VISIT STATE HEALTH COMPARE
Publication
SHADAC Newsletter - September 2016
The SHADAC newsletter contains updates on SHADAC activities, news from the states, resource updates, and blog highlights. Subscribe to our newsletter here.
Blog & News
SHADAC Data Summary: Geographic Concentration of the Uninsured in 2013 and 2014 Using SAHIE
June 16, 2016:SHADAC researchers recently created a data summary of the geographic concentration of the uninsured in 2013 and 2014 using the most recent Small Area Health Insurance Estimates (SAHIE). This summary includes tabular information on the 100 counties with the highest estimated numbers of uninsured in 2013 and in 2014, and introduces an interactive map that illustrates the changes in uninsured from 2013 to 2014 for all counties.
About the New SAHIE Data
The U.S. Census Bureau released the 2014 Small Area Health Insurance Estimates (SAHIE) on May 12, 2016. The Census Bureau updated the SAHIE models for 2014, incorporating more current Medicaid data sources in order to better capture Medicaid expansion under the Affordable Care Act (ACA). The Census Bureau also re-released 2013 estimates using this updated methodology to facilitate comparisons between 2013 and 2014. For more information on the new SAHIE estimates, visit this SHADAC blog entry.
Data Summary Highlights:
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• The 100 counties with the highest uninsured numbers represent only three percent of all U.S. counties (100 out of 3,141), but they include almost half of the nation's uninsured population (48% in 2013 and 47% in 2014).
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• Although 96 of the top 100 counties in 2013 remained in the top 100 in 2014, each of the top 100 counties saw a decrease in the number of uninsured in 2014, with the top 100 counties dropping from 21.3 million to 17 million from 2013 to 2014. This represents a 20 percent decline, which was larger than the 19 percent decline seen in the U.S.
Interactive Map:
- • The interactive map created by SHADAC's team of analysts provides information on the number of uninsured, the percent of the population that is uninsured, and the change in the uninsured rate from 2013 to 2014 for all counties.
Publication
Geographic Concentration of the Uninsured in 2013 & 2014
This data summary provides results from the 2013 and 2014 Small Area Health Insurance Estimates (SAHIE) program at the U.S. Census Bureau. Taken together, the 2013 and 2014 estimates illustrate the geographic concentration of the uninsured across U.S. counties before and after the full implementation of the Affordable Care Act (ACA).
This document (1) includes tabular information on the 100 counties with the highest estimated numbers of uninsured in 2013 and in 2014, and (2) introduces an interactive map that illustrates the changes in uninsured from 2013 to 2014 for all counties.
The information provided in this data summary can inform efforts to design targeted outreach and enrollment initiatives aimed at the remaining uninsured.
Publication
Webinar Podcast: Overview of the 2014 SAHIE Estimates with Census Experts
This webinar (recorded June 9, 2016) provides an overview of the recently released 2014 Small Area Health Insurance Estimates (SAHIE) from the U.S. Census Bureau .
David Powers and Lauren Bowers of the U.S. Census Bureau presented highlights from the recent SAHIE data release, provided guidance on how researchers can access the estimates, and discussed the updated Medicaid figures to generate new SAHIE data.
SHADAC researcher Brett Fried introduced the forthcoming SHADAC analyses that use SAHIE data to characterize the geographic concentration of the uninsured across the United States.
Presentation Materials
Click here to access the webinar slides.
Click here to access the webinar transcript.
Additional recording formats: Video for iPod, MP3 128 kbps, MP3 64 kbps
About the SAHIE
The SAHIE program uses statistical modeling of survey and administrative data to create estimates of health insurance coverage for counties and states by detailed demographic and income groups. SAHIE data can be used to analyze geographic variation in health insurance coverage as well as coverage differences by age, sex, race, and income.
Why Are the SAHIE Important?
The SAHIE are the only source of single-year health insurance coverage estimates for all U.S. counties. They are an enhanced version of the American Community Survey (ACS) health insurance coverage estimates.
What's New with this Release?
The 2014 SAHIE incorporate more current Medicaid data, helping to capture Medicaid expansion under the Affordable Care Act (ACA). The Census Bureau also re-released the 2013 SAHIE, likewise using more current Medicaid data, in order to facilitate comparisons between the 2013 and 2014 data.
The latest SAHIE release provides researchers and policy analysts with the first opportunity to compare uninsured rates for all U.S. counties during the implementation of the coverage provisions of the ACA.
Additional SAHIE Resources
From SHADAC:
Data Summary: Geographic Concentration of the Uninsured in 2013 & 2014: Provides results from the 2013 and 2014 Small Area Health Insurance Estimates (SAHIE) program at the U.S. Census Bureau.
Interactive Map: Provides information on the number of uninsured, the percent of the population that is uninsured, and the change in the uninsured rate from 2013 to 2014 for all counties.
Blog Entry: Discusses the 2014 SAHIE release.
From the U.S. Census Bureau:
Release Highlights of 2014 Estimates
Interactive Data Visualization and Mapping Tool
Blog & News
New Brief: Using HCUP Data for State Health Policy Analysis
May 12, 2017:
The SHARE grant program has released a new brief examining the use of administrative data for the purpose of state health policy analysis. In particular, the brief highlights the hospital administrative data available from the Healthcare Cost and Utilization Project (HCUP) and presents a case study of a SHARE-funded project that uses HCUP data to evaluate the impacts of California’s early ACA Medicaid expansion on inpatient hospital utilization.
What is the HCUP?
The HCUP is a collection of six different databases sponsored by the federal Agency for Healthcare Research and Quality (AHRQ) that can be purchased through the HCUP Central Distributor. These databases consist of longitudinal hospital data—with a primary focus on community hospitals--based on de-identified discharge records for individual patients. The six different HCUP databases are:
- • National Inpatient Sample (NIS)
- • Kids’ Inpatient Database (KID)
- • Nationwide Emergency Department Sample (NEDS)
- • Nationwide Readmissions Database (NRD)
- • State Inpatient Databases (SID)
- • State Emergency Department Databases (SEDD)
Using HCUP Data to Examine State-Level Utilization
For state-focused health policy research, the State Inpatient Databases (SID), which consist of hospital inpatient discharge data on approximately 90 percent of all U.S. hospital discharges, are especially useful for understanding patient utilization. The SID not only allow researchers to examine hospital-level differences within states but also foster multi-state comparisons and analyses because of their uniformity.
Case Study: Early Medicaid Expansion in California
Researchers at Virginia Commonwealth University (VCU), led by Dr. Peter Cunningham, used the SID to examine the utilization impact of California’s early Medicaid expansion. Specifically, the research team compared
- Utilization at hospitals in California from 2010 to 2013 with utilization at hospitals in neighboring states without an early Medicaid expansion, and
- Utilization over the same time period at safety net and non-safety net hospitals within California.
Preliminary Findings: Highlights
Preliminary findings from the VCU study include (among others):
- • Inpatient volumes increased at California hospitals relative to the comparison states following California’s Medicaid expansion, when controlling for national trends.
- • Medicaid admissions as a percent of total admissions increased after California’s Medicaid expansion, while uninsured admissions declined when compared to non-expansion states (again, controlling for national trends).
- • Overall inpatient volumes at safety net hospitals within California increased to a greater extent than at the state’s non-safety net hospitals following the early Medicaid expansion.
- • Both safety net and non-safety net hospitals within California observed similar patterns in payer mix after the Medicaid expansion, with an increase in Medicaid admissions as a percent of total admissions and a decrease in uninsured admissions as a percent of total admissions.
Further Details
For more information on the HCUP, the SID, and preliminary findings from the VCU study, view the full issue brief: “Using HCUP Data for State Health Policy Analysis: A Case Study Examining the Impacts of an Early Medicaid Expansion.”
