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.
Publication
State-Level Trends in Employer-Sponsored Health Insurance: 2016 Report
This annual SHADAC report examines state-level trends in employer-sponsored insurance (ESI) and the factors that influence ESI.
State-Level Summary Tables
SHADAC's 2016 report on employer-sponsored insurance is accompanied by state-level summary tables of key ESI characteristics. These can be downloaded as one file for all 50 states and the District of Columbia or chosen individually by clicking on the map below.
Download the United States fact sheet.
Download the 50-state fact sheet file.
About the Data
This report uses data from the Current Population Survey and the Medical Expenditure Panel Survey, Insurance Component. Visit the SHADAC Data Center to generate and download additional estimates using these data sources.
Publication
Evaluation of the Minnesota Accountable Health Model: First Annual Report
The State Innovation Model (SIM) Program is sponsored by the Centers for Medicare and Medicaid Services (CMS) and administered by CMS’s Center for Medicare and Medicaid Innovation (CMMI). SIM provides funding and support to states to transform their public and private health care payment and service delivery systems with the aims of lowering health system costs, maintaining or improving health care quality, and improving population health.
In 2013, Minnesota received a SIM award to implement and test the Minnesota Accountable Health Model. Between October 2013 and December 2016, the Minnesota Department of Human Services (DHS) and the Minnesota Department of Health (MDH) are implementing the Model across the state of Minnesota.
The State Health Access Data Assistance Center (SHADAC) is managing the state-level self-evaluation efforts for the Minnesota Accountable Health Model project during 2015 and 2016 under a contract with DHS and in collaboration with both DHS and MDH. Five goals have been identified for Minnesota's self-evaluation. These goals include:
- Document the activities carried out under the Minnesota Accountable Health Model.
- Document the variation in design, approaches, and innovation in Minnestoa Accountable Health Model activities and programs.
- Identify opportunities for continuous improvement in Minnesota Accountable Heatlh Model activities and programs.
- Examine how the Model has contributed to advancing the goals of SIM in Minnesota.
- Identify lessons learned for sustaining the Minnesota Accountable Health Model beyond Minnesota's SIM grant.
This report describes the activities conducted during, and the results from, the first year of this two-year evaluation.
Blog & News
Californians with Individual Health Insurance Spent Almost $2,500 Less on Care in Year One of Health Reform (Cross-Post)
July 04, 2016:The following content is cross posted from California Healthcare Foundation. It was first published on May 25, 2016.
Authors: Amy Adams, California Healthcare Foundation, and Sam Patnoe, State Health Access Data Assistance Center (SHADAC)
Newly available data on the CHCF's ACA 411 tool show that state residents who bought insurance through the individual market spent significantly less on health care in 2014, year one of the Affordable Care Act (ACA), than they did the year before. The first year that ACA premium tax credits and cost-sharing subsidies were available was 2014.
Median out-of-pocket spending for families with individual coverage dropped from $7,345 in 2013 to $4,893 in 2014 (see green line in first graph below). The percentage of Californians with individual coverage who reported a "high health care cost burden" — health care costs ate up more than 10% of household income — dropped from 42.9% in 2013 to 34.5% in 2014 (see yellow line in second graph).
While these declines in spending among those with individual coverage mirrored national trends in 2014, they were more pronounced in California. In fact, it's likely that the declines in spending for this group in California, the most populous state, helped pull down the national averages.
ACA Largely Credited with Declines in Spending for Those with Individual Coverage
Spending for those with individual coverage was likely driven down primarily by the premium tax credits and cost-sharing subsidies made available for the first time in 2014 through Covered California, the state's ACA health insurance marketplace. In 2014, 2.2 million Californians had individual health coverage — and 51% of them purchased it through Covered California. Ninety percent of Covered California enrollees were eligible for premium tax credits (valued on average at $436 a month); over half were eligible for additional cost-sharing subsidies (worth on average $100 a month) to defray the cost of deductibles and copays.
Looking across all coverage types (including Medi-Cal, Medicare, employer/military, and uninsured), changes in spending varied in 2014 — and were far less dramatic. Improvements were also seen for those on Medicare: the percentage of beneficiaries reporting a high health care cost burden dropped from 28.4% to 23.9%, and out-of-pocket spending declined by $476. However, out-of-pocket spending increased by approximately $200 for those with employer/military coverage. There were no statistically significant changes in high health care cost burden or in out-of-pocket spending for those on Medi-Cal or the uninsured. It will be important to continue monitoring these data in the coming years.
More Work Needed to Improve Affordability
Data newly available on ACA 411 shows that striking progress was made in the ACA's first year to reduce the burden of health care costs for those with individual coverage. Yet even with the substantial declines in their spending, more than one in three with individual coverage still spent more than 10% of their income on health care. Cost was the top reasonreported by California's uninsured for not obtaining coverage in 2014.
CHCF is studying cost barriers to low-income consumers' ability to purchase, maintain, and use health coverage in order to inform policy solutions. This includes an analysis of how high local cost of living impacts Californians' ability to afford health insurance. The county-by-county analysis, performed by the UC Berkeley Center for Labor Research and Education, will be released in the coming weeks.
Stay tuned for ongoing updates to ACA 411. Share your thoughts on this latest affordability data on social media using #ACA411.
Blog & News
SHARE Research at ASHEcon 2016
June 15, 2016:Seven research teams are presenting their SHARE-funded work at the 2016 American Society of Health Economics Conference (ASHEcon), which takes place this year at the Leonard Davis Institute for Health Economics at the University of Pennsylvania from June 12th through the 15th. We encourage you to check out these presentations if you’re attending the conference.
Podium presentations of SHARE-funded research at ASHEcon 2016 are as follows:
Early Evidence on Employment Responses to the Affordable Care Act
Speaker: Jean Abraham (University of Minnesota)
Discussant: Laura Dague (Texas A&M)
Date/Time: Monday (6/13), 10:55 a.m.
Location: G50 (Huntsman Hall)
As the insurance market changes with the implementation of the ACA, this research examines how the existence of employer-based health insurance coverage impacts employees’ access to such insurance as well as labor market outcomes, such as part-time work. Researchers investigate how labor market outcomes are changing over time as the ACA is implemented.
Speaker: Pinar Karaca-Mandic (University of Minnesota)
Discussant: Anthony LoSasso (University of Illinois at Chicago)
Date/Time: Monday (6/13), 5:25 p.m.
Location: B26 (Stiteler Hall)
This research documents the relationship between television media campaigns and health insurance enrollment, as federal and state governments, as well as nonprofit organizations, spent over $3 billion on media advertising to promote newly available insurance through ACA marketplaces in the first open enrollment period.
Choice Dynamics of “Money Wasting” Plan Choices in ACA State Marketplaces
Speaker: Anna Sinaiko (Harvard University)
Discussant: Chapin White (RAND)
Date/Time: Wednesday (6/15), 8:50 a.m.
Location: G60 (Huntsman Hall)
This research examines the decisions made by people, particularly members of vulnerable populations, in choosing health insurance plans that potentially result in wasted money. The researchers surveyed enrollees in the ACA marketplace in 2015 to determine whether enrollees were enrolled in the most cost effective plan.
Speaker: Lindsay M. Sabik (Virginia Commonwealth University)
Discussant: Ari B. Friedman (University of Pennsylvania)
Date/Time: Wednesday (6/15), 9:10 a.m.
Location: G50 (Huntsman Hall)
This study examines the impact of early Medicaid expansion in California on admissions of patients at safety net hospitals, defined as hospitals that serve a disproportionately high number of uninsured and Medicaid patients. By comparing California hospital admissions from 2010-2013 to other states that did not experience significant changes to their Medicaid coverage during this time period, the researchers find that both safety net and non-safety net hospitals in California experienced an increase in Medicaid patient admissions and decreases in uninsured admissions.
Pent-up Health Care Demand Among New Medicaid Enrollees after the Affordable Care Act
Speaker: Angela Fertig (Medica Research Institute)
Discussant: James Marton (Georgia State University)
Date/Time: Wednesday (6/15), 12:40 p.m.
Location: F55 (Huntsman Hall)
This study examines claims data for evidence of pent-up demand for health care, meaning that newly insured individuals access care at higher rates due to delaying or foregoing care while uninsured or underinsured, for new Medicaid enrollees in Minnesota.
Poster presentations of SHARE-funded research at ASHEcon 2016 are as follows:
Specialty Drug Benefit Design and Patient Out-of-Pocket Costs in the ACA Health Insurance Exchanges
Speaker: Erin A.Taylor (RAND)
Date/Time: Tuesday (6/14), 12:00 p.m.
Location: Annenberg Center, Lobby
Insurers often require more cost sharing from patients for high-cost specialty drugs, meaning that patients end up paying more money out-of-pocket for these drugs than they would for other drugs. This research simulates potential out-of-pocket costs in health exchange plans for patients taking three specialty drugs.
Speaker: Michael Dworsky
Date/Time: Tuesday (6/14), 12:00 p.m.
Location: Annenberg Center, Lobby
Overview: This research examines the impact of the ACA’s Medicaid expansion on insurance status and type of coverage for adults who became newly eligible for Medicaid in 2014. The researchers use 2009 – 2014 data from the National Health Interview Survey to estimate the effect of Medicaid expansion on insurance status, and compare states that chose to expand Medicaid coverage to states that chose not to do so. They find that expanding Medicaid to non-disabled childless adults in poverty reduced uninsurance rates without impacting the number of enrollees on private market plans.
