Presentation by Lynn Blewett at the AcademyHealth State Coverage Initiatives (SCI) State Coverage Institute, September 26 2007.

1. State Health Access Reform Evaluation Lynn A. Blewett, Ph.D. State Health Access Data Assistance Center AcademyHealth State Coverage Initiatives (SCI) State Coverage Institute Chicago, Illinois September 26, 2007 Funded by a grant from the Robert Wood Johnson Foundation

4. Quick Overview of State Health Reform

6. Continued Increase in Uninsured Source: U.S. Census Bureau, Current Population Surveys (March), 1989-2006 New verification question Millions of Uninsured, all ages 15.8% of Population

7. Drop in Employer-Sponsored Coverage (U.S.) Source: US. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2006.

8. Increase in Uninsured Children, 2005-06 710,000 New Uninsured Children <200% FPL 200-399% FPL 400%+ FPL 220,000 340,000 150,000 31.3% 47.5% 21.2% Note: 200% to 399% of the federal poverty level (FPL) is roughly $40,000-$80,000 in annual income for a family of four in 2006. Source: KCMU/Urban Institute analysis of the March 2007 CPS .

10. Increase in State Revenues Source: Quarterly Summary of State and Local Government Tax Revenue, U. S Census Bureau. Annual Change in 2nd Quarter State and Local Tax Revenue Drop in 2007?

11. Source: Congressional Budget Office Federal Relief?

12. States Are in Different Phases of Reform Process Illinois (kids) Maine Massachusetts PA (kids) Vermont WI (kids) California Oregon WI Colorado Minnesota Illinois (all ) New Jersey New Mexico PA (all) WI (all) Post –Implementation Legislation Passed/ Implementation Legislation Introduced In Discussion

14. Health Reform Evaluation -101

25. Examples: Performance Outcomes for Health Reform

30. Data Sources – State vs. National

31. Assumption “ Good policy needs good data and collecting good data is good policy.” Source: Ernie Ingles, Chief Librarian, University of Alberta

35. HRSA-SPG Funded Survey Activity 2000-2005 Household and Employer Survey Employer Survey Household Survey

37. On Average Uninsurance Estimates from State Surveys are 22% Lower than CPS Uninsurance Estimates for Select States

38. Increased Sample Size in State Surveys

41. Technical Assistance - State Health Access Reform Evaluation - State Health Access Data Assistance Center

44. State Health Reform If States are the Laboratories….. Where are the lab reports?

47. The SHADAC Vision Federal Data (e.g., CPS) Better Understanding of the Characteristics of the Uninsured State Data (e.g., State Surveys) Increase Coverage and Access THANK YOU!

48. Contact Information www.shadac.org www.statereformevaluation.org University of Minnesota School of Public Health Division of Health Policy and Management 2221 University Avenue, Suite 345 Minneapolis Minnesota 55414 (612) 624-4802 Principal Investigator: Lynn A. Blewett, Ph.D. (blewe001@umn.edu)