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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
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.
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.
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
