Infographic: First Look at 2015 State Level Uninsurance Rates
The infographic below illustrates the change in point-in-time uninsurance from January through June 2014 to January through June 2015 at the national level and for selected states using early release estimates from the National Health Interview Survey (NHIS).
News from the SHARE grant program and our grantees.
Announcements
SHARE Panel at APPAM Will Consider Early Post-Expansion Utilization Data
Four researchers will present findings from their SHARE-funded studies on a panel at the 2015 Fall Research Conference hosted by the Association for Public Policy Analysis and Management (APPAM) in Miami, Florida. The panel, titled “Early Data on Health Care Utilization after Coverage Expansion,” will take place on Thursday, November 12th, and will feature presentations from Peter Cunningham (Virginia Commonwealth University), Marguerite Burns (University of Wisconsin – Madison), Angela Fertig (Medica Research Institute), and Michael Dworsky (RAND Corporation). Kathy Hempstead, Coverage Team Director at the Robert Wood Johnson Foundation, and Brett Fried, SHADAC Senior Research Fellow, will act as discussants. Learn more.
December 8th Webinar: Analysis of Provider Network Monitoring Practices
Karen Brodsky and Barbara Markham Smith of Health Management Associates (HMA), will discuss their SHARE-funded analysis of trends in provider network monitoring practices by states and health plans during a December 8th webinar hosted by HMA. They will highlight key findings from a survey of health plans and state regulators concerning provider network adequacy compliance and monitoring standards (detailed in an in-depth report here). Based on these findings, they will provide recommendations for states and health plans seeking more effective and efficient ways of ensuring adequate provider access for members. Register for the webinar.
Sarah Gollust Discusses Geographic Variations in Media Messages about Reform
Dr. Sarah Gollust of the University of Minnesota discussed her SHARE-funded research in a presentation titled, “Media and the Politics of Implementation: Geographic Variation in ACA Coverage,”at the 2015 Annual Meeting of the American Political Science Association (APSA) on September 6th in San Francisco. The presentation focused on an analysis of the geographic variation in the volume and content of televised messages about the ACA from October 2013 through March 2014. The next stage of the project will link patterns of media messaging at the market level to individuals’ attitudes and behavior using national survey data (Kaiser Health Tracking Poll and the National Health Interview Survey).
Angie Fertig Finds Evidence Consistent with Pent-Up Demand among New ACA Enrollees
A new brief from Dr. Angie Fertig at Medica Research Institute highlights initial findings from a SHARE-funded study examining pent-up demand after the ACA. In the brief, Dr. Fertig, with co-authors Dr. Caroline Carlin and Dr. Sharon Long, examines administrative and claims data from a Minnesota health insurer to identify early patterns in the first claim for new Medicaid and commercial non-group (including Marketplace) enrollees who signed up for coverage between January and March 2014. The researchers found patterns of utilization that are consistent with pent-up demand among new Medicaid enrollees. However, the evidence of pent-up demand among new enrollees with non-group coverage relative to the comparison group is mixed.
Tal Gross Explains Why Medicaid Expansion Makes Economic Sense
In a recent video from Columbia University’s Mailman School of Public Health, Dr. Tal Gross summarizes the policy implications of his SHARE-funded analysis of the economic impact of state ACA Medicaid expansion decisions. Dr. Gross and his colleagues at Northwest University found that the amount of money that state governments save from not expanding Medicaid is roughly equal to the amount of money that the hospitals in those states have to spend to care for the uninsured (i.e., their uncompensated care costs). These findings are detailed in Dr. Gross’s recent NBER working paper.
V-BID in Connecticut: Early Results Show Beneficial Impact on Utilization
The research team led by Dr. Richard Hirth at the Center for Value-Based Insurance Design (V-BID Center) at the University of Michigan released a brief highlighting initial findings from their SHARE-funded analysis of Connecticut’s Health Enhancement Plan (HEP) for state employees, which reduces cost-sharing for high-value clinical services and targets patient incentives to eliminate barriers to evidence-based care. The authors found significant improvements among HEP enrollees during the first HEP plan year for a variety of standard preventive measures compared to a control group of state employee health plan enrollees in four different states without a comparable intervention. The findings from this brief are highlighted in the podcast of an August 4th webinar that was co-hosted by SHARE and the V-BID Center.
Grantee Spotlight
Sarah Gollust, PhD
Sarah Gollust is the principal investigator on a SHARE-funded project to measure geographic variation in ACA-related media messages and the subsequent relationship of media messages to insurance enrollment from 2013 to 2014. Her broad research interests are in the politics and ethics of health policy, and she is particularly interested in understanding the media’s role in influencing the public’s opinions and perceptions of health policy issues. Learn more.
Who Was Uninsured in 2014? A Sub-State Look (Interactive Map)
November 11, 2015:
SHADAC has created a new interactive map that uses recently-released American Community Survey data to examine the characteristics of the uninsured in 2014 at a sub-state level--i.e., by Census Region, or Public Use Microdata Area (PUMA).
By clicking on a given Census Region on the map, users can access detail on the characteristics of the region's uninsured, including income, educational attainment, race, ethnicity, and nativity status.
Application - Moving Beyond the Low-Hanging Fruit
Health insurance coverage gains related to the Affordable Care Act are well documented. Many have argued, however, that these early gains have been among the "low-hanging fruit" and that those who remain uninsured are the "hard to reach." A recent SHADAC analysis that examined the characteristics of the uninsured in 2013 versus 2014 seems to bear that out: Our analysis shows that compared to the uninsured in 2013, those in 2014 were more concentrated in groups that have consistently been uninsured (e.g. men, Hispanic, non-citizens, those with less education). The tool presented here can be used by folks like enrollment navigators and assisters to target enrollment outreach more precisely to the specific population of remaining uninsured in a given area.
The 2015 Fall Research Conference for the Association for Public Policy Analysis & Management (APPAM) Conference is occurring this week in Miami, FL. The conference’s theme is “The Golden Age of Evidence-Based Policy” to showcase the importance of high quality evaluation practices. We are pleased to highlight apanel on Early Data on Health Care Utilization after Coverage Expansion that features four different SHARE-funded analyses.
The Effect of Early Medicaid Expansion in California on Safety Net Hospital Utilization
Peter Cunningham and Lindsay Sabik utilize the Healthcare Cost and Utilization Project (HCUP), the American Hospital Association annual survey, and the Area Health Resource File to examine the effects of California’s early ACA coverage expansions on inpatient and emergency department utilization of safety net hospitals.
Pent-up Health Care Demand after the Affordable Care Act (ACA)
Angie Fertig, Caroline Carlin, and Sharon Long use private claims data to examine whether there is evidence of pent-up demand for health care among newly-insured adults in individual and family health insurance plans and Medicaid under the ACA in Minnesota.
Early Effects of the 2014 Medicaid Expansion on Coverage and Access to Care
Michael Dworsky and Christine Eibner present a pre-post analysis using the 2014 National Health Interview Survey (NHIS) to examine the short-run effects of the ACA Medicaid expansion on insurance coverage, access to care, and health status among the expansion population, comparing outcomes for expansion and non-expansion states.
The panel chair is Katherine Hempstead, Director and Senior Program Officer for SHARE at the Robert Wood Johnson Foundation, and the discussant is SHADAC Senior Research Fellow, Brett Fried. The panel takes place on Thursday, November 12, from 3:30pm-5:00pm.
Publication
MEPS-IC Tables: Employer Coverage Estimates by Firm Size
The Medical Expenditure Panel Survey – Insurance Component (MEPS-IC), sponsored by the federal Agency for Healthcare Research and Quality (AHRQ) is a survey of private and public sector employers that focuses on employer-sponsored insurance.
In order to support state policy analysis related to health reform, SHADAC annually requests special firm-size tabulations of the estimates (e.g. estimates for firms with 0-50 and 50-99 employees). These tabulations provide estimates of employer offer and take-up, premiums, and cost-sharing (i.e., deductibles) for:
All firms together.
Firms with fewer than 50 employees,
Firms with 50 to 99 employees,
Firms with 100 to 249 employees (beginning in 2013)*
Firms with 250 or more employees (beginning in 2013)*
To help make this information easily accessible for states, SHADAC has created three sets of tables (separate tables by firm size for each state). These include:
* For years before 2013, the largest firm size category provided is firms with 100 or more employees.
** The enrollee cost sharing tables for 2006, 2008, and 2009 have been revised slightly. For each year, the last estimate in these tables (% of private sector employees enrolled in a health insurance plan that had an individual deductible of $x,xxx or more and a family deductible of $x,xxx or more) is based on the minimum plan deductible criteria set by the IRS for that year for HSA-qualified plans (previously, the tables for all years used the 2009 criteria). Additionally, the denominator used in calculating the last estimate in these tables has been corrected to include all plans (including those without a deductible).
These are unpublished estimates from the 2006, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 MEPS-IC surveys. Some have large standard errors, and users should be careful to use the estimates appropriately. Any estimate with a relative standard error greater than or equal to 30% does not meet the MEPS-IC standard for publication. In SHADAC’s summary tables, estimates with a relative standard error greater than or equal to 30% are marked with an asterisk.