Trends in Employer-Sponsored Health Insurance (ESI)
Anew SHADAC reportexamines recent trends in employer-sponsored insurance (ESI), finding a substantial erosion in ESI coverage during the time period of the analysis (1999/2000 to 2010/2011). Using data from the Annual Social and Economic Supplement (ASEC) of the Current Population Survey (CPS) and the Insurance Component of the Medical Expenditure Panel Survey (MEPS-IC), the report examines national and state-level changes in ESI both overall and along several dimensions: family income, policyholder vs. dependent status, employer/employment characteristics, and premium costs. The report is accompanied bystate-level 10-year summary tables of key ESI characteristics.
Subannual Estimates Would Increase the Value of the American community Survey (ACS) for ACA Evaluation
In a newreport and accompanyingbrief, researchers from the Urban Institute and SHADAC make the case that the value of the ACS for the purposes of monitoring and evaluating the ACA could be improved through the generation of subannual estimates of insurance coverage. The authors point out that such estimates, whether monthly, quarterly, or semi-annual, would provide a closer link between the timing of state decisions and insurance outcomes than is discernable using annual estimates. The authors describe how ACS subannual estimates could be developed, the challenges associated with this task, and potential next steps.
SHADAC Awarded MACPAC Contract to Study Value-Based Purchasing Approaches in Medicaid
SHADAC has been awarded a contract with theMedicaid and CHIP Payment and Access Commission(MACPAC) to organize site visits and develop learnings about different value-based purchasing approaches in Medicaid. Through semi-structured interviews with state officials, payers, provider groups, and other important stakeholders, SHADAC and MACPAC staff will develop contextual knowledge about Accountable Care Organizations (ACOs), bundled payment initiatives, and other pay-for-performance and shared savings approaches in Medicaid. Based on this research, SHADAC will produce a report to inform MACPAC staff, Congressional staff, and other audiences about different payment reform approaches, implementation activities and challenges, and ongoing operations.
News from the States
ACA Impact Analyses: Ohio, Pennsylvania
“Expanding Medicaid in Ohio: Analysis of Likely Effects,”was prepared jointly by authors from the Health Policy Institute of Ohio, Ohio State University, Urban Institute, and Regional Economic Models, Inc. (REMI), for the Ohio Medicaid Expansion Study. The report is a follow-up to the release of preliminary findings in January and includes refined projectionss and further analysis. The report uses the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) and an actuarial-type model from Ohio State University to estimate that the state would see net state budget gains from 2014 through 2022 of between $1.8 and $1.9 billion under a Medicaid expansion.
“The Economic and Fiscal Impact of Medicaid Expansion in Pennsylvania,”was prepared by the Pennsylvania Economy League, Inc., and Econsult Solutions, Inc., for the PA Health Funders Collaborative. The report details projected impacts of a Medicaid coverage expansion on the state budget from 2013 to 2022. The research team used anIMPLANeconomic model and projections from the Kaiser Family Foundation to estimate that Pennsylvania would save approximately $4.4 billion from 2013 to 2022 due to reduced state health care costs while spending $1.6 billion on expanded Medicaid, for an overall savings of $2.8 billion.
2012 Insurance Coverage Estimates for Kansas
The Kansas Health Institute released itsAnnual Insurance Update for 2012, providing coverage estimates for the state based on two-year averages from the Current Population Survey (CPS). The report estimates that 13.1 percent of all Kansans (about 365,000 people) were uninsured in 2010/2011, which was not statistically different from the 12.7 percent who were uninsured in 2009/2010. The analysis provides coverage estimates stratified by age, race/ethnicity, income, and employment, and it looks at sources of coverage as well. The report also addresses variations in coverage and Medicaid participation across the state and concludes with an analysis of coverage trends from 2001/2002 to 2010/2011.
Colorado: New Local Coverage Estimates for 2016, Characteristics of Medicaid Newly-Eligible
Colorado Health Institute (CHI) releasedstatewide and county-level coverage estimatesfor Colorado in 2016 based on a review of available data and assuming state implementation of the ACA Medicaid expansion. The estimates focus on the number of Coloradans under age 65 who will have public insurance; employer-sponsored coverage; individual coverage (including coverage through the Colorado Health Benefit Exchange); or some other type of coverage, such as military coverage. The analysis estimates that Colorado's uninsured population will be reduced by more than half between 2011 and 2016, with the number of uninsured Coloradans falling from 829,000 to 390,000 during this time.
CHI also released areportanalyzing the demographic characteristics of the one-in-six Coloradans who would become newly eligible for Medicaid coverage if Colorado chooses to implement the ACA Medicaid expansion. The newly eligible—about half of whom are projected to enroll—are younger and less educated than the Colorado population as a whole, more likely to be male than current Medicaid enrollees, about 70 percent white, generally in worse health than average, and likely to be employed. The analysis uses data from the 2011 Colorado Health Access Survey (CHAS).
Minnesota: Reductions in Hospital Uncompensated Care by 2016 under ACA
Abrieffrom researchers at the Minnesota Department of Health, Health Economics Program provides preliminary projections of the potential reduction in hospital uncompensated care in Minnesota by 2016 with and without implementation of the ACA. Assuming full Medicaid expansion and a Basic Health Plan option, hospital uncompensated care would total between $185 million and $244 from 2011 to 2016; without reform, hospital uncompensated care would total between $319 million and $412 million during this time—approximately 70 percent more.
National Health Interview Survey: Early Release Estimates and Special Report from January-September 2012
The National Center for Health Statistics (NCHS) issued anearly releaseof estimates for 15 selected health measures based on data from the January-September 2012 National Health Interview Survey (NHIS). Among the selected measures are lack of health insurance coverage and type of coverage, usual source of care, obtaining needed care, and general health status. Estimates are available by age, sex, and three race/ethnicity groups, with estimates from 1997 through 2011 provided for comparison.
Accompanying the early release is aspecial report on health insurance coverage, which details survey findings about lack of health insurance coverage and type of coverage. Key findings from the report include: From January through September 2012, 20.8 percent of people aged 18 to 64 were uninsured at the time of the interview, down from a 2010 high of 22.3 percent. Additionally, enrollment in high-deductible health plans increased from 29.0 percent in 2011 to 30.7 percent in the first nine months of 2012.
MEPS-HC: 2011 Full-Year Population Characteristics Public Use File Now Available
The Agency for Heatlhcare Research and Quality (AHRQ) released apublic use filecontaining nationally representative Medical Expenditure Panel Survey (MEPS) data collected during calendar year 2011. The file contains variables relating to survey administration, demographics, employment, health status, quality of care, patient satisfaction, health insurance, and person-level medical care use counts. The data are available in ASCII format (with related SAS, SPSS, and STATA programming statements) and SAS transport format.
Report: Out-of-Pocket Medicaid Spending Varies by State, Medicaid Expansion Will Have Uneven Impact
A newreportfrom researchers at the Urban Institute offers a detailed look at total family medical out-of-pocket (OOP) spending as a proportion of income (i.e., “out-of-pocket burden”) for all 50 states and the District of Columbia using data from the Current Population Survey’s Annual Social and Economic Supplement (CPS). The authors find significant variation between states on this measure: Idaho and Mississippi had the highest OOP burden, with the upper quartile of healthcare spending relative to income equaling 10.9 and 10.7 percent, respectively. At the other end, the District of Columbia and New York had upper quartile health care spending totaling 5.0 and 6.4 percent of total income, respectively. The authors point out that states with relatively larger proportions of low-income, high-burden residents stand to benefit significantly from the ACA Medicaid expansion.
The State Health Access Data Assistance Center (SHADAC) is a program of the Robert Wood Johnson Foundation and a part of the Health Policy and Management Division of the School of Public Health at the University of Minnesota.