The document discusses using survey data to track the impact of the Affordable Care Act (ACA) at the state level. It outlines three priority areas to measure - health insurance coverage, affordability and comprehensiveness of coverage, and access to health care services. For each area, it lists specific measures that can be obtained from population surveys, like uninsured rates, premium costs, and barriers to care. State-specific surveys are recommended because they can provide timely, flexible data across these measures to help policymakers monitor the effects of health reform.

1. Use of Survey Data for Tracking the
Impact of the ACA in States
Kathleen Thiede Call
National Network of State and Local Health Surveys
APHA San Francisco
October 29, 2012
Support for this work was provided by a grant from the California HealthCare Foundation.

2. Overview
• Monitoring health reform:
1. Health insurance
coverage
2. Affordability and
comprehensiveness of
coverage
3. Access to health care
services
2

3. Considerations for Selecting Measures
• Measures that reflect major
goals and provisions of the
law
• Outcomes rather than
implementation process
• Relevant/meaningful to
policymakers
3

4. Considerations for Recommending Data Sources
• Comparability over time
• Ability to do in-depth analysis (e.g.,
by geography, age, income,
race/ethnicity)
• Population coverage – complete
population of interest
• Availability of benchmarks/national
comparisons
• Timeliness of estimates
• Accessibility of data
• Flexibility to adapt to changing
needs
4

5. Measures come from Varied Data Sources
• Population surveys
• Employer surveys
• Health care provider data
• Health plan data
• State public program data
• Today’s focus: review framework discussing
measures available through population surveys
5

6. State-specific Household Survey Activity
http://www.shadac.org/content/state-survey-research-activity
6

7. Priority Measures: Coverage
Distribution of Insurance Coverage
Uninsured Public Coverage Employer Coverage
Point in time Enrollment trend Employers offering
Uninsured for a year Participation rate Employees in firms
or longer that offer
Churning
Uninsured at some % Eligible
point in past year
% Enrolled
Health Insurance
Reasons for
uninsurance Exchange Families with ESI
offer
Exempt from mandate Nongroup coverage:
exchange and as % of All family
Paying penalty market members enrolled
Employer coverage: Employers paying
exchange and as % penalty
of market
7

8. Priority Measures: Coverage
Distribution of Insurance Coverage
Uninsured Public Coverage Employer Coverage
Point in time Enrollment trend Employers offering
Uninsured for a year Participation rate Employees in firms
or longer that offer
Churning
Uninsured at some % Eligible
point in past year
% Enrolled
Health Insurance
Reasons for
uninsurance Exchange Families with ESI
offer
Exempt from mandate Nongroup coverage:
exchange and as % of All family
Paying penalty market members enrolled
Employer coverage: Employers paying
exchange and as % penalty
of market
8

9. Priority Measures: Coverage
Distribution of Insurance Coverage
Uninsured Public Coverage Employer Coverage
Point in time Enrollment trend Employers offering
Uninsured for a year Participation rate Employees in firms
or longer that offer
Churning
Uninsured at some % Eligible
point in past year
% Enrolled
Health Insurance
Reasons for
uninsurance Exchange Families with ESI
offer
Exempt from mandate Nongroup coverage:
exchange and as % of All family
Paying penalty market members enrolled
Employer coverage: Employers paying
exchange and as % penalty
of market
9

10. Priority Measures: Affordability &
Comprehensiveness of Coverage
Insurance Premiums Comprehensiveness Financial Burden
Employer coverage Enrollment by benefit % of families with high
level cost burden
Total premium
Single ESI “Affordable” premium
as % of income
Family Nongroup
Employee share Deductibles Subsidies
Single ESI: single, family # receiving premium
Family Nongroup: single, and cost sharing
family subsidies in exchange
Nongroup coverage
Average value of
Per enrollee
subsidies
10

11. Priority Measures: Affordability &
Comprehensiveness of Coverage
•
Insurance Premiums Comprehensiveness Financial Burden
Employer coverage Enrollment by benefit % of families with high
level cost burden
Total premium
Single ESI “Affordable” premium
as % of income
Family Nongroup
Employee share Deductibles Subsidies
Single ESI: single, family # receiving premium
Family Nongroup: single, and cost sharing
family subsidies in exchange
Nongroup coverage
Average value of
Per enrollee
subsidies
11

12. Priority Measures: Affordability &
Comprehensiveness of Coverage
•
Insurance Premiums Comprehensiveness Financial Burden
Employer coverage Enrollment by benefit % of families with high
level cost burden
Total premium
Single ESI “Affordable” premium
as % of income
Family Nongroup
Employee share Deductibles Subsidies
Single ESI: single, family # receiving premium
Family Nongroup: single, and cost sharing
family subsidies in exchange
Nongroup coverage
Average value of
Per enrollee
subsidies
12

13. Priority Measures: Access to Care
Individuals System
Use of services Barriers to care % of physicians Safety net
accepting new
Has usual Did not get patients, by payer Volume and type of
source of care necessary care services provided
(& reasons) % of physicians by safety net clinics
Type of place participating in
for usual source Not able to get public programs Uncompensated
of care timely care
appointment Ambulatory care
County indigent
Preventive care sensitive hospital
Difficulty finding care volume and
visit in past year admissions
provider to take cost
new patients Emergency room
Any doctor visit visit rate
in past year Difficulty finding
provider that
accepts Preventable/
insurance type avoidable ER visits
13

14. Priority Measures: Access to Care
Individuals System
Use of services Barriers to care % of physicians Safety net
accepting new
Has usual Did not get patients, by payer Volume and type of
source of care necessary care services provided
(& reasons) % of physicians by safety net clinics
Type of place participating in
for usual source Not able to get public programs Uncompensated
of care timely care
appointment Ambulatory care
County indigent
Preventive care sensitive hospital
Difficulty finding care volume and
visit in past year admissions
provider to take cost
new patients Emergency room
Any doctor visit visit rate
in past year Difficulty finding
provider that
accepts Preventable/
insurance type avoidable ER visits
14

15. Concluding comments
• State-specific surveys provide data in all three
priority areas: coverage, affordability, access
• State-specific survey advantage
– Wide range of policy relevant questions
– Flexibility to alter survey content
– Quick turnaround availability
• State-specific survey have and will continue to
play a role in monitoring health reform
15

16. Complete copy of the Framework report is available at:
http://www.shadac.org/publications/framework-tracking-impacts-
affordable-care-act-in-california
Kathleen Thiede Call
callx001@umn.edu
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