Publication
SHADAC Newsletter - September 2016
The SHADAC newsletter contains updates on SHADAC activities, news from the states, resource updates, and blog highlights. Subscribe to our newsletter here.
The SHADAC newsletter contains updates on SHADAC activities, news from the states, resource updates, and blog highlights. Subscribe to our newsletter here.
This blog was originally published on August 2, 2016, on the California Health Care Foundation's ACA 411 Insights Blog.
Most Californians under age 65 with health insurance receive it through an employer, but since 2009 the availability of employer-sponsored insurance (ESI) in the state has been on the decline. A key question around the Affordable Care Act (ACA) was whether the reforms would further erode ESI coverage.
Recent results from the 2015 California Employer Health Benefits Survey, now available on ACA 411, show that the availability of ESI remained stable in the state following implementation of the law. There was no significant change in the share of firms that offered coverage between 2013 and 2015, and the share of employees who work at firms that offer coverage also remained stable. (The declines in both measures between 2013 and 2015 in the graphs below are not statistically significant.)
Worker Eligibility for ESI Remained Stable Overall, Increased Among Some Groups
Another issue of potential concern with ACA was whether firms would reduce employees' eligibility for ESI by taking such steps as shifting full-time workers to part-time. This does not appear to be the case in California, where the share of eligible workers at firms that offer coverage remained stable at about 79% between 2013 and 2015. At firms with a larger share of low-wage employees (more than 35% of workers earning less than $23,000 per year), the proportion of workers who were eligible for coverage actually increased significantly from 62.3% to 76.7% between 2013 and 2015.
Fewer Eligible Workers Enroll in ESI
Availability of ESI for Workers' Family Members Remained Stable, While EnrollmentDropped Among Low-Income Family Members
Many individuals obtain ESI as a spouse or dependent of another worker, so it is helpful to track trends in the availability and take-up of ESI at the family level.
Between 2013 and 2014 (the latest year for which data are available) the share of families in California with any offer of ESI was statistically unchanged, as was the share of families with any ESI offer who enrolled all eligible family members. However, there was a significant decline in enrollment in ESI among low-income families. The share of families with incomes below 138% of the federal poverty level who were offered ESI and enrolled all eligible family members declined by nearly 13 percentage points from 49.4% to 36.7%.
The reduction in the share of employees and low-income family members deciding to enroll in ESI when eligible could be driven by multiple factors, including cost and the availability of alternative coverage options, such as Medi-Cal and subsidized coverage through Covered California.
SHADAC has been engaged in a project sponsored by Foundation for a Healthy Kentucky to assess the impact of the ACA in Kentucky over time. We are grateful for this opportunity and to be working with the foundation at a time of significant change.
As part of our project work, we produce quarterly snapshots intended to provide the most up-to-date data available on select health reform topics of interest to the state. In a newly-released snapshot, we focus on data from the first quarter of 2016. Here are a few highlights:
The State Innovation Model (SIM) Program is sponsored by the Centers for Medicare and Medicaid Services (CMS) and administered by CMS’s Center for Medicare and Medicaid Innovation (CMMI). SIM provides funding and support to states to transform their public and private health care payment and service delivery systems with the aims of lowering health system costs, maintaining or improving health care quality, and improving population health.
In 2013, Minnesota received a SIM award to implement and test the Minnesota Accountable Health Model. Between October 2013 and December 2016, the Minnesota Department of Human Services (DHS) and the Minnesota Department of Health (MDH) are implementing the Model across the state of Minnesota.
The State Health Access Data Assistance Center (SHADAC) is managing the state-level self-evaluation efforts for the Minnesota Accountable Health Model project during 2015 and 2016 under a contract with DHS and in collaboration with both DHS and MDH. Five goals have been identified for Minnesota's self-evaluation. These goals include:
This report describes the activities conducted during, and the results from, the first year of this two-year evaluation.
Seven research teams are presenting their SHARE-funded work at the 2016 American Society of Health Economics Conference (ASHEcon), which takes place this year at the Leonard Davis Institute for Health Economics at the University of Pennsylvania from June 12th through the 15th. We encourage you to check out these presentations if you’re attending the conference.
Podium presentations of SHARE-funded research at ASHEcon 2016 are as follows:
Early Evidence on Employment Responses to the Affordable Care Act
Speaker: Jean Abraham (University of Minnesota)
Discussant: Laura Dague (Texas A&M)
Date/Time: Monday (6/13), 10:55 a.m.
Location: G50 (Huntsman Hall)
As the insurance market changes with the implementation of the ACA, this research examines how the existence of employer-based health insurance coverage impacts employees’ access to such insurance as well as labor market outcomes, such as part-time work. Researchers investigate how labor market outcomes are changing over time as the ACA is implemented.
Speaker: Pinar Karaca-Mandic (University of Minnesota)
Discussant: Anthony LoSasso (University of Illinois at Chicago)
Date/Time: Monday (6/13), 5:25 p.m.
Location: B26 (Stiteler Hall)
This research documents the relationship between television media campaigns and health insurance enrollment, as federal and state governments, as well as nonprofit organizations, spent over $3 billion on media advertising to promote newly available insurance through ACA marketplaces in the first open enrollment period.
Choice Dynamics of “Money Wasting” Plan Choices in ACA State Marketplaces
Speaker: Anna Sinaiko (Harvard University)
Discussant: Chapin White (RAND)
Date/Time: Wednesday (6/15), 8:50 a.m.
Location: G60 (Huntsman Hall)
This research examines the decisions made by people, particularly members of vulnerable populations, in choosing health insurance plans that potentially result in wasted money. The researchers surveyed enrollees in the ACA marketplace in 2015 to determine whether enrollees were enrolled in the most cost effective plan.
Speaker: Lindsay M. Sabik (Virginia Commonwealth University)
Discussant: Ari B. Friedman (University of Pennsylvania)
Date/Time: Wednesday (6/15), 9:10 a.m.
Location: G50 (Huntsman Hall)
This study examines the impact of early Medicaid expansion in California on admissions of patients at safety net hospitals, defined as hospitals that serve a disproportionately high number of uninsured and Medicaid patients. By comparing California hospital admissions from 2010-2013 to other states that did not experience significant changes to their Medicaid coverage during this time period, the researchers find that both safety net and non-safety net hospitals in California experienced an increase in Medicaid patient admissions and decreases in uninsured admissions.
Pent-up Health Care Demand Among New Medicaid Enrollees after the Affordable Care Act
Speaker: Angela Fertig (Medica Research Institute)
Discussant: James Marton (Georgia State University)
Date/Time: Wednesday (6/15), 12:40 p.m.
Location: F55 (Huntsman Hall)
This study examines claims data for evidence of pent-up demand for health care, meaning that newly insured individuals access care at higher rates due to delaying or foregoing care while uninsured or underinsured, for new Medicaid enrollees in Minnesota.
Poster presentations of SHARE-funded research at ASHEcon 2016 are as follows:
Specialty Drug Benefit Design and Patient Out-of-Pocket Costs in the ACA Health Insurance Exchanges
Speaker: Erin A.Taylor (RAND)
Date/Time: Tuesday (6/14), 12:00 p.m.
Location: Annenberg Center, Lobby
Insurers often require more cost sharing from patients for high-cost specialty drugs, meaning that patients end up paying more money out-of-pocket for these drugs than they would for other drugs. This research simulates potential out-of-pocket costs in health exchange plans for patients taking three specialty drugs.
Speaker: Michael Dworsky
Date/Time: Tuesday (6/14), 12:00 p.m.
Location: Annenberg Center, Lobby
Overview: This research examines the impact of the ACA’s Medicaid expansion on insurance status and type of coverage for adults who became newly eligible for Medicaid in 2014. The researchers use 2009 – 2014 data from the National Health Interview Survey to estimate the effect of Medicaid expansion on insurance status, and compare states that chose to expand Medicaid coverage to states that chose not to do so. They find that expanding Medicaid to non-disabled childless adults in poverty reduced uninsurance rates without impacting the number of enrollees on private market plans.