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The Impact of the Patient Protection and Affordable Care Act (ACA) on Low-Income Enrollees of the Minnesota Comprehensive Health Association (MCHA)
Kerry LandryMPH Candidate: Public Health Administration & Policy
Minnesota Health Services Research Conference
St. Paul, Minnesota
March 1st, 2011
www.shadac.org
Acknowledgements
• Minnesota Comprehensive Health Association (MCHA)
• Halleland Habicht Consulting• State Health Access Data Assistance Center
(SHADAC)• University of Minnesota School of Public Health
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www.shadac.org
What are the new coverage options available to MCHA enrollees under the Affordable Care Act?
• In 2014 there will be new coverage options for low-income Minnesotans
• The new coverage options will be based on income eligibility with no asset test
• Assuming that health reform is fully implemented, what coverage options will be available for current MCHA enrollees?
3
www.shadac.org
Overview of Presentation
1. Affordable Care Act coverage expansions
2. Overview of MCHA and the Low-Income Subsidy Program
3. What we know about Low-Income Subsidy recipients
4. Estimate of MCHA enrollees eligible for new coverage options
5. Policy Implications
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www.shadac.org
1. Affordable Care Act Coverage Expansions
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www.shadac.org
Affordable Care Act (ACA)Coverage Expansions
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Income Level ACA Provision
0-138% FPL Medicaid Expansion for ALL
139-200% FPL Basic Health Plan (State opt-in)
201-400% FPLTax credit for premium assistance in the
Exchange
www.shadac.org
2. Overview of MCHA and Low-Income Subsidy Program
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www.shadac.org
High-Risk Pools
• State health coverage mechanism for:– Medically uninsurable– HIPAA eligible– Health Care Tax Credit (HCTC) eligible
• 35 states• Financing
– Mostly through enrollee premiums and insurer assessments
– CMS grants
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www.shadac.org
Minnesota Comprehensive Health Association (MCHA)
• MCHA– Largest high-risk pool in the country
(~27,000 enrollees)– 2nd oldest – in operation since 1976– Currently administered by Medica– ‘Presumptive conditions’ also eligible
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www.shadac.org
Low-Income Subsidy Programs
• Approximately 15 states offer a subsidy• Financing through CMS grants
– Annual application for federal grant money; some years not offered
• Most states distribute as monthly premium discount
• High variation across programs
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www.shadac.org
Minnesota’s Low-Income Subsidy Program
2010
Amount Distributed $1,674,608
Income Eligibility Up to 220% FPL
Distribution Method Total $ divided by # of qualified members
Subsidy Recipients 2,774
Subsidy Amount per member $610.28 one-time check
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www.shadac.org 12
www.shadac.org
3. What we know about low-income subsidy recipients
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www.shadac.org
MCHA and Low-Income Subsidy Program Participants: Age
0-5 6-18 19-25 26-34 35-44 45-54 55-64 65+0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
0% 2%5%
9%
13%
25%
45%
0%2%6% 6%
8%
12%
24%
42%
0%
Percentage of LISP recipients Percent of MCHA population
Age
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www.shadac.org
MCHA and Low-Income Subsidy Program Participants: Deductible Level
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$500 $1,000 $2,000 HDHP $5,000 $10,000 0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
5.9%
19.3%
33.7%
6.7%
19.1%
15.3%
7.6%
19.7%
31.6%
13.9%16.2%
10.9%
Percentage of LISP recipients Percent of MCHA population
Deductible Level
www.shadac.org
Low-Income Subsidy Recipients
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Percent of Federal Poverty Level
Estimate of Subsidy Program Recipients
0-138% 1,362
139-200% 959
201-220% 453
Total 2,774
www.shadac.org
What can we say about ALL MCHA enrollees from the Subsidy Program data?
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• At a minimum,
• 5.3% potentially eligible for Medicaid
• 3.7% potentially eligible for Basic Health Plan
www.shadac.org
4. Estimate of MCHA enrollees eligible for new coverage options
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www.shadac.org 19
www.shadac.org
Estimating income for all MCHA enrollees• Income information not available for all
enrollees – only those who applied for the subsidy program
• Do have zip code information for all enrollees
• Use zip code to determine community level income
• Estimate MCHA enrollee income using community level income
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www.shadac.org
American Community Survey (ACS)
• Annual survey conducted by the US Census Bureau
• Information on demographics, income, education, employment, health insurance, etc.
• Sub-state (community-level) analysis possible
• Public use file available
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www.shadac.org
Estimating income for all MCHA enrollees
1. Find the % of people in different income categories for each community from the ACS
– 0-138%FPL– 139-200%FPL– 201-400%FPL– 401%+FPL
2. Imputation of income for MCHA enrollees based on community level income
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www.shadac.org
Estimate of income level for all MCHA enrollees
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16.7%
9.3%
32.0%
42.0%
0-138%
139-200%
201-400%
401%FPL+
Subsidies in the exchange
Basic Health PlanNo subsidy
Medicaid
www.shadac.org
5. Policy Implications
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www.shadac.org
Policy Implications
• 58% of MCHA enrollees potentially eligible for some form of subsidized health insurance
(n = 14,179)
• There are likely more low-income enrollees than what we estimate from the subsidy program
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Policy Implications (2)
• Potential for many individuals with chronic conditions moving to Medicaid and the individual market – Increase in risk profile of these groups– Added costs– Potential increase in premiums for private coverage– Risk adjustment in the exchange and individual
market
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www.shadac.org
Limitations
• These results are estimates • Could improve estimate through:
– Income information on all MCHA members through an enrollee survey
• Further research needed to assess affordability of new options compared with MCHA coverage
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www.shadac.org
Contact information
Kerry Landrylandr018@umn.edu
State Health Access Data Assistance Center (SHADAC)
www.shadac.org
28©2002-2009 Regents of the University of Minnesota. All rights reserved.The University of Minnesota is an Equal Opportunity Employer
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