Blog & News
SHADAC at the 2019 AcademyHealth Annual Research Meeting (ARM)
May 29, 2019:A number of SHADAC researchers will be presenting their research at the 2019 AcademyHealth Annual Research Meeting (ARM) in Washington, D.C., from Sunday, June 2nd to Tuesday, June 4th, and at the State Health Research and Policy Interest Group Meeting on Saturday, June 1st. Their presentations include:
The Evolving Opioid Crisis: Overdose Trends and Variation across the States
Robert Hest - State Health Policy and Research Interest Group
Coverage Erosion among Kids: Exploring the Increase in Uninsurance among Children Nationally and at the State Level
Natalie Schwehr - State Health Policy and Research Interest Group
Identifying the Geographic Concentration of the Remaining Uninsured in Minnesota and Their Characteristics
Cynthia Pando - State Health Policy and Research Interest Group
Coverage Erosion among Kids: Exploring the Increase in Uninsurance among Children Nationally and at the State Level
Natalie Schwehr
Sustaining community engaged research to promote health equity: Lessons from the RWJF's Interdisciplinary Research Leaders (IRL) Program
Kathleen T. Call
Medical Homes, Neighborhood Characteristics, and Their Impact on Child Health Outcomes
Natalie Schwehr
Immediate Changes in Access to Care after Implementing Mandatory Paid Sick Leave in Minnesota
Kathleen Call (SHADAC)
Identifying the Geographic Concentration of the Remaining Uninsured in Minnesota and Their Characteristics
Cynthia Pando
Visit Us in the Exhibit Hall - Booth #212
SHADAC researchers will be available at the SHADAC booth to answer your questions about state and national data sources on coverage, access, and costs; to discuss our technical assistance offerings; and to walk visitors through State Health Compare. Stop by to chat, check out some of our latest projects, and grab some swag! Be sure to tag and hashtag us (@SHADAC and #SHADACatARM2019) on Twitter to keep up with what we're doing at the conference!
The full presentation schedule for SHADAC faculty, staff, and students can be downloaded by clicking the document on the right.
Blog & News
2018 NHIS Full-Year Early Release: Insurance Coverage Held Steady Overall, with Some Subgroup Changes
May 15, 2019:The National Center for Health Statistics (NCHS) released health insurance coverage estimates for 2018 from the National Health Interview Survey (NHIS) as part of the NHIS Early Release Program. These are the first available full-year coverage estimates for 2018 from a federal survey, with estimates available for the U.S. and 17 states.
Key Findings
Uninsurance
Approximately 30.4 million persons of all ages, or 9.4%, were uninsured nationwide in 2018. This uninsured rate was statistically unchanged from 2017, as were the rates in the 17 states for which the NHIS provided 2018 estimates.[1] Uninsurance also held steady among most populations by age, sex, race/ethnicity, Marketplace type, state, state Medicaid expansion status, and region. There were, however, significant increases in uninsurance among adults age 45-64 (from 9.3% to 10.3%) who, the report noted, were the most likely group to be uninsured, and among nonelderly adults (age 18-64) with household incomes above 400% of the Federal Poverty Level (FPL).
Public and Private Coverage
Like uninsurance, public coverage and private coverage held steady nationwide in 2018 at 36.7% and 62.3%, respectively. Public and private coverage were also largely stable in the 17 select NHIS states, with the exception of New York, where public coverage increased in 2018 from 38.9% to 43.6%, and Virginia, where public coverage increased from 31.8% to 38.4%. Public coverage also increased from 67.9% to 72.7% among children (age 0-17) with household incomes from 100% to 200% FPL. Private coverage decreased from 26.5% to 21.4% among non-elderly adults with incomes below 100% FPL.
Behind the Numbers
From 2017 to 2018, premiums for silver Marketplace plans increased an average of 32%, with bronze premiums rising 17% and gold premiums rising 18%.[2] Since 45-64 year-olds are subject to age rating both on and off the Marketplace, they face even higher premiums than average, while individuals above 400% FPL are ineligible for Marketplace subsidies and therefore face the entire cost of premium increases. With this in mind, increasing uninsurance among these two groups suggests that some were dropping coverage in response to rising premium costs in 2018. An increase in the rate of high-deductible health plan (HDHP) enrollment, which grew from 43.7% in 2017 to 45.8% in 2018 among the nonelderly (age 0-65) nationwide, provides additional evidence that premium increases played a role in 2018 coverage changes, as individuals may be responding to rising premium costs by shifting to coverage with higher deductibles.
About the Numbers
The above estimates provide a point-in-time measure of health insurance coverage, indicating the percent of persons with that type of coverage at the time of the interview. The 2018 estimates based on a sample of 72,762 persons from the civilian noninstitutionalized population, a decrease from the 2017 sample of 78,074 persons.
For more information about the early 2018 NHIS health insurance coverage estimates, read the National Center for Health Statistics brief.
[1] Significant differences between 2017 and 2018 are at the 95% confidence level or greater.
[2] Semanskee, A., Claxton, G., & Levitt, L. (November 29, 2017). How Premiums Are Changing in 2018. Kaiser Family Foundation. Retrieved from https://www.kff.org/health-costs/issue-brief/how-premiums-are-changing-in-2018/
Citation
Cohen, R.A., Terlizzi, E.P., & Martinez, M.E. (May 2019). Health Insurance Coverage: Early Release Estimates from the National Health Interview Survey, 2018 [PDF file]. National Center for Health Statistics: National Health Interview Survey Early Release Program. Retrieved from https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf
Blog & News
New SHADAC Brief Explores Methods for Adapting BRFSS Survey Income Measure to Align with FPG Thresholds
June 18, 2019:The Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey can be a valuable data source for researchers seeking to evaluate the impact of health insurance coverage programs such as Medicaid on measures of health outcomes and health behaviors; yet the BRFSS’ income measure, which asks respondents to classify their income within one of eight possible categories, creates challenges when trying to define the relevant eligible populations.
A new brief from SHADAC evaluates common methods for better using categorical income measures, such as the one in the BRFSS, to calculate income as a percent of the federal poverty guidelines (FPG).
Evaluation and Methods
Three of the four methods start by assigning a continuous income value to the respondent based on the respondent’s reported income category, choosing either the lower bound of each category, the upper bound of each category, or the midpoint of each category. A fourth method utilizes the uniform distribution to randomly assign an income value within the reported category.
Employing data from the 2017 BRFSS, the brief presents the distribution of income as a percent of FPG produced by each method as well as the state-level poverty rates produced by each method. It then evaluates the accuracy of these methods using data from the 2018 Current Population Survey’s Annual Social and Economic Supplement (CPS-ASEC), which has both a categorical income measure and a continuous income measure. The brief compares the distribution of income as a percent of FPG produced by the CPS’s continuous income measure to the distributions of income produced by each method when applied to the CPS’s categorical income measure.
Conclusions
Evaluation results reveal substantial differences in the distribution of income as a percent of FPG produced by each of the methods. The brief shows that the lower bound method skews towards the lower part of the income distribution, that the uniform distribution and midpoint methods produce a more even distribution of income, and that the upper bound method skews towards the upper part of the income distribution. Comparing the distributions produced by these methods against the distribution from a continuous income measure, the brief concludes that the upper bound method is likely the most accurate method across the income distribution while also acknowledging that the best method for assigning continuous income remains partially dependent on which population(s) is most relevant to the researcher’s chosen outcomes for analysis.
SHADAC utilizes data from the BRFSS, CPS, and other federal surveys to produce measures on a range of topics including income inequality, social and economic determinants of health, health insurance coverage, cost of care, health behaviors and outcomes, access to and utilization of care, and public health. Visit our State Health Compare web tool to explore the data further.
Related Resources
FPG vs. FPL: What’s the Difference?
Blog & News
SHADAC Researcher Colin Planalp Talks Trends in the Opioid Crisis with the University of Minnesota
March 25, 2019:In a recent interview with the University of Minnesota, SHADAC researcher Colin Planalp provided an overview of recent trends in the nation's evolving opioid crisis, discussing the growth in opioid overdose deaths since 2000, and how Minnesota’s statistics on opioid overdoses compare with the rest of the country.
Story highlights include:
- From 2000-2011 the national opioid overdose death rate nearly quadrupled from 1.0 to 3.7 deaths per 100,000, driven primarily by overdose deaths from natural and semi-synthetic prescription opioid painkillers.
- In 2011, the growth in the death rate from prescription opioid painkillers began to slow, but overdose deaths from illicit drugs began to rise sharply.
- In 2017, the U.S. death rate from synthetic opioids was 9.0 per 100,000 people — nearly twice the rate from heroin (4.9) and more than twice the rate from prescription opioid painkillers (4.4).
- Minnesota has lower opioid overdose death rates than the national average, but the state has followed the general trend in opioid overdose deaths, with steady growth in death rates from prescription opioids since 2000, and rapid growth in overdose death rates from heroin and synthetic opioids since 2010.
Mr. Planalp also discussed SHADAC's ongoing efforts to track data on overdose deaths, noting that recent data signal a potential expansion of the opioid crisis beyond synthetic, natural, and semi-synthetic opioids to include cocaine and methamphetamine.
Read the full interview here, and for more on the opioid overdose data referenced in the interview, visit SHADAC’s State Health Compare.
Suggested Further Reading
New Data on Drug Overdose Deaths Highlight the Need for State-level Analysis
Blog & News
NHIS: Nationwide Uninsured Rate for January to September 2018 Unchanged from 2017
February 27, 2019:Nationwide, the uninsurance rate among non-elderly adults (ages 18-64) in the first three quarters of 2018 was 13.0%, statistically unchanged from 12.7% in the same period in 2017.
This finding is based on new health insurance coverage estimates for Q1-Q3 2018 from the National Health Interview Survey (NHIS). These estimates were released by the National Center for Health Statistics (NCHS) as part of the NHIS Early Release Program and are the first available coverage estimates for 2018 from a federal survey.
Uninsurance and Public and Private Coverage Rates Remained Stable for Nearly All Groups in 2018
The new NHIS estimates show that uninsurance rates, as well as rates of public and private coverage, were statistically unchanged across age, race/ethnicity, and most income groups between the first three quarters of 2017 and the first three quarters of 2018. Figure 1 shows levels of health insurance coverage by type among non-elderly adults overall across this time period.
Changes in Coverage Type among Some Subgroups
Among non-elderly adults with incomes below 100% of the federal poverty level (FPL), the rate of private coverage fell to 19.9% in the first three quarters of 2018 from 25.6% in the first three quarters of 2017 (Figure 2). The rates of uninsurance and public coverage among this group remained statistically unchanged over the same period.
Non-elderly adults with incomes between 100% and 138% FPL also saw a change in coverage type, with uninsurance among this group increasing from 68.7% in the first three quarters of 2017 to 73.6% in the first three quarters of 2018. The rates of private and public coverage among this group remained statistically unchanged over the same period.
Increase in Uninsurance in the Midwest Region
The rate of uninsurance among non-elderly adults in the Midwest[1] increased from 9.5% in the first three quarters of 2017 to 11.0% in the first three quarters of 2018 (Figure 3). This change was larger among non-elderly adults in the East North Central[2] region, a subset of the Midwest region, where uninsurance increased from 8.9 % to 10.6% over the same period. No other coverage changes occurred in the Midwest region over this period, and no other regions experienced a significant change in coverage type.
Note: No state-level coverage estimates were released for the first three quarters of 2018, although NCHS released 11 state-level estimates for the same period of 2017 and 38 state-level estimates for the same period of 2016. Detailed Regions were the lowest level of geography for which estimates were released for the January through September 2018 Early Release report.
About the Numbers
The above estimates provide a point-in-time measure of health insurance coverage, indicating the percent of persons with that type of coverage at the time of the interview. The 2018 estimates are for the months of January to September 2018 and are based on a sample of 61,484 persons from the civilian noninstitutionalized population.
Differences described in this post are statistically significant at the 95% confidence level unless otherwise specified.
For more information about the early 2018 NHIS health insurance coverage estimates, read the National Center for Health Statistics brief.
Citation
Terlizzi, EP, Cohen, RA, & Martinez, ME. February 27, 2019. “Health Insurance Coverage: Early Release Estimates from the National Health Interview Survey, January–September 2018.” National Center for Health Statistics: National Health Interview Survey Early Release Program. Available at https://www.cdc.gov/nchs/data/nhis/earlyrelease/Insur201902.pdf.
[1] The Midwest region includes Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; the Northeast region includes Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; the South region includes Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia;
and the West region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
[2] The East North Central region includes Illinois, Indiana, Michigan, Ohio, and Wisconsin.