Working Paper: Examining the Medicaid Undercount in the ACS Using Linked Data
SHADAC researchers, in collaboration with experts from the U.S. Census Bureau, released aworking paperexamining the Medicaid undercount that is typically seen in survey data measuring health insurance coverage. This analysis is the first research on the Medicaid undercount using the full production American Community Survey (ACS); previous efforts have examined the Current Population Survey (CPS), the National Health Interview Survey (NHIS), the Household Component of the Medical Expenditure Panel Survey (MEPS-HC), and the 2006 ACS content test. Linking the 2008 ACS to the Medicaid Statistical Information System (MSIS), the authors conclude that the undercount in the ACS is on par with, if not slightly lower than, some other federal population surveys that measure health insurance coverage. The authors also explore how the undercount varies by age, poverty level, and state of residence.
Webinar Podcast Available: Prospective Benefit Design for the Medicaid Expansion Population
Dr. Lindsey Leininger, Assistant Professor at the University of Illinois at Chicago, discussed the predictive capacity of self-reported health measures for the purposes of prospective benefit design on a SHARE webinar on October 16, 2013. The analysis, which was funded through a SHARE grant from the Robert Wood Johnson Foundation, indicates that self-reported health measures are sufficiently predictive of utilization and cost outcomes to be used as a predictive tool for programmatic purposes. This finding has potentially significant implications as states prepare to absorb millions of previously uninsured enrollees—about whose health care needs relatively little is known—into their expanded Medicaid programs in 2014. Click hereto access the podcast and presentation materials.
HealthAffairs: University of Minnesota Researchers Examine Barriers to Mental Health Care by Insurance Status
In anarticlein the October 2013 issue ofHealthAffairs, University of Minnesota Researchers Kathleen Rowan, Donna McAlpine, and Lynn Blewett examine changes in insurance coverage and cost for mental health services for people with public insurance, private insurance, and no coverage, from 1999/2000 to 2009/2010. Using data from the Integrated Health Interview Series (IHIS), the authors found that people with mental health problems were more likely to have public insurance and less likely to have private insurance in 2009/2010 than in 1999/2000. Additionally, cost barriers increased over time among the uninsured and the privately insured who indicated serious mental illness.
The IHIS is project of the Minnesota Population Center at the University of Minnesota. Click hereto learn more about the IHIS.
Lynn Blewett and Jessie Kemmick-Pintor Discuss ACA Impacts in Healthy Generations
SHADAC Director Lynn Blewett and doctoral student Jessie Kemmick-Pintor were featured in theFall 2013 issue ofHealthy Generations, a publication of the Center for Leadership Education in Maternal and Child Public Health at the University of Minnesota. This issue focuses on the implications of the ACA for maternal and child health and public health services. Ms. Kemmick-Pintor and Dr. Blewett co-authored an article, “Immigrant Access to Health Care,” in which they examine the composition of the immigrant population in Minnesota; federal policies—including the ACA—addressing immigrant access to coverage; and the barriers that immigrants face in accessing care. In a separate piece, Healthy Generationsinterviewed Dr. Blewett about the ACA more broadly. Dr. Blewett emphasized that the target population for the ACA’s coverage expansion provisions represents just 10 to 15 percent of the US population overall.
News from the States
ACA Impact Analyes: Alabama, New Hampshire
Ananalysisprepared by researchers at the University of Alabama for the Alabama Hospital Association estimates the statewide and industry-level impacts of an ACA Medicaid expansion in the state. Using an input-output modeling framework, the authors conclude that an expansion in Alabama would have significant positive annual impacts on the state’s economy from 2014 through 2020, and every industry in the state would benefit. A scenario of intermediate Medicaid take-up (292,635 new enrollees; considered the most likely scenario) would lead to the creation of roughly 30,700 jobs; the generation of $1.3 billion in wage and salary earnings; and GDP growth of $4.5 billion.
Areportprepared by The Lewin Group for the New Hampshire Department of Health and Human Services estimates the impact of an ACA Medicaid expansion on areas outside of the state’s Medicaid program, including other state programs, the uninsured, providers, the state economy, and the commercial health insurance market. The authors estimate that the state’s number of uninsured would decline by roughly 99,100 in 2014 under an expansion scenario, falling from 170,000 to about 70,900. Without expansion the number of uninsured would drop by about 76,800 people, to 93,200. Using a REMI model, the authors estimate a significant boost to New Hampshire’s economy, revenues, and employment under both expansion and non-expansion scenarios; however, the expansion scenario maximizes the economic, fiscal, and employment impacts.
Michigan: Private Health Insurance Coverage, Employee Cost-Sharing
The Center for Healthcare Research and Transformation (CHRT) at the University of Michigan has released two reports on health insurance in the state.
Thefirst reportexamines trends in private insurance coverage from 2008 to 2011 using the American Community Survey (ACS) and the Insurance Component of the Medical Expenditure Panel Survey (MEPS). The authors note that over 500,000 people lost private coverage in Michigan during this time, primarily due to the erosion of employer-sponsored insurance (ESI).
Thesecond reportanalyzes trends in health insurance premiums and employee cost-sharing for health insurance in Michigan from 2002 to 2012 using the MEPS-IC. Among key findings of the report is that the proportion of family premiums paid by employees in Michigan grew at three times the national rate during the time period of the analysis, rising from 16 percent in 2002 to 24 percent in 2012.
The ACS estimates used for the first report above were accessed through the SHADAC Data Center.Click hereto learn more about this tool.
2012 MEPS-IC: State-Level ESI Estimates for Multiple Firm Sizes
SHADAC has created three sets oftablescontaining state-level estimates related to employer-sponsored insurance (ESI) from the Insurance Component of the 2012 Medical Expenditure Panel Survey (MEPS-IC). The tables provide information about ESI offers, eligibility, take-up, premiums, and enrollee cost-sharing information for each state, sorted by firm size. SHADAC has added a MEPS-IC firm size category of 50 to 99 employees in order to facilitate state decision-making about small employer definitions under the ACA, which allows states to cap the definition at 100 or fewer employees or at 50 or fewer employees.
State Variation in Projected Coverage Changes under the ACA
In a newbrief, Urban Institute researchers Matthew Buettgens, Genevieve Kenney, Hannah Recht, and Victoria Lynch, use the American Community Survey (ACS) to model the likely impact of the ACA on the uninsured and their eligibility for coverage assistance in each state both with and without a Medicaid expansion. The model estimates that eight of the states currently planning to expand Medicaid will see their number of uninsured reduced by more than 50 percent, led by West Virginia at 57 percent.
The Coverage Gap in States That Do Not Expand Medicaid
Abrieffrom the Kaiser Commission on Medicaid and the Uninsured provides estimates of the low-income nonelderly uninsured population living in states that do not plan to expand Medicaid. People in this category (numbering about five million) have incomes above current state Medicaid eligibility levels but below the threshold at which they would qualify for subsidies to purchase coverage on the Exchange. Most of these people have very limited coverage options and will likely remain uninsured without a Medicaid expansion. The brief uses the 2013 Current Population Survey (CPS) to estimate the size of this population in each of the 25 states not currently planning to expand Medicaid and the contribution of this sub-population to each state’s uninsured population more broadly.
The KCMU analysis in this brief draws on the methods used by SHADAC to impute immigration status in the CPS using a regression model developed from the Survey of Income and Program Participation (SIPP).Click hereto learn more about SHADAC’s method for imputing immigration.
ACA Impact on Uninsured Community Health Center Patients: State-by-State Analysis
Abrieffrom researchers at the George Washington University School of Public Health and Health Services uses data from the 2009 HRSA Health Center User Survey and the 2011 Uniform Data System to estimate that 5 million uninsured community health center (CHC) patients (i.e., two-thirds of all such patients nationwide) would be eligible for coverage under a nationwide Medicaid expansion. However, more than one million of these patients will remain uninsured due to state decisions to opt out of the expansion. The report provides state-level data on the overall size of the CHC patient population and the number of CHC patients who are uninsured, along with the potential state-specific revenue gains and losses under Medicaid expansion and non-expansion scenarios as attributable to coverage of the CHC population.
Impact of ACA on Health Coverage and Care for American Indians and Alaska Natives by State
Abrieffrom the Kaiser Family Foundation examines the potential impacts of the ACA on health coverage and care for American Indians and Alaska Natives (AI/ANs). Using data from the 2009 to 2011 American Community Survey (ACS), the brief estimates that nearly one in three of the nation’s 5.1 million AI/ANs individuals is uninsured. The report provides state-specific estimates of the AI/AN population, the percent of AI/ANs who are uninsured, and distribution of the AI/AN uninsured by income. Half of uninsured adult AIANs with incomes below 100 percent FPL live in the 26 states not moving forward with the Medicaid expansion.
U.S. Census Bureau Modifies Release Dates for ACS Products
The U.S. Census Bureau announced arevised timetablefor the release of several American Community Survey (ACS) products:
Estimates from the three-year (2010-2012) ACS will be available throughAmerican FactFindertables on November 14th, and estimates from the five-year (2008-2012) ACS will be available on December 17th.
The Public Use Microdata Sample (PUMS) for the 2012 ACS one-year statistics will be released on December 17th; the files for the three-year statistics will be released on February 6th; and the files for the five year statistics will be released on March 6th.
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.