Hest, Robert
Senior Research Fellow

p 612-624-5507
e hestx005@umn.edu

Community and Uninsured Profile in Action: Local Case Studies

With the end of the public health emergency in 2023 and the subsequent “unwinding” of the Medicaid continuous coverage requirement, many Americans have had to navigate changes in health insurance coverage. And while coverage transitions aren’t necessarily unique, the post-pandemic world is; lasting effects of the pandemic combined with the unwinding has spurred many states to think critically about how to mitigate the impacts of this event on potentially vulnerable populations.

Existing data on local communities is invaluable for states and community organizations considering their approach for helping their residents secure coverage both now and beyond this historic moment. The Minnesota Community and Uninsured Profile is one example of the type of data that can make a meaningful difference in efforts to reach and cover communities. 

The Minnesota Community and Uninsured Profile features population details and characteristics that can be applied for a variety of different purposes, including strategic planning, equity work, outreach efforts, and public health case studies. In this post, we will present an example case study that shows how the profile can be used to support community-level enrollment efforts. 

Community and Uninsured Profile in Action: Duluth Case Study

Navigator and assister organizations typically have limited staffing and resources to serve their communities, and, given that, their teams have to be strategic in how they do community outreach and enrollment. Several of these types of organizations serve Duluth, such as Accend Services, Community Action Duluth, and Lake Superior Community Health Center, among others.

The Profile can be a useful tool for these and other organizations to work efficiently – it allows them to focus and tailor outreach & enrollment activities, communications, and outreach strategies to specific communities that are more likely to be uninsured or who need help connecting to health care resources. Their navigators can then conduct enrollment and educational events within those areas, equipped with the important context on the local population found in the profile.

Using the Profile: ZIP Code Uninsured Rates

Staff at these organizations could use the profile tab “ZIP Code Uninsured Rates” to hone in on the ZIP Codes in Duluth with available data – doing so shows 8 community ZIP codes. Among those communities, ZIP code 55811 has the largest number of uninsured at 924 people, and 55806 has the highest rate of uninsured (7.8%) and second-largest number of uninsured at 720 people.

Figure 1. ZIP Codes in Duluth with Available Data on Minnesota Community and Uninsured Profile

Additionally, the profile shows that both of these communities are uninsurance hotspots in the Arrowhead Region (defined as being in the top three ZIP Codes in the region by uninsurance rate or number of uninsured), with 55811 being a hotspot by count and 55806 being a hotspot by rate. 

With that information and context, both of these communities (ZIP codes 55811 and 55806) would be logical sites for targeted enrollment and outreach efforts by community navigators and their organizations.

Using the Profile: Uninsured Profile Tab

Now that navigators have identified two communities for targeted outreach efforts using information from the ZIP code uninsured rates tab, they can get even more details on those communities in the ‘Uninsured Profile’ tab. 

By entering “55811” and then “55806”, community organization staff could get more pertinent information about these communities to help effectively target outreach in each. Not only will they get more detailed information on these communities by various breakdowns, they will also be able to understand any important differences between these communities that could change how they approach outreach and enrollment efforts. 

And, indeed, differences between these two communities in Duluth are evident when looking in the Uninsured Profile tab. 

Take income-eligibility for Medical Assistance or subsidized coverage through MNsure, for example. In ZIP code 55806, 35.1% of the uninsured are likely income-eligible for Medical Assistance (<138% Federal Poverty Level [FPL]); in 55811, though, a lower share of the uninsured are likely income-eligible for Medical Assistance at 27.9%. However, 55811 has a larger share of the uninsured likely income-ineligible for subsidized coverage through MNsure (>400% FPL) at 12.3% compared to 55806’s 2.2%.

Figure 2. Uninsured Population in ZIP Code 55806 by Ratio of Income to Poverty Level

Figure 3. Uninsured Population in ZIP Code 55811 by Ratio of Income to Poverty Level

There are also important differences by race and ethnicity of the uninsured populations in these communities. Though both communities’ uninsured populations are predominantly White, a substantial percentage of the uninsured population in 55806 identify as American Indian / Alaska Native alone (17.6%), Some Other Race alone (9.7%), or Hispanic or Latino of any race (12.6%). 

In 55811, on the other hand, uninsured people are relatively more likely to identify as White alone (87.3% versus 72.6% in 55806), Black or African American alone (1.1% versus 0.0%), Asian alone (4.2% versus 0.0%), or as two or more races (7.4% versus 0.0%), and are less likely to identify as Hispanic or Latino of any race (0.8% versus 12.6%).

Assister organizations could use this information to tailor outreach and enrollment efforts and materials to be more culturally relevant to the different uninsured populations in each community.

Figure 4. Uninsured Population in ZIP Code 55806 by Race and Ethnicity

Figure 5. Uninsured Population in ZIP Code 55811 by Race and Ethnicity

Further, there are also differences in these two communities' uninsured populations by both sex and disability status. Though a majority of uninsured populations in both communities are male, 70.3% of the uninsured in 55811 are male versus 58.1% in 55806. A larger share of the uninsured in 55811 have a disability (27.7%) compared with those in 55806 (14.0%). 

These differences could have implications for targeting enrollment efforts in spaces disproportionately frequented by men or partnering with organizations serving individuals with disabilities.

Figure 6. Uninsured Population in ZIP Code 55806 by Sex and Disability Status

Figure 7. Uninsured Population in ZIP Code 55811 by Sex and Disability Status

In addition, there are important differences by age in the composition of the uninsured populations in these two communities. Critically, 16.9% of the uninsured in 55806 are children (age 0-18) compared to just 1.7% in 55811, which could both inform outreach strategies (such as partnerships with schools) and the types of programs uninsured individuals would be eligible to be enrolled into in these two communities. And beyond that, this information highlights the urgency of connecting these uninsured children in 55806 with insurance and health care at a critical age for development.

Figure 8. Uninsured Population in ZIP Code 55806 by Age

Figure 9. Uninsured Population in ZIP Code 55811 by Age

Diving deeper by age, a large share of the uninsured in both communities are in the young adult category (age 19-25). It is at these ages when individuals are more likely to become disconnected from the care system as they transition out of pediatric care and public coverage programs with child-specific eligibility categories. However, a much larger share of the uninsured in 55811 – nearly half at 46.8% – are in this age group, compared with a smaller but still substantial 22.6% in 55806. 

Looking more broadly at the ‘younger adult’ age category (age 19-34), uninsurance is more concentrated among that population in 55811 with more than 70% of the uninsured in this age group; uninsurance is more evenly distributed across age groups in 55806, with each age group between age 19 and 64 making up between 13% - 23% of the uninsured population. 

The differences in these age distributions could imply that an age-targeted approach would be more effective in 55811, particularly one focused on adults in their late teens to early thirties.

More broadly, the differences between the characteristics of the uninsured in these two communities imply different strategies for outreach and enrollment efforts, such as providing culturally appropriate materials and assistance, selecting different sites or partners for enrollment events, and being prepared to enroll uninsured community-members into different types of health coverage programs.

What Are Your Community and Uninsured Profile Stories?

Are you a part of an organization that uses the Minnesota Community and Uninsured Profile? We would love to hear stories of how you have used the profile in your work. If you have a story to share, please send it to shadac@umn.edu or via our contact us page. 

Want to know more about what the profile has to offer? Learn more about the profile, the accompanying interactive map, and more in our post here.