Blewett, Lynn A.
Principal Investigator

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

On Point: Tracking the ACA in Kentucky

SHADAC has been engaged in a project sponsored by Foundation for a Healthy Kentucky to assess the impact of the ACA in Kentucky over time. We are grateful for this opportunity and to be working with the foundation at a time of significant change. 

As part of our project work, we produce quarterly snapshots intended to provide the most up-to-date data available on select health reform topics of interest to the state. In a newly-released snapshot, we focus on data from the first quarter of 2016. Here are a few highlights:

• Remaining Uninsured
  We are still reporting on the significant drop in uninsurance from the access expansion provisions of the ACA. In the current report we also identify some of characteristics of the remaining uninsured: When compared to those with coverage, the uninsured are more likely to be Hispanic/Latino, young adults (age 19-25), have low incomes and less likely to have some college education or a college degree.
   
• Uncompensated Care
  We continue to monitor the significant drop in uncompensated care over time. The most recent data, however, show an uptick in uncompensated care for rural hospitals. This is a trend we will be watching closely.
   
• Child Medicaid/CHIP Participation
  In many of our reports we compare Kentucky to the U.S. and neighboring states. From 2013-2014, Kentucky had the second largest increase in children’s Medicaid/CHIP participation rates compared to neighboring states, with 94 percent Kentucky child participation in 2014.  West Virginia and Arkansas also show high rates of child Medicaid participation (95.9% and 95.8%, respectively).
   
• Medicaid Service Provision  
  Medicaid covered over 6,500 births in Kentucky in the first quarter of 2016 along with thousands of prevention screening services, including: 6,300 for colorectal cancer; more than 5,400 for Hepatitis C; and more than 9,500 for breast cancer.   
   
• Enrollment
  Medicaid covered nearly 611,000 working-age adults  (ages 19-64)in the first quarter of 2016. The Medicaid expansion was particularly important for young adults in the state: over 50% of the expansion population was age 19-25 (23%) or 26-34 (28%).

Evaluation of the Minnesota Accountable Health Model: First Annual Report

The State Innovation Model (SIM) Program is sponsored by the Centers for Medicare and Medicaid Services (CMS) and administered by CMS’s Center for Medicare and Medicaid Innovation (CMMI). SIM provides funding and support to states to transform their public and private health care payment and service delivery systems with the aims of lowering health system costs, maintaining or improving health care quality, and improving population health.

In 2013, Minnesota received a SIM award to implement and test the Minnesota Accountable Health Model. Between October 2013 and December 2016, the Minnesota Department of Human Services (DHS) and the Minnesota Department of Health (MDH) are implementing the Model across the state of Minnesota.

The State Health Access Data Assistance Center (SHADAC) is managing the state-level self-evaluation efforts for the Minnesota Accountable Health Model project during 2015 and 2016 under a contract with DHS and in collaboration with both DHS and MDH.  Five goals have been identified for Minnesota's self-evaluation. These goals include:

1. Document the activities carried out under the Minnesota Accountable Health Model.
2. Document the variation in design, approaches, and innovation in Minnestoa Accountable Health Model activities and programs.
3. Identify opportunities for continuous improvement in Minnesota Accountable Heatlh Model activities and programs.
4. Examine how the Model has contributed to advancing the goals of SIM in Minnesota.
5. Identify lessons learned for sustaining the Minnesota Accountable Health Model beyond Minnesota's SIM grant.

This report describes the activities conducted during, and the results from, the first year of this two-year evaluation.

• View the full report.
• View the Executive Summary.

Learn more about SHADAC's evaluation of SIM in Minnesota.

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

SHARE Research at ASHEcon 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 12^th 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.

Television Advertising, News and the Uninsured: Market Level Evidence from the First Open Enrollment Period of Health Insurance Marketplaces

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.

The Effects of Early Medicaid Expansion in California on Inpatient Utilization of Safety Net Hospitals

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.

The Impact of the Affordable Care Act Medicaid Expansion on Insurance Status and Type of Coverage for Non-Disabled Childless Adults in Poverty

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.

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

Infographic: Urban Institute Report on Medicaid/CHIP Participation Among Kids in 2013-2014

The infographic below features high-level findings of Medicaid/CHIP participation among kids in 2013 and 2014. These findings were taken from the Urban Institute report, "Children's Coverage Climb Continues: Uninsurance and Medicaid/ CHIP Eligibility and Participation Under the ACA" that was released on May 10, 2016. 

This report looks at how uninsurance changed between the first year of implementation of the Affordable Care Act (ACA)’s major coverage provisions. Larger gains overall were seen in states that expanded Medicaid under the ACA. 

Download a PDF of the infographic.