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Publication
SHADAC Newsletter, November 2015
The SHADAC newsletter contains updates on SHADAC activities, news from the states, resource updates, and blog highlights.
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Blog & News
Happy National Rural Health Day!
November 19, 2015:The National Organization of State Offices of Rural Health (NOSORH) sets aside the third Thursday of every November – this year, November 19th, 2015 – to celebrate National Rural Health Day. Learn more.
Publication
Infographic: Good News on National Rural Health Day
The National Organization of State Offices of Rural Health (NOSORH) sets aside the third Thursday of every November – this year, November 19th, 2015 – to celebrate National Rural Health Day. Learn more.
Blog & News
Brett Fried: Expanding access to health care coverage critical to reducing a state's uninsurance rate (Cross-Post)
November 19, 2015:The following content is cross-posted from Health Talk, the blog of the University of Minnestoa's Academic Health Center. It was first published November 10, 2015, and posted by Matt DePoint:
Photo: New York Times http://www.nytimes.com/interactive/2015/10/31/upshot/who-still-doesnt-have-health-insurance-obamacare.html?emc=edit_th_20151101&nl=todaysheadlines&nlid=20932956&_r=2
According to a recent New York Times article, the majority of people who remain uninsured after the Affordable Care Act (ACA) was implemented in the United States live in the South and Southwest and they tend to be poor.
But why is this the case?
Health Talk spoke with Brett Fried, a senior research fellow at the State Health Access Data Assistance Center (SHADAC), to learn more about why there are such glaring differences in uninsurance rates across the United States.
Health Talk (HT): There is a distinct difference geographically in the NYT map. Why do you think this is?
Brett Fried (BF): As mentioned in the New York Times article, whether a given state chose to expand Medicaid seems to be the major driver of how many people remain uninsured the state. This association is consistent with recently released data from the National Center for Health Statistics (NCHS): These data show that, compared with non-expansion states, the percentage of uninsured non-elderly adults in Medicaid expansion states was generally lower and declined more dramatically between 2013 and the first quarter of 2015 (with an average drop of 7.8 percentage points in the expansion states and an average drop of 5.9 percentage points in non-expansion states).
HT: What is Minnesota doing well compared to other states?
BF: Minnesota has a long history of reform, including pre-ACA coverage expansions, which contributed to relatively low rates of uninsurance even before federal reform. Minnesota continued this tradition by implementing the early Medicaid expansion option under the ACA in 2010 (along with only six other states and the District of Columbia) and expanding Medicaid fully in 2014. In addition, Minnesota’s state-based marketplace, MNsure, conducted an intensive outreach and enrollment campaign and funded widespread in-person enrollment assistance. The impacts of these efforts can be seen in the New York Times map, which shows Minnesota already low uninsurance rate declining significantly between 2013 and 2014. This is consistent with U.S. Census Bureau data, which show the Minnesota uninsured rate dropped from 8.2 percent in 2013 to 5.9 percent in 2014.
HT: What can those predominantly southern states learn from Minnesota?
BF: The predominant lesson from Minnesota (and other states) is that a commitment to expanding access to coverage—whether through traditional Medicaid, a Medicaid waiver, or other public coverage programs—is critical to significantly reducing a state’s uninsured rate. While Minnesota has historically been a leader in health reform, resulting in consistently low rates of uninsurance, southern states such as Kentucky and Arkansas that expanded Medicaid under the ACA (the first through an expansion of traditional Medicaid and the second through a Medicaid waiver initiative) also saw dramatic reductions in their rates of uninsured. In fact, Census data show that the uninsurance rate dropped from 14.3 percent to 8.5 percent in Kentucky and from 16.0 percent to 11.8 percent in Arkansas between 2013 and 2014.
HT: Can you explain the role Medicaid expansion and politics plays in the uninsured rates?
BF: Data clearly show the Medicaid expansion has been the driver of coverage gains under the ACA. The Centers for Medicaid and Medicare services reports an increase in 13.6 million additional enrollees between October 2013 and August 2015. While Medicaid enrollment growth occurred in all states, it was driven by states that expanded coverage: Among states that expanded coverage, Medicaid grew by 31 percent between a pre-ACA baseline period and August 2015, compared to 10 percent growth among non-expansion states.
Among the 19 states that have not expanded Medicaid, politics seems be driving the debate around whether to expand. The political debate varies in each state, but opponents of expansion commonly cite: opposition to expanding a “broken system,” a belief that Medicaid reduces the incentive for personal responsibility among enrollees, concerns over the impacts of expansion on state budgets, and a belief that expansion would constitute an infringement on “states’ rights”, among others. In order to gain political support, a handful of states have applied for and received a waiver to expand Medicaid in a non-traditional way. Non-traditional approaches have included implementing expansion through a premium assistance program, charging premiums/contributions, eliminating select required benefits and providing incentives for healthy behaviors.
HT: What can be done to encourage more people to become insured?
BF: It has been commonly reported that states have seen enrollment gains among the “low hanging fruit” and that those who remain uninsured are the “hard to reach.” This seems particularly true for states with very low rates of uninsurance, like Minnesota. A recent SHADAC analysis 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). State data can play in important role in targeting outreach to the uninsured, and to that end, SHADAC provides data to states on the characteristics and location of the remaining eligible for Medicaid and the health insurance marketplaces.
Publication
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).
