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Overview of the MNHA survey, methodology, and evidence of the impact of the aca on health insurance coverage in Minnesota
1. Minnesota Health Services Research Conference
March 1, 2016
University of Minnesota, St. Paul Campus
Overview of the MNHA Survey,
Methodology, and Evidence of the
Impact of the ACA on Health Insurance
Coverage in Minnesota
1
2. MNHA Team
MDH
Alisha Simon
Sarah Hagge
Kendal Orgera
Stefan Gildemeister
SSRS
David Dutwin
Susan Sherr
Arina Goyle
SHADAC
Kathleen Call
Giovann Alarcon
Karen Turner
Jessie Kemmick
Pintor
MINNESOTANS!
2
3. Minnesota Health Access Survey:
Background
General Population Telephone Survey
Sampling designed to results of specific geographic
regions, ages, race and ethnic groups
Sample telephone numbers in landline and cell frame
History
Early surveys conducted by the University
Since 2001, a partnership between MDH/SHADAC
Funding until 2007 through various sources
Starting in 2007 funding through
Biennial state appropriation
Matching funds provided by DHS
Operation funding by MDH
3
4. Minnesota Health Access Survey: Methods
4
MNHA
Total
Completes
Percent
Landline
Completes
Response
Rate
2001 27,315 100% 67%
2004 13,802 100% 59%
2007 9,728 100% 43%
2009^ 12,031 82% 45%
2011^ 11,355 62% 44%
2013^ 11,778 42% 48%
2015*^ 11,178 28% 35%
^ Age screen (in landline; added to cell 2015) and child oversample.
* Oversampled pre-paid cell phones.
5. Minnesota Health Access Survey: Content
5
Respond to stakeholder needs
Changing policy environment
Added questions
Health insurance literacy
Discrimination
Having insurance or type of insurance
Race, ethnicity or nationality
Affordability
Access
7. Uninsurance in Minnesota – 2001-2015
MNHA
6.1%
7.7*
7.2%
9.0* 9.0%
8.2%
4.3*
0%
2%
4%
6%
8%
10%
2001 2004 2007 2009 2011 2013 2015
* Indicates statistically significant difference from previous year shown at the 95% level
Source: 2001, 2004, 2007, 2009, 2011, 2013 and 2015 Minnesota Health Access Survey.
7
8. Uninsurance in Minnesota and the US
2001-2015
6.1%
7.7*
7.2%
9.0* 9.0%
8.2%
5.9%
4.3*
15.1% 15.1%
14.4*
11.6*
0%
4%
8%
12%
16%
2001 2004 2007 2009 2011 2013 2014 2015
Minnesota (MNHA) US (ACS)
* Indicates statistically significant difference from previous year shown at the 95% level within the same survey
Source: 2001, 2004, 2007, 2009, 2011, 2013 and 2015 Minnesota Health Access Survey (Minnesota) and U.S. Census Bureau, American Community
Survey (ACS), US rates and 2014 Minnesota Rate. Although estimates for Minnesota align well, direct comparisons are not encouraged.
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9. Alternate Measures of Uninsurance
* Indicates statistically significant difference from previous year shown at the 95% level
Source: 2011, 2013 and 2015 Minnesota Health Access Surveys.
6.6% 6.1%
2.2*
2.4%
2.1%
2.1%
3.8%
4.1%
3.8%
0%
2%
4%
6%
8%
10%
12%
14%
2011 2013 2015
Insured now, but was uninsured during the year
Uninsured now, but had some insurance during the year
Uninsured all year
Point in
time rate:
9.0%
Point in
time rate:
8.2%
Point in
time rate:
4.3%*
9
10. The Percent of Uninsured who are
“Long Term” is Changing
* Indicates statistically significant difference from previous year shown at the 95% level
Source: 2007, 2011, 2013 and 2015 Minnesota Health Access Survey.
10
62.0% 63.6%*
70.8%*
50.3%*
38.0% 36.4%*
29.2%*
49.7%*
0%
20%
40%
60%
80%
100%
2001 2007 2013 2015
Long Term Uninsured Short Term Uninsured
12. Sources of Health Insurance Coverage
68.1% 62.5%*
55.2%* 55.9%
4.8%
5.1%
5.4% 6.3%
21.1%
25.2%*
31.1%* 33.6%*
6.1% 7.2% 8.2% 4.3%*
0%
20%
40%
60%
80%
100%
2001 2007 2013 2015
Group Non-Group Public Uninsured
* Indicates statistically significant difference from previous year shown at the 95% level
Source: 2001, 2007, 2013 and 2015 Minnesota Health Access Survey.
12
13. Access to Employer Coverage
Non-elderly Minnesotans
13
* Indicates statistically significant difference from previous year shown at the 95% level
1 Person works for or has a family member who works for an employer that offers health insurance coverage to at least some employees.
2 Percent of those who work for or have a family member who works for an employer that offers coverage who are eligible for that coverage.
3 Percent of those eligible for employer coverage as an employee or dependent who elect to participate in the employer provided health insurance coverage.
Source: 2001, 2007, 2013 and 2015 Minnesota Health Access Survey.
15. Uninsurance Rates by Age, Non-Elderly
7.3%
5.6%^
13.9%^
17.1%^
8.9%
6.2%^
8.2%
2.8%*
3.8%
6.1%*
8.2%*^
5.3%*
2.8%*^
4.3%*
0%
5%
10%
15%
20%
0-5 6-17 18-25 26-34 35-54 55-64 All Ages
2013 2015
* Indicates statistically significant difference from previous year shown at the 95% level
^ Indicates statistically significant difference from all races/ethnicities in the same year at the 95% level
Source: 2013 and 2015 Minnesota Health Access Survey.
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16. Uninsurance Rates by Race, Ethnicity
6.0%*^
14.5%^
17.0%^
14.0%
34.7%^
8.2%
3.4%*^
8.4% 8.7%
3.7%*
11.7*^
4.3%*^
0%
10%
20%
30%
40%
White Black American Indian Asian Hispanic/ Latio All Races/
Ethnicities
2013 2015
* Indicates statistically significant difference from previous year shown at the 95% level
^ Indicates statistically significant difference from all races/ethnicities in the same year at the 95% level
Source: 2013 and 2015 Minnesota Health Access Survey.
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17. Uninsurance Rates by Household Income
17.6%^
14.3%^
9.6%
5.5%^
2.6%
8.2%
11.5%*^
6.4%*^
4.3%*
2.1%*^ 2.1%^
4.3%*
0%
5%
10%
15%
20%
0 to 100% 101 to 200% 201 to 300% 301 to 400% 401%+ All Income
2013 2015
* Indicates statistically significant difference from previous year shown at the 95% level
^ Indicates statistically significant difference from all races/ethnicities in the same year at the 95% level
Source: 2013 and 2015 Minnesota Health Access Survey.
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18. Remaining Uninsured 2015
There are dramatically fewer uninsured
Gains in coverage across virtually all
demographic groups
Historical patterns in inequities largely remain :
More likely to have household incomes below 200% FPG
More likely to have fair or poor self-reported health
More likely to have high school or less education
Less likely to be white
Less likely to be married
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19. Reasons For Being Uninsured 2015
19
Other/Don't know includes just moved to state, getting coverage soon, immigration issues, IHS, other and don't know
Source: 2015 Minnesota Health Access Survey.