetts New Jersey California Hawaii New York District of ColumbiaSource 2011 CPS ASEC 16
  18. 18. Potential Impact of ACA on Very High(>20%) Burden Spending 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Montana Wyoming Utah Mississippi Idaho South Dakota Tennessee Nevada Arkansas Oregon Colorado Kentucky Florida North Dakota Washington Maine Kansas Nebraska North Carolina Alabama Louisiana Wisconsin Oklahoma pre‐ACA Georgia Pennsylvania Indiana post‐ACA Missouri Ohio West Virginia New Mexico Minnesota Total Illinois South Carolina Michigan Arizona New Hampshire Vermont Connecticut Delaware Alaska Virginia Rhode Island Texas New Jersey Iowa Maryland Massachusetts Hawaii California District of Columbia New YorkSource 2011 CPS ASEC 17
  19. 19. Characteristics of People with High BurdenSpending After ACA• Compared to total population – Income below 250% FPG (48% vs. 42%) – Fair/poor health (18% vs. 12%) – Elderly (22% vs. 13%)• Compared to high burden before – Income above 250% FPG (51% vs. 40%) – Employer based coverage (59% vs. 53%) – Elderly (28% vs. 22%) 18
  20. 20. Conclusions, Policy Implications• High burden spending issue for many Americans, varies across states• Estimate ACA will help many, 40 million remain high burden• Policy solutions for people with ESI and elderly• CPS useful new data source for – Monitoring – Informing policy solutions
  21. 21. Lacey Hartman hartm042@umn.edu Sign up to receive our State Health Access Data Assistance Center newsletter and updates at University of Minnesota, Minneapolis, MN www.shadac.org 612-624-4802 @shadacSign up to receive our newsletter and updates at www.shadac.org www.facebook.com/shadac4states @shadac
  22. 22. Sign up to receive ournewsletter and updates at www.shadac.org @shadac

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