Infographic: Urban Institute Releases 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. 

Download a PDF of the infographic.

 

 

 

Adding complexity to an already difficult task: Monitoring the impact of the Affordable Care Act (ACA) on the misreporting of Medicaid coverage

View a PDF of the presentation.

Presentation by Brett Fried at the 2016 American Association for Public Opinion Research Conference (AAPOR), May 14, 2016.

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

Small Area Health Insurance Estimates (SAHIE) Allow First Look at Post-ACA Uninsurance Rates in All U.S. Counties

UPDATE: WEBINAR DETAILS

SHADAC will host a coffee-break webinar on June 9, 2016, featuring experts from the U.S. Census Bureau, who will discuss findings from the 2014 SAHIE data along with the recent Medicaid data changes used in SAHIE production.

The webinar will take place from 12:00 - 12:30 a.m. ET / 11:00 - 11:30 CT. 

REGISTER HERE.

May 16, 2016:

Although All States Saw Declines in Overall Uninsurance, Changes in Uninsurance Vary at the Sub-State Level 

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.

The current SAHIE release provides researchers and policy analysts with the first opportunity to compare uninsurance rates for all U.S counties before and after full implementation of the coverage provisions of the ACA. 

Highlights from the 2014 Data

State-level estimates from the 2014 ACS show decreases in the uninsured rates for all 50 states and the District of Columbia, but the new SAHIE results indicate that coverage changes vary  at the sub-state level:

• • According to the new SAHIE analysis, 2,325 counties, or 74.1 percent of all counties, saw a decrease in the uninsurance rate.
• • In Medicaid expansion states, 96.1 percent of counties saw a decrease in their estimated uninsured; in non-expansion states, on the other hand, only 36.8 percent of counties saw a decrease in uninsurance.

Table 1 displays the 10 counties with the highest number of nonelderly (0-64) uninsured for 2013 and 2014.

• • Approximately 17% percent of the nation’s 2014 uninsured lived in these 10 counties.
• • All the 2014 top counties saw year-over-year decreases in the estimated number of uninsured.
• • Nine of the top ten 2014 counties were also among the top ten counties in 2013.
• • The top 4 counties with the highest number of uninsured remained the same from 2013 to 2014. 

SHADAC's full analysis of the geographic concentration of the uninsured in 2013 and 2014 (updating past work) will be available soon.

Learn More about the New SAHIE Data

2014 SAHIE Data Release Highlights can be viewed here, and Interactive estimates can be viewed here.

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

New Brief: Using HCUP Data for State Health Policy Analysis

The SHARE grant program has released a new brief examining the use of administrative data for the purpose of state health policy analysis. In particular, the brief highlights the hospital administrative data available from the Healthcare Cost and Utilization Project (HCUP) and presents a case study of a SHARE-funded project that uses HCUP data to evaluate the impacts of California’s early ACA Medicaid expansion on inpatient hospital utilization.

What is the HCUP?

The HCUP is a collection of six different databases sponsored by the federal Agency for Healthcare Research and Quality (AHRQ) that can be purchased through the HCUP Central Distributor. These databases consist of longitudinal hospital data—with a primary focus on community hospitals--based on de-identified discharge records for individual patients. The six different HCUP databases are:

• • National Inpatient Sample (NIS)
• • Kids’ Inpatient Database (KID)
• • Nationwide Emergency Department Sample (NEDS)
• • Nationwide Readmissions Database (NRD)
• • State Inpatient Databases (SID)
• • State Emergency Department Databases (SEDD)

Using HCUP Data to Examine State-Level Utilization

For state-focused health policy research, the State Inpatient Databases (SID), which consist of hospital inpatient discharge data on approximately 90 percent of all U.S. hospital discharges, are especially useful for understanding patient utilization. The SID not only allow researchers to examine hospital-level differences within states but also foster multi-state comparisons and analyses because of their uniformity. 

Case Study: Early Medicaid Expansion in California

Researchers at Virginia Commonwealth University (VCU), led by Dr. Peter Cunningham, used the SID to examine the utilization impact of California’s early Medicaid expansion. Specifically, the research team compared

1. Utilization at hospitals in California from 2010 to 2013 with utilization at hospitals in neighboring states without an early Medicaid expansion, and
2. Utilization over the same time period at safety net and non-safety net hospitals within California.

Preliminary Findings: Highlights

Preliminary findings from the VCU study include (among others):

• • Inpatient volumes increased at California hospitals relative to the comparison states following California’s Medicaid expansion, when controlling for national trends.
   
• • Medicaid admissions as a percent of total admissions increased after California’s Medicaid expansion, while uninsured admissions declined when compared to non-expansion states (again, controlling for national trends).
   
• • Overall inpatient volumes at safety net hospitals within California increased to a greater extent than at the state’s non-safety net hospitals following the early Medicaid expansion.
   
• • Both safety net and non-safety net hospitals within California observed similar patterns in payer mix after the Medicaid expansion, with an increase in Medicaid admissions as a percent of total admissions and a decrease in uninsured admissions as a percent of total admissions.

Further Details

For more information on the HCUP, the SID, and preliminary findings from the VCU study, view the full issue brief: “Using HCUP Data for State Health Policy Analysis: A Case Study Examining the Impacts of an Early Medicaid Expansion.”

Using HCUP Data for State Health Policy Analysis: A Case Study Examining the Impacts of an Early Medicaid Expansion

This brief from the SHARE grant program examines a rich source of US hospital administrative data--the Healthcare Cost and Utilization Project (HCUP)--and provides an example of how a SHARE-funded research project led by Dr. Peter Cunningham at Virginia Commonwealth University has used these data to evaluate the impacts of an early ACA Medicaid expansion on utilization-related outcomes at hospitals in California.

Download a PDF of the brief.