Overview of the MNHA survey, methodology, and evidence of the impact of the aca on health insurance coverage in Minnesota

Minnesota Health Services Research Conference
March 1, 2016
University of Minnesota, St. Paul Campus
Overview of the MNHA Survey,
Methodology, and Evidence of the
Impact of the ACA on Health Insurance
Coverage in Minnesota
1

MNHA Team
 MDH
 Alisha Simon
 Sarah Hagge
 Kendal Orgera
 Stefan Gildemeister
 SSRS
 David Dutwin
 Susan Sherr
 Arina Goyle
 SHADAC
 Kathleen Call
 Giovann Alarcon
 Karen Turner
 Jessie Kemmick
Pintor
 MINNESOTANS!
2

Minnesota Health Access Survey:
Background
 General Population Telephone Survey
 Sampling designed to results of specific geographic
regions, ages, race and ethnic groups
 Sample telephone numbers in landline and cell frame
 History
 Early surveys conducted by the University
 Since 2001, a partnership between MDH/SHADAC
 Funding until 2007 through various sources
 Starting in 2007 funding through
 Biennial state appropriation
 Matching funds provided by DHS
 Operation funding by MDH
3

Minnesota Health Access Survey: Methods
4
MNHA
Total
Completes
Percent
Landline
Completes
Response
Rate
2001 27,315 100% 67%
2004 13,802 100% 59%
2007 9,728 100% 43%
2009^ 12,031 82% 45%
2011^ 11,355 62% 44%
2013^ 11,778 42% 48%
2015*^ 11,178 28% 35%
^ Age screen (in landline; added to cell 2015) and child oversample.
* Oversampled pre-paid cell phones.

Minnesota Health Access Survey: Content
5
 Respond to stakeholder needs
 Changing policy environment
 Added questions
 Health insurance literacy
 Discrimination
 Having insurance or type of insurance
 Race, ethnicity or nationality
Affordability
Access

Uninsurance in Minnesota – 2001-2015
MNHA
6.1%
7.7*
7.2%
9.0* 9.0%
8.2%
4.3*
0%
2%
4%
6%
8%
10%
2001 2004 2007 2009 2011 2013 2015
* Indicates statistically significant difference from previous year shown at the 95% level
Source: 2001, 2004, 2007, 2009, 2011, 2013 and 2015 Minnesota Health Access Survey.
7

Uninsurance in Minnesota and the US
2001-2015
6.1%
7.7*
7.2%
9.0* 9.0%
8.2%
5.9%
4.3*
15.1% 15.1%
14.4*
11.6*
0%
4%
8%
12%
16%
2001 2004 2007 2009 2011 2013 2014 2015
Minnesota (MNHA) US (ACS)
* Indicates statistically significant difference from previous year shown at the 95% level within the same survey
Source: 2001, 2004, 2007, 2009, 2011, 2013 and 2015 Minnesota Health Access Survey (Minnesota) and U.S. Census Bureau, American Community
Survey (ACS), US rates and 2014 Minnesota Rate. Although estimates for Minnesota align well, direct comparisons are not encouraged.
8

Alternate Measures of Uninsurance
Source: 2011, 2013 and 2015 Minnesota Health Access Surveys.
6.6% 6.1%
2.2*
2.4%
2.1%
2.1%
3.8%
4.1%
3.8%
0%
2%
4%
6%
8%
10%
12%
14%
2011 2013 2015
Insured now, but was uninsured during the year
Uninsured now, but had some insurance during the year
Uninsured all year
Point in
time rate:
9.0%
Point in
time rate:
8.2%
Point in
time rate:
4.3%*
9

The Percent of Uninsured who are
“Long Term” is Changing
Source: 2007, 2011, 2013 and 2015 Minnesota Health Access Survey.
10
62.0% 63.6%*
70.8%*
50.3%*
38.0% 36.4%*
29.2%*
49.7%*
0%
20%
40%
60%
80%
100%
2001 2007 2013 2015
Long Term Uninsured Short Term Uninsured

Sources of Health Insurance Coverage
68.1% 62.5%*
55.2%* 55.9%
4.8%
5.1%
5.4% 6.3%
21.1%
25.2%*
31.1%* 33.6%*
6.1% 7.2% 8.2% 4.3%*
0%
20%
40%
60%
80%
100%
2001 2007 2013 2015
Group Non-Group Public Uninsured
12

Access to Employer Coverage
Non-elderly Minnesotans
13
1 Person works for or has a family member who works for an employer that offers health insurance coverage to at least some employees.
2 Percent of those who work for or have a family member who works for an employer that offers coverage who are eligible for that coverage.
3 Percent of those eligible for employer coverage as an employee or dependent who elect to participate in the employer provided health insurance coverage.

Uninsurance Rates by Age, Non-Elderly
7.3%
5.6%^
13.9%^
17.1%^
8.9%
6.2%^
8.2%
2.8%*
3.8%
6.1%*
8.2%*^
5.3%*
2.8%*^
4.3%*
0%
5%
10%
15%
20%
0-5 6-17 18-25 26-34 35-54 55-64 All Ages
2013 2015
^ Indicates statistically significant difference from all races/ethnicities in the same year at the 95% level
Source: 2013 and 2015 Minnesota Health Access Survey.
15

Uninsurance Rates by Race, Ethnicity
6.0%*^
14.5%^
17.0%^
14.0%
34.7%^
8.2%
3.4%*^
8.4% 8.7%
3.7%*
11.7*^
4.3%*^
0%
10%
20%
30%
40%
White Black American Indian Asian Hispanic/ Latio All Races/
Ethnicities
2013 2015
16

Uninsurance Rates by Household Income
17.6%^
14.3%^
9.6%
5.5%^
2.6%
8.2%
11.5%*^
6.4%*^
4.3%*
2.1%*^ 2.1%^
4.3%*
0%
5%
10%
15%
20%
0 to 100% 101 to 200% 201 to 300% 301 to 400% 401%+ All Income
2013 2015
17

Remaining Uninsured 2015
 There are dramatically fewer uninsured
 Gains in coverage across virtually all
demographic groups
 Historical patterns in inequities largely remain :
 More likely to have household incomes below 200% FPG
 More likely to have fair or poor self-reported health
 More likely to have high school or less education
 Less likely to be white
 Less likely to be married
18

Reasons For Being Uninsured 2015
19
Other/Don't know includes just moved to state, getting coverage soon, immigration issues, IHS, other and don't know
Source: 2015 Minnesota Health Access Survey.

www.shadac.org
@shadac
Contact Information
Kathleen Thiede Call, PhD
Callx001@umn.edu

Overview of the MNHA survey, methodology, and evidence of the impact of the aca on health insurance coverage in Minnesota

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Overview of the MNHA survey, methodology, and evidence of the impact of the aca on health insurance coverage in Minnesota