pres hsr mar5_pintor

Funded by a grant from the Robert Wood Johnson Foundation

Putting Out the Welcome Mat: Targeting

Outreach Under the Affordable Care Act

Profile of Minnesota’s Uninsured Jessie Kemmick Pintor, MPH

MN Health Services Research Conference

March 5th, 2013

Purpose/Overview

• To provide an in-depth profile of the

uninsured in Minnesota in order to inform

targeted outreach to non-elderly adults who

will be newly eligible for Medicaid coverage

or subsidies through the exchange:

– Overall uninsured

– Potentially Medicaid-eligible non-elderly adults:

<138% FPG

– Potentially subsidy-eligible non-elderly adults :

139-400% FPG

2

2011 MN Health Access Survey

• Conducted by MDH and SHADAC (Sep to Dec 2011)

• Purpose:

– Document trends in health insurance coverage and access to

insurance and health care

– Describe characteristics of the uninsured, and economic and

demographic factors associated with lack of coverage

– Establish baseline data for evaluating health reform

• Dual frame survey targeting 11,000 completes

– 62% landline, 38% cell

• Stratified sampling to produce reliable estimates for: – Regions of the state

– Most populous racial/ethnic groups

3

Uninsured Minnesotans, 2011

• 489,000, or 9.1% of, Minnesotans uninsured

– 675,000, or 12.6% uninsured at some time in 2011

• Uninsurance rates highest among: – 26-34 year olds, individuals with lower education/income

levels, Hispanics/Latinos, and foreign-born

• Uninsured as likely to be employed as overall – However, more likely to be self employed or work for

smaller employers, work part-time, hold more than one job,

and hold temporary or seasonal jobs

• Most report lack of coverage due to cost, and

loss of coverage due to job termination

4

Nearly half of Medicaid-eligible already have

public coverage, most subsidy-eligible have ESI

5

Public

45%

Group

27%

Individual

5%

Uninsured

23%

Public

15%

Group

62%

Individual

6%

Uninsured

17%

Source: 2011 Minnesota Health Access Survey

Insurance coverage among non-elderly adults at or below 138%

and 139-400% FPG, 2011

Uninsured Medicaid- and subsidy-eligible

much younger than non-elderly adults overall

6

*Indicates statistically significant difference (95% level) from overall non-elderly population


29%* 26%

31%

13%

18%

30%*

41%

11%

16% 19%

46%

19%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

18-25 26-34 35-54 55-64

Uninsured Medicaid-eligible Uninsured subsidy-eligible Overall

Age distribution of non-elderly adults, 2011

Latinos greatly overrepresented among Medicaid-

eligible; Blacks overrepresented among subsidy-eligible

7

59%

10% 6% 4%

17%*

5%

75%

12%*

4% 1%

7% ƚ

84%

5% 4% 1%

4% 2% 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

White Black Asian American

Indian

Hispanic/Latino Other

Uninsured Medicaid-eligible Uninsured subsidy-eligible Overall


ƚ Less than 1%


Race/ethnicity among non-elderly adults, 2011

Three in ten Medicaid-eligible have less than

a high school education

8

30%*

13% 8%

33%

37%

25%

29%

32%

34%

8% 19%

34%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Uninsured Medicaid-

eligible

Uninsured subsidy-

eligible

Overall

College grad

Some college

HS grad

Less than HS



Level of education among non-elderly adults, 2011

What else do we know about Medicaid- and

subsidy-eligible non-elderly adults? • Males slightly overrepresented

• Less likely to be in excellent/very good health

• Similar distribution across TC metro/Greater MN

• Just over half of Medicaid-eligible employed,

compared to 76% of nonelderly overall

• 11% of Medicaid-eligible and 19% of subsidy-eligible

have access to ESI

• Over half of Medicaid-eligible and 1/3 of subsidy-

eligible have children under 21 in household

9

Interaction of uninsured non-elderly adults with

Minnesota Public Health Care Programs, 2011

10


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Asked/given

information

about public

programs

Would enroll if

eligible

Of those who say

no: would enroll

if coverage was

free

Would

participate in a

premium

assistance

program

Uninsured Medicaid-elgible

Uninsured subsidy-eligble

Main reason for not enrolling in MN Health Care

Programs among uninsured non-elderly adults, 2011

11


Too expensive

23%

Do not know

what to do/where

to go/how to

enroll

21%

Applied but not

eligible

11%

Too much

hassle/paperwork

9%

Will get insurance

soon

8%

Don't need or

want insurance

right now/rarely

sick

10%

Don't think the

care/benefits are

good

4%

Other

14%

Applied but not

eligible

23%

Don't think I'm eligible

14%

Too expensive

14%

Do not know

what to

do/where to

go/how to

enroll

11%

Don't need or want

insurance right now

11%

Will get insurance

soon

6%

Don't think

government should

pay for my health care

4%

Too much

hassle/paperwork

3%

Don't think the

care/benefits are good

3% Other

11%

Subsidy-eligible Medicaid-eligible

Next steps/Potential analyses for MN Health

Insurance Exchange • 3-year (2008-2010) pooled sample of the American

Community Survey (ACS) allows for geographic

specificity (PUMA) in answering a number of questions

• Characteristics of uninsured across PUMAs:

– Education levels across PUMAs

– Individuals in linguistically-isolated households across PUMAs

– Individuals in households where someone receives

TANF/SNAP benefits across PUMAs

• Potential to generate regions designed by the state

• Adding layer information such as location of schools,

community centers, libraries, etc.

12

Percent uninsured nonelderly US citizens, <=138%

FPL and 139-400% FPL, 2008-2010, by PUMA

13

Conclusions/Implications for outreach to

Medicaid-eligible

• Medicaid outreach will need to target younger

Minnesotans with lower levels of education

• Over half of uninsured Medicaid-eligible have

inquired about MHCP and 4 in 5 report they

would enroll in Medicaid if they were eligible

– Still, many report that they do not know where to

go, how to apply and/or that the process is too

much of a hassle/too much paperwork

• Many live in households with children under 21,

which may be a potential avenue for outreach

14

Conclusions/Implications for outreach to

subsidy-eligible

• Slightly younger and lower levels of education

compared to nonelderly overall

• Only 1 in 5 of the uninsured who are potentially

eligible for subsidies under the exchange have

access to employer-sponsored insurance

• Over half have inquired about MHCP and most

report they would enroll in a premium

assistance program if eligible

– Still, again, they report problems accessing MHCP

15

Sign up to receive our newsletter and updates at

www.shadac.org

@shadac

Jessie Kemmick Pintor

[email protected]

612.624.2083

mailto:[email protected]

pres hsr mar5_pintor

Documents