SHADAC Staff

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NHIS: Coverage Changes Occurred among Key ACA Subgroups from First Three Quarters of 2016 to First Three Quarters of 2017

New coverage estimates from the National Health Interview Survey for the first three quarters of 2017 were published today and indicate few significant changes in health insurance coverage rates when compared with the first three quarters of 2016. At 12.7%, the uninsurance rate for nonelderly adults (ages 18 to 64) at the time of interview was stable, as were the rates of public coverage (19.5%) and private coverage (69.3%) for this group.

This stability in NHIS estimates of uninsurance from 2016 to 2017 mirrors the stability seen from 2015 to 2016, which was preceded by historic declines from 2013 to 2014 and from 2014 to 2015.

Few Significant Changes in Coverage, Except by Income

The new NHIS estimates show that uninsurance rates were stable across age and race/ethnicity when comparing the first three quarters of 2016 to the first three quarters of 2017. The few significant changes that did occur between January-September 2016 and January-September 2017 were seen in coverage by income group. An analysis of non-elderly adults (ages 18-64) by ACA-relevant income breakdowns shows that:

• Among those below 100% FPL, public coverage decreased from 55.0% to 51.3%, and private coverage increased from 20.6% to 25.6%.
• Among those between 138% and 250% FPL, the uninsured rate increased from 19.6% to 21.5%, and private coverage decreased from 54.5% to 52.2%.
• Among those with incomes between 250% and 400% FPL, the uninsured rate increased from 9.9% to 12.1%, and private coverage decreased from 78.3% to 76.1%.

These changes are important to note from a policy perspective because the income groups are among the population (below 400% FPL) specifically targeted by the ACA’s coverage provisions: The ACA’s Medicaid expansion provision aims to increase public coverage among nonelderly adults below 138% FPL, and the ACA’s individual market provisions specifically aim to expand private coverage among nonelderly adults between 138% and 400% FPL.

Increased Enrollment in High-Deductible Health Plans

The percentage of nonelderly Americans enrolled in high-deductible health plans (HDHPs) was one of the few broad points of change in the NHIS estimates, increasing significantly between the first three quarters of of 2016 and the first three quarters of 2017, from 39.1% to 43.2% (4.1pp). This increase was even more pronounced among individuals with employer-sponsored insurance, among whom the percentage enrolled in HDHPs jumped from 39.1% in the first three quarters of 2016 to 43.7% in the first half of 2017 (4.6pp). 

A Note about the Numbers

The above estimates provide a point-in-time measure of uninsurance, indicating the percent of persons without coverage at the time of the interview. First three quarters of the year refers to January through September.

For more information about the early 2017 NHIS health insurance coverage estimates, read the National Center for Health Statistics brief. Estimates for the first three quarters of 2016 are available here.

Citation

Martinez, M.E., Zammitti, E.P., & Cohen, R.A. February 22, 2018. “Health Insurance Coverage: Early Release Estimates from the National Health Interview Survey, January-September 2017.” National Center for Health Statistics: National Health Interview Survey Early Release Program. Available at https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201802.pdf

Minnesota's Uninsured in 2017: Rates and Characteristics

This issue brief uses data from the 2017 Minnesota Health Access Survey (MNHA) to provide additional context on uninsurance in Minnesota by (1) illustrating the persistent disparities in the rates of uninsurance across population groups; and (2) describing Minnesota's uninsured population along key demographic characteristics, including their connection to the labor market.

The MNHA is a biennial telephone survey of the Minnesota population that is conducted in partnership betweeen the Minnesota Department of Health's Health Economics Program and SHADAC.

Download a PDF of the brief.

Download the 2017 Health Insurance Coverage Appendix Tables.

Minnesota's Changing Health Insurance Landscape: Results from the 2017 Minnesota Health Access Survey

This brief summarizes findings from the 2017 Minnesota Health Access Survey, focusing on trends in how Minnesotans obtained health insurance coverage and providing an understanding of how the 2017 climate may have contributed to a contraction of coverage.

The Minnesota Health Access Survey is a biannual telephone survey of the Minnesota population conducted as a partnership between the Minnesota Department of Health's Health Economics Program and SHADAC.

Download a PDF of the brief.

Accompanying the brief is a technical report, providing context via a survey overview; sampling methodology discussion; content additions, revisions, and omissions; and concluding with a survey administration walkthrough.

 

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

Minnesota's Uninsured Rate Climbed to 6.3 Percent in 2017

Minnesota saw a significant jump in its 2017 uninsured rate, which climbed to 6.3 percent from 4.3 percent in 2015. In all, about 349,000 Minnesota residents lacked coverage in 2017, which is about 116,000 more than in 2015. These new estimates come from the biannual Minnesota Health Access Survey (MNHA), which is administered by the Health Economics Program at the Minnesota Department of Health in conjunction with researchers from SHADAC. 

The Big Picture

Researchers point out that although uninsurance increased significantly in 2017, Minnesota’s 2017 uninsured rate is still below uninsurance levels seen in most years predating the ACA, when uninsurance in the state peaked at 9.1% (in 2011).

Declines in Employer-Sponsored and Individual Coverage Drove the Increase in Uninsurance

Minnesota’s overall coverage decrease in 2017 was driven by declines in the share of Minnesotans covered by employer-sponsored insurance, which fell from 55.9% in 2015 to 52.9% in 2017, and by declines in individual market coverage, which fell from 6.2% in 2015 to 4.4% in 2017.

The decline in employer-sponsored insurance from 2015 to 2017 was due to a drop in the share of Minnesotans who are connected to employer coverage through their own or a spouse’s job. This share fell from 77.1% in 2015 to 74.2% in 2017.

The marketplace for individually-purchased health insurance in Minnesota was subject to a great deal of volatility in 2016 and 2017, with two health plans significantly limiting their offerings; premiums increasing an average of 50 to 60 percent; and enrollment capacity limits being put into place. The report’s authors speculate that these factors contributed to enrollment declines.

In contrast to employer and individual coverage, public coverage expanded in Minnesota in 2017, growing from 33.6% in 2015 to 36.5% in 2017. This gain was not, however, enough to compensate for reductions in employer and individual coverage.

Why Did the People Lose Coverage in 2017?

The MNHA asked previously insured respondents about their reasons for losing coverage. About 32.5% of respondents reported that they lost their job that had offered coverage or their job no longer provided insurance coverage; another 18.3% reported that they were no longer eligible for their insurance but didn’t state why; and 17.5% cited cost barriers. Other reasons that accounted for a smaller share of responses included complexities involving paperwork and the perceived value of the benefit.

Conclusions

The report authors express concern about an increase in the state’s uninsured rate during a time of high employment and economic growth. This unprecedented trend raises questions about the stability of the state’s employer-sponsored insurance market, which currently covers just over half of all Minnesotans, down from nearly 70 percent in 2001. The authors also indicate concern about the state’s individual market, which is the primary option for individual coverage in the face of employer coverage declines. Enrollment in the individual market is down, and any policy changes that leave even fewer people in the market will make individual coverage even less affordable, and therefore less attractive, to people who are unable to enroll through an employer. 

View the primary findings report for the 2017 MNHA.

Visit the Minnesota Health Access Survey Interactive Data Tool.

Related Content: Characteristics of the Uninsured in Minnesota

See an accompanying report to learn more about rates of uninsurance among subpopulations of Minnesotans and characteristics of the uninsured in 2017.

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

New SHADAC Brief Explores the Impact of Federal Health Care Reform in Minnesota

A new brief from SHADAC deputy director Elizabeth Lukanen considers Minnesota’s health insurance market before and after passage of the Affordable Care Act (ACA) as well as the outlook for the state’s market given the current policy environment.

Minnesota’s Market before and after the ACA

The brief, “The Impact of Health Care Reform in Minnesota,” explores insurance coverage, public program generosity, insurance market regulations, and care quality and costs in Minnesota. Except in the area of costs, Minnesota had relatively high marks in these areas predating the ACA. Since the ACA went into effect, the state’s uninsured rate has declined further, although the cost of health care and coverage in Minnesota continues to rise, with a substantial number of Minnesotans (an estimated 50,000 to 70,000) foregoing coverage on the individual market between 2016 and 2017 due to costs.

Health Reform Today: Minnesota

The current health reform focus in Minnesota is the state’s individual insurance market, which state lawmakers have been working to stabilize following the exit of several major insurers. Lawmakers passed a premium relief bill in 2017 to assist consumers in the individual market with the cost of coverage. To further reduce premiums, the state established a state-funded reinsurance program that will reimburse insurers for 80% of insurance claims between $50,000 and $250,000.

Health Reform Today: The National Picture

There have been numerous attempts to repeal and replace the ACA since President Trump took office, but none has so far been successful. In the meantime, the Trump administration can significantly reform health care through other legislative vehicles and has taken steps to do so. Most recently, President Trump signed legislation overhauling the nation’s tax code that included a provision repealing the ACA’s individual mandate tax penalty. The impact of this particular change on the health insurance market as a whole—and the individual market in particular—is not yet known, but experts are concerned about the likelihood of healthier individuals choosing to opt-out of purchasing health insurance, leaving the market to support less healthy individuals.

Looking Ahead

Federal direction on health reform remains unclear, and this uncertainty may be taking a toll on coverage gains made under the ACA, with recent Gallup data showing an increase in the national uninsured rate since the end of 2016. In the face of federal uncertainty and the potential for coverage losses, many states, including Minnesota, are likely to continue to move forward with state-specific legislation to stabilize their individual markets and provide coverage for their residents.

Read the full brief.

Related

Learn about states' efforts to stabilize their individual insurance markets through 1332 waiver reinsurance programs.