The document summarizes preliminary findings from a 2012 survey of enrollees in the Minnesota Comprehensive Health Association (MCHA). Key findings include: - Most MCHA enrollees have preexisting conditions and have been enrolled for many years. They rely on MCHA for affordable coverage of their conditions. - Enrollees are worried about changes under health reform, especially paying more for premiums, deductibles, and needed healthcare services. - While over half may not qualify for financial support, outreach is needed to educate enrollees on their options under reform, address cost concerns, and combat negative views of public programs. Mail and one-on-one meetings are preferred

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
– 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
– Peggy Zimmerman-Belbeck , Director of Operations
– Kirby Erickson, Executive Director
• Medica
– Kris Messner, Strategic Account Manager
– Anton Dmytrenko, Strategic Account Executive
• 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
• Implications for Outreach
3

4. Minnesota Comprehensive Health
Association
• Five Eligibility Avenues:
– Loss of group coverage
– Medicare ineligibility
– Health-related rejection
– Presumptive condition(s)
– Health Coverage Tax Credit (HCTC) program
• Among the longest-running and largest state high risk
pools in the country
– Currently, 26,000 enrollees
• Premiums capped at 125% of individual market
• Lifetime maximum benefit of $5,000,000
• Administered by Medica Health Plan
4

5. Individuals with Preexisting Conditions and
Health Reform
• The Affordable Care Act (ACA):
– Prohibits pre-existing condition exclusions
– Introduces premium rate restrictions in individual
and small group markets
– Prohibits lifetime or annual limits
– 100% coverage for preventive care
– Provides new coverage options
• Medicaid (income ≤ 138% FPL)
• Premium and cost sharing subsidies
through the exchange (income 139 to 400% FPL)
5

6. 2012 MCHA ENROLLEE
SURVEY
6

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
• $2 incentive payment with survey mailing
• Oversampling of low-income enrollees (used receipt of
low income subsidy as proxy) and those in rural areas
• Survey response rate was 50.2%
• Weighting adjustments were
conducted
• Income imputed for 6% of cases
8

9. PRELIMINARY RESULTS
9

10. Enrollee General Demographics
• Mean age is 52 years
• Slightly more females than males (53%)
• Almost 60% live in an urban area
• A quarter have less than a high school education
• 70% are employed or self employed
• Majority report incomes above 400% FPG
• 92% of enrollees report at least one chronic
condition, 22% report more than four
• 45% reporting being in very good/excellent
health
10

11. Enrollee Experience with MCHA
• More than two-thirds have been
in MCHA for more than 4 years
• Almost a quarter have been in
MCHA for 10 years or more
• 81% report being somewhat/very
satisfied with their MCHA
insurance coverage
11

12. 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"
12

13. 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
13

14. 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
Satisfied with coverage
16% 21%
Other
Don't know how to change plans
14

15. 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 Financial
Income as % FPG % MCHA Enrollees
Support
Less than or equal to138%
9% Medicaid
FPG
Premium and cost-sharing
139-400% FPG 37% subsidies through the
exchange
Above 400% FPG 55% None
15

16. 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
16

17. 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%
17

18. 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
18

19. 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
19

20. Implications for Outreach
• The “selling” of the new coverage
options needs to start now in a variety
of formats
• Messaging should include:
– No exclusion based on pre-existing
conditions
– First dollar coverage for preventive
services
– No lifetime limits
– Financial support (for those that qualify)
– Information about finding insurance that
covers preferred doctors and Rx
20

21. Implications for Outreach
• Messaging and outreach may need to differ by:
– Rural vs urban
– Eligibility type (Medicaid vs exchange)
• Outreach will need to address expectations about the
cost of new coverage options (very difficult!)
• Messaging needs to combat the negative image of
“public programs”
• Ideally, assistance should be specialized for this
population (e.g. special training for in person assisters)
21

22. Contact Information
Elizabeth Lukanen
Senior Research Fellow
elukanen@umn.edu
612.626.1537
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