Blog & News
Minnesota’s uninsured rate hit historic low in 2021 but racial disparities increased (Minnesota Department of Health Cross Post)
July 14, 2022:Today, the Health Economics Program (HEP) of the Minnesota Department of Health (MDH) and the University of Minnesota School of Public Health, State Health Access Data Assistance Center (SHADAC) released results from the 2021 Minnesota Health Access Survey (MNHA) - a biennial state-based population survey that collects information on how many people in Minnesota have health insurance and how easy it is for them to get health care. The survey is conducted as a partnership between MDH and SHADAC.
Key findings from the survey showed mixed results, with the statewide uninsured rate dropping to its lowest-ever rate (4.0%) and periodic uninsurance dropping significantly (2.9% from 4.8%). However, the survey also found that disparities in coverage increased when examined by race and ethnicity, with uninsured rates among American Indians and people of color rising to 10.2%.
The following content from the full press release is cross-posted from the Minnesota Department of Health published on April 21, 2022.
Authors: Alisha Simon, MDH; Stefan Gildemeister, MDH; Kathleen Call, SHADAC
The Minnesota Department of Health (MDH) released new data showing mixed news regarding health insurance coverage in Minnesota during 2021. While actions taken by state officials helped drop the state’s uninsured rate to the lowest level ever measured, racial disparities in coverage worsened.
Federal and state policies and funding during 2021 shielded Minnesota’s health insurance coverage against the pandemic’s economic shock. With the help of these efforts, the state’s uninsured rate fell to 4.0%, the lowest-ever measured level, essentially tying the 2015 rate.
Economic downturns often result in higher rates of uninsurance in the U.S. due to the link between employment and health insurance coverage. With the help of state and federal funding, Minnesota took steps to prevent insurance loss in 2020 and 2021, including government efforts to maintain coverage for low-income Minnesotans and premium subsidies in the individual market. Data from the Minnesota Health Access Survey found that 34,000 fewer Minnesotans went without health insurance in 2021 compared to 2019. Fewer Minnesotans also said they went without some type of needed health care due to cost in 2021 (20%) compared to 2019 (25%).
However, not all Minnesotans were equally able to access or retain coverage. Racial disparities worsened as the uninsured rate among Minnesotans of color and American Indians rose from 7.6% in 2019 to 10.2% in 2021. In contrast, the uninsured rate dropped among non-Hispanic Whites from 3.7% in 2019 to 2.4% in 2021.
“The investments we made before and during the pandemic to ensure Minnesotans had access to affordable health coverage helped more people stay insured, even in the midst of job losses and economic instability,” said Minnesota Commissioner of Health Jan Malcolm. “Sadly, we saw that people of color and American Indians did not benefit as much from these efforts. We must learn about what worked and what didn’t so we can adapt our approach to reach the goal of ongoing and equitable access to affordable health care for all Minnesotans.”
The number of Minnesotans with public insurance increased by 238,000 so that 41.2% of those insured had coverage through public sources in 2021, including Medicare, Medical Assistance and MinnesotaCare. This growth in public coverage made up for a decrease in private coverage – down from 57.8% in 2019 to 54.8% in 2021.
While most Minnesotans weathered the first two years of the pandemic with health insurance, there are concerns about maintaining coverage moving forward. Many government programs that added financial supports to families, increased subsidies for private health insurance plans sold through MNsure to make insurance more affordable or allowed people to stay on Medicaid longer ended or are set to expire this year.
“Historically, Minnesota has enjoyed a strong labor market and a strong employer-sponsored insurance market,” said Kathleen Call, a professor with the University of Minnesota School of Public Health and an investigator at the State Health Access Data Assistance Center. “However, alongside the crisis of the pandemic, the long-term erosion of private coverage over the past two decades, combined with the fact that not all employees are offered insurance and not all Minnesotans can afford it, reminds us that continued commitments are needed to support and promote Medical Assistance, MinnesotaCare and premium subsidies in the individual market available through MNsure.”
The survey suggests that COVID-19 had an impact in delaying care in 2021 but didn't keep most people from getting that care eventually. In the second year of the pandemic, COVID-19 concerns affected only 8% of people not receiving health care. The primary reasons for not using health care were cost or not needing it.
Both physical and mental health declined during the pandemic, according to the survey. The number of unhealthy days reported for a 30-day period climbed to an average 3.3 days for physical health and 4.3 days for mental health, compared to 2.8 for physical health and 3.7 for mental health in 2019.
“The reports of Minnesotans having fewer healthy days in 2021 are concerning, particularly in light of the continued strain on the state’s health care workforce and our structural weaknesses in mental health care,” said Stefan Gildemeister, MDH state health economist. “We will continue to monitor how effective our investments in community connections and resources during the pandemic are in reversing lingering harms to physical and mental health as the state moves into the next stage of the pandemic and as the economy recovers.”
The Minnesota Health Access Survey is a biennial state-based population survey that collects information on how many people in Minnesota have health insurance and how easy it is for them to get health care. The survey is conducted as a partnership between MDH and the University of Minnesota School of Public Health, State Health Access Data Assistance Center. The survey had responses from more the 18,000 Minnesotans across the state and was conducted between October 2021 and January 2022. More findings from the survey are available on the MDH Health Economics Program website.
Additional Resources
MDH Uninsurance Chartbook MNHA 2021 Survey Infographic MNHA Survey Tool
Publication
New SHADAC Brief Summarizes Study of Effects of Medicaid Expansion on Physician Participation
With the Affordable Care Act's (ACA) expansion of Medicaid, approximately 15 million people were able to enroll in the program - many of whom were previously uninsured. However, researchers have long worried that an expansion of insurance coverage would not translate to an equal expansion in access to care. A particular point of concern is the worry that these newly eligible and enrolled individuals would not be able to find enough physicians who participate in Medicaid to treat them.
Existing research has traditionally relied on physician survey data to study trends in physician acceptance of Medicaid and the factors associated with participation in the Medicaid program. For example, under contract with the Medicaid and CHIP Payment and Access Commission (MACPAC), SHADAC researchers used data from the National Electronic Health Records Survey (NEHRS) to create state-level estimates of physician participation in Medicaid before and after expansion and to study the physician- and practice-level characteristics associated with participation.
However, a new study led by Dr. Hannah Neprash is the first to provide direct answers about how clinicians responded to the Medicaid expansion. In their paper, "The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care” published in the December 2021 issue of the Journal of Health Economics, Dr. Neprash and her co-authors use all-payer claims and practice management data from 2012 through 2017 to examine how clinicians changed their labor supply and payer mix in response to Medicaid expansion.
This brief summarizes key findings from this study, including the effect of expansion on the number of Medicaid appointments and number of Medicaid patients seen by primary care clinicians (i.e., Medicaid participation), the total number of appointments provided (i.e., their labor supply) and the share of those appointments paid for by Medicaid versus private coverage or other payers (i.e., payer mix). The study also compares the relative change in participation in states subject to the Medicaid expansion compared to the change in states not subject to the expansion, estimating a causal effect of expansion on clinician participation in Medicaid.
Click on the image to the upper right to access and download a PDF of the full brief.
Related Resources
Physician Acceptance of New Medicaid Patients: Findings from the National Electronic Health Records Survey (MACPAC Fact Sheet)
Explore Physician Acceptance of New Medicaid Patients through Two New Measures on SHADAC’s State Health Compare and in a New MACPAC Factsheet (SHADAC Blog)
Physicians who accept new Medicaid patients (State Health Compare Data Measure)