This document summarizes preliminary findings from a 2012 survey of enrollees in the Minnesota Comprehensive Health Association (MCHA), which provides health insurance to medically uninsurable individuals. Key findings include: most MCHA enrollees have chronic health conditions and have been enrolled for many years; the most important coverage features are prescription drug and specific service coverage; over half may not qualify for subsidies under the Affordable Care Act; and most are worried about potential cost increases and changes under health reform.
1. Putting Out the Welcome Mat: Targeting Outreach Under the
Affordable Care Act
Preliminary Findings from the 2012 Minnesota
Comprehensive Health Association (MCHA) Enrollee
Survey
Elizabeth Lukanen, MPH
SHADAC, University of Minnesota
MN Health Services Research Conference
St. Paul, MN
March 5, 2013
Funded by a grant from the Robert Wood Johnson Foundation
2. Acknowledgements
• SHADAC Collaborators
– Lynn Blewett, SHADAC Director and Professor
– Kathleen Call, Professor
– Elizabeth Lukanen, Senior Research Fellow
– Karen Turner, Senior Program Analyst
– Heather Dahlen, PhD Student and Research Assistant
• MCHA and Medica Staff
• Support for this work was provided by a grant from
the Robert Wood Johnson Foundation’s State Health
Reform Assistance Network
2
3. Presentation Overview
• MCHA and Health Reform
• 2012 MCHA Enrollee Survey
• Preliminary Results
– General characteristics of MCHA enrollees
– Experience with MCHA
– Important features of coverage
– MCHA enrollees and health reform
3
4. Minnesota Comprehensive Health
Association
• Provides health insurance coverage for the “medically
uninsurable”
• Five Eligibility Avenues:
– Loss of group coverage
– Health Coverage Tax Credit (HCTC) program
– Medicare ineligibility
– Health-related rejection
– Presumptive condition(s)
• Among the longest-running and largest state high risk
pools in the country
– Currently, 26,000 enrollees
• Administered by Medica Health Plan
4
5. High Risk Pools and Heath Reform
• Short term
– State mandate to create a high risk pool or
participate in new federal high risk pool
• Long Term
5
7. 2012 MCHA Survey: Objectives
• Provide information to MCHA to help transition
enrollees into new ACA coverage options
– Assess potential eligibility for Medicaid and exchange
– Gauge enrollee familiarity with ACA changes
– Collect information to inform outreach and
communication strategies
• Gain knowledge of how MCHA enrollees might
impact risk pools
– Collect information on health status, pent-up
demand
7
8. Methodology
• Mail survey of 5,200 MCHA enrollees
– Policy holders enrolled for 12 months
– Excluded children and those with Ryan White and HCTC
eligibility
• Three-stage mailing
• $2 incentive payment with first mailing
• Oversampling of low-income enrollees and those in
rural areas
• Survey response rate was 50.2%
• Weighting adjustments were conducted
8
10. Enrollee General Demographics
• Mean age is 52 years
• Slightly more females than males (53%)
• Almost 60% live in an urban area
• Less than a quarter have less than a high school
education
• More than two-thirds are employed or self
employed
• Majority report incomes above 400% FPG
• 45% reporting being in very good/excellent
health
10
11. Enrollee Self-Reported Chronic Conditions
• 92% of enrollees report at least one chronic condition,
22% report more than 4
• The most commonly reported conditions include:
Condition Percent
High blood pressure 33%
Weight condition 30%
High cholesterol 30%
Allergies 29%
Arthritis/osteoporosis 23%
Back/neck condition 22%
Mental health conditions 20%
Diabetes 18%
Headaches 14%
11
12. Enrollee Experience with MCHA
• More than two-thirds have been in MCHA for
more than 4 years
• 23% have been in MCHA for 10 years or more
• 16% report receiving a low-income subsidy
• 90% report that they and their family pay for
their MCHA premium
• 81% report being somewhat/very satisfied with
their MCHA insurance coverage
12
13. MCHA Program Use Among Enrollees
• Reports of participation in health improvement
programs were low, but those that used the services
found them helpful
Program Participation Participants that Found
Program Somewhat/Very
helpful
AccordantCare Disease 6% 63%
management program
Medica Health 7% 88%
Coaching
• Other programs mentioned: Health and Wellness
program, MCHA’s Campaign for Healthy Living,
MyMedica.com
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14. Features of MCHA Coverage that are
Important to Enrollees
80%
73%
Rx coverage
70% 67% 66%
62%
60% Coverage for a specific
Services
50% Ability to see a specific
provider
40%
40% Cost of premium
30% Ability to go to Mayo Clinic
20% 18% 17%
Low income subsidy
10%
HSA option
0%
Rated "Extremely Important"
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15. Coverage for a Specific Service –
Top Mentions
• Annual exams, preventive services, screenings
• Chiropractic services
• Mental health/Chemical dependency
• Mammograms
• Dental and vision
• Physical therapy
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16. Reasons Enrollees Would Leave MCHA
Primary Reason
Can no longer afford
5% premium
5%
New job with Insurance
27% offer
10%
Nothing would make me
leave
10% My health improves and I
can get in private market
Turning 65
20% 23% MCHA doesn't offer
benefits I need
Other
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17. Reasons Enrollees Would Remain on MCHA
Primary Reason
(for those who indicated nothing would make them leave)
2% Unaware of other options
4% Other companies will not cover my pre-exiting
5%
6% conditions
31% MCHA is only coverage I can find with Mayo
Other companies will not cover me
14%
MCHA offers benefits other plans do not
21% Satisfied with coverage
16%
Other
Don't know how to change plans
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18. Reasons Enrollees Would Remain on MCHA
• Unaware of other options
• Other companies will not cover my pre-existing
conditions
• This is the only insurance coverage I can find that
includes Mayo
• Other companies will not cover me
• MCHA offers benefits other plans do not
• Satisfied with coverage
• Don't know how to change plans
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19. MCHA Enrollees Potential Eligibility for
New Coverage Options in 2014
• The majority of enrollees will likely get no federal
financial support for their health insurance coverage
Eligibility for Subject to Mandate
Income as % FPG % MCHA Enrollees
Financial Support
Less than 138% FPG 9% Medicaid Yes
Premium and cost-
138-400% FPG 37% sharing subsidies through Yes
the exchange
Above 400% FPG 55% None Yes
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20. Enrollee Familiarity with Health Reform
100% 1% 1% 1%
5%
90% 15%
80% 31%
70% 24%
60% No answer
50% 24% Very familiar
Somewhat familiar
40%
Somewhat unfamiliar
30% 59%
Very unfamiliar
20% 39%
10%
0%
General familiarity with Familiarity with potential
health reform coverage changes
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21. Enrollees Worries About Changes Under
Health Care Reform
Self Report of Worried/Very Worried % Enrollees
Having to pay more for premiums 91%
Having to pay more for deductibles and coinsurance 89%
Not being able to afford the health care services you think you need 85%
Not being able to afford the prescription drugs you need 78%
Having to change doctors 72%
The quality of health care services you receive getting worse 70%
Not being able to get the health care services you need for reasons
70%
other than money
Having to change health plans 66%
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22. Enrollee Deductible Level by Health Reform
Income Categories
Less than 138% Above 400% All Income
138-400% FPG
FPG FPG Levels
Plan Deductible
$500 6% 3% 4% 4%
$1,000 15% 13% 17% 15%
$2,000 31% 33% 30% 31%
$2,700 8% 13% 17% 15%
$5,000 19% 21% 20% 20%
$10,000 20% 17% 12% 14%
Note: deductible is from MCHA administrative data
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23. Willingness to Enroll in a Public Program
If you learned you were eligible for a public program
at no cost, would you enroll?
51% 49% Yes
No
23
24. Possible Outreach Methods
How would you most like to receive information
about coverage changes?
1%
3% 2% 2%
Mail
4%
Website
16% One-on-One meetings
Phone number to call with
questions
Don't want to receive
72%
information
Group meetings
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25. Key Contact
Elizabeth Lukanen
Senior Research Fellow
elukanen@umn.edu
612.626.1537
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