SHADAC Staff

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e shadac@umn.edu

SHARE Grant Findings: More Insurance-Related Google Searches Occurred in Areas of High Uninsurance

Dr. Sarah Gollust of the University of Minnesota led a SHARE-funded analysis published online last month in Medical Care Research and Review (early view). The article is titled, “Search and You Shall Find: Geographic Characteristics Associated With Google Searches During the Affordable Care Act’s First Enrollment Period.”

Policy-Relevant Analysis: Insurance Is Local

In the article, Gollust and her co-authors examine whether geographic regions with higher rates of uninsurance spent more time researching ACA market plans and health insurance coverage generally. Gollust’s research offers a unique perspective on insurance-related information seeking patterns because it looks at local-level variation in ACA-related search patterns. This perspective is particularly informative because information about insurance enrollment in private, Medicaid, and marketplace plans is by its nature local, given the primary role of the state in decision-making about Medicaid and insurance market regulation.

A Unique Data Source: Google Trends

The authors merged data from Google Trends with metro-area-level and state-level characteristics to examine factors associated with health insurance-related Google searches in the most populous U.S. metro areas during the first open enrollment period under the Affordable Care Act, or ACA (October 2013 through March 2014). Google Trends is a publically available internet search tool that captures temporal and geographic variation in Google searches (which account for more than 80% of all internet searches) for various search terms.

Each metro area was matched with is corresponding designated market area (DMA). Metro-area-level and state-level characteristics came from a variety of other data sources, including the Census Bureau’s Small Area Health Insurance Estimates, the American Community Survey, the Bureau of Labor Statistics, county-level vote data, Kaiser Family Foundation Data, and data from the Robert Wood Johnson Foundation.

Key Finding: Areas with High Uninsurance Are More Likely to Search Online for Coverage Information

Dr. Gollust and her team found that internet searches for health insurance terms vary greatly across the country, with areas of high pre-ACA rates of uninsurance more likely to search in higher volumes for the key terms “Obamacare” and “health insurance.” This finding is adjusted for sociodemographic, political, and insurance market characteristics.

Why These Findings Matter

Gollust’s results indicate that Google searches are an important way in which people gain information about health insurance coverage, especially in areas with greater need for coverage. Understanding how the uninsured are likely to research coverage options under the ACA can guide future outreach efforts by health advocates and policymakers, particularly as they move beyond initial broad outreach strategies to more targeted approaches tailored to specific audiences, including audiences that are more precisely geographically defined than in the past. The next step in research, writes Gollust and her team, is to examine whether and how internet searching relates to actual insurance enrollment.

Blewett, Lynn A.
Principal Investigator

p 612-624-4802
e blewe001@umn.edu

More Employees Chose High-Deductible Plans in 2014

This analysis used data from the Insurance Component of the 2010 to 2014 Medical Expenditure Panel Survey (MEPS), sponsored by the federal Agency for Healthcare Research and Quality (AHRQ).

Read the full report, which includes 50-state tables and individual state profiles, here.

Stay tuned for further state-level analysis of premiums and costs related to employer-sponsored insurance, coming soon.

What  is a high deductible health plan (HDHP)? 

A plan with a deductible requires an upfront payment  for medical services before insurance coverage kicks in. For example, if the deductible is set at $500, the individual will have to pay all of the expenses of any covered medical treatment up to $500.  After the deductible has “been met” (i.e., the individual has paid for $500 worth of medical bills). All medical bills greater than the $500 deductible are covered by the health plan. [1]

For the purposes of our analysis, we define a high deductible health plan as one that meets the IRS-defined minimum plan deductible amount required for Health Savings Account (HSA) eligibility – i.e., $1,250 for an individual and $2,500 for a family in 2013 and 2014. 

Why are more people enrolling in HDHPs? 

HDHPs have become increasingly popular over recent years because they help to keep premiums affordable, thereby helping get more people covered, and are meant to provide an incentive for people to (a) use medical care only when they need it and (b) shop around for the care they do use.

What's the relationship between HDHPs and Health Savings Accounts?

HDHPs can be coupled with Health Savings Accounts (HSAs), which are accounts set up by individuals or employers where individuals can use pre-tax money to pay for incurred medical expenses. To be eligible for an HSA in 2016, the IRS set minimum deductible levels  at $1,300 for individual or self-only coverage and $2,600 for family coverage.  Many of the lowest price premiums for coverage sold on the Health Insurance Marketplace (i.e., the bronze plans) will have deductibles that make them HSA-eligible. 

The advantage of HDHPs is that they are associated with lower premiums – making health insurance more affordable and accessible.  Additionally, deductibles do not apply to preventive services – including screening, immunizations and an annual physical – which must be provided with no out-of-pocket (OOP) payment under the ACA.

And what's the downside of HDHPs?

The main disadvantage of HDHPs is that the higher deductibles (which in 2016 can reach up to $6,550 for an individual and $13,100 for a family in 2016) may act as a significant barrier to getting needed care. This can be especially problematic for people with chronic conditions or those facing a medical emergency. Additionally, while deductibles do not apply to preventive services, there may be confusion about this among HDHP enrollees, who may unnecessarily forgo preventive care due to cost concerns.

Another disadvantage of HDHPs is that it can be difficult to understand what payments are eligible to contribute toward one's deductible. In most cases, payments for services provided by out-of-network providers or for non-covered benefits (e.g., vision, dental, over-the-counter medicines, brand name prescriptions, etc.) do not count toward the deductible.

Finally, hospitals and other providers have raised concerns about the difficulty of collecting the required out-of-pocket payments at the point of service, a challenge that can contribute to bad medical debt.

[1] Individuals may still be required to pay a portion of medical expenses after this point if their plan involves co-insurance – for example, many plans will pay 80% of the billed amount with the patient covering the remaining 20%. Additionally, any co-pays would still apply.   

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.

Download the report.

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 full report.

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.

 

Hartman, Lacey
Senior Research Fellow

p 612-625-0410
e hartm042@umn.edu

California Employers Continue to Offer Insurance, but Fewer Workers Enroll (Cross-Post)

This blog was originally published on August 2, 2016, on the California Health Care Foundation's ACA 411 Insights Blog.

Most Californians under age 65 with health insurance receive it through an employer, but since 2009 the availability of employer-sponsored insurance (ESI) in the state has been on the decline. A key question around the Affordable Care Act (ACA) was whether the reforms would further erode ESI coverage.

Recent results from the 2015 California Employer Health Benefits Survey, now available on ACA 411, show that the availability of ESI remained stable in the state following implementation of the law. There was no significant change in the share of firms that offered coverage between 2013 and 2015, and the share of employees who work at firms that offer coverage also remained stable. (The declines in both measures between 2013 and 2015 in the graphs below are not statistically significant.)

Worker Eligibility for ESI Remained Stable Overall, Increased Among Some Groups

Another issue of potential concern with ACA was whether firms would reduce employees' eligibility for ESI by taking such steps as shifting full-time workers to part-time. This does not appear to be the case in California, where the share of eligible workers at firms that offer coverage remained stable at about 79% between 2013 and 2015. At firms with a larger share of low-wage employees (more than 35% of workers earning less than $23,000 per year), the proportion of workers who were eligible for coverage actually increased significantly from 62.3% to 76.7% between 2013 and 2015.

Fewer Eligible Workers Enroll in ESI

Many individuals obtain ESI as a spouse or dependent of another worker, so it is helpful to track trends in the availability and take-up of ESI at the family level. 

Between 2013 and 2014 (the latest year for which data are available) the share of families in California with any offer of ESI was statistically unchanged, as was the share of families with any ESI offer who enrolled all eligible family members. However, there was a significant decline in enrollment in ESI among low-income families. The share of families with incomes below 138% of the federal poverty level who were offered ESI and enrolled all eligible family members declined by nearly 13 percentage points from 49.4% to 36.7%.