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Measuring the Affordable Care Act in Minnesota: Access to Health Care

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Measuring the Affordable Care Act in Minnesota: Access to Health Care Issue Brief Health Economics Program February 2014 The Health Economics Program of the Minnesota Department of Health and SHADAC of the While the ultimate goal of health insurance is to University of Minnesota School of Public Health protect individuals’ financial assets in the event of a conduct a biennial population survey to assess health problem, health insurance also facilitates trends in access to coverage and costs in Minnesota. access to health care services. Thus, having health The 2013 Minnesota Health Access Survey insurance increases confidence in the ability to get (MNHA) was conducted as the health care market needed care, increases access to high-quality prepared for implementation of substantial federal treatments and providers, and is associated with health reform provisions in 2014, including: improved health outcomes.4 Expansion of income eligibility for Medical Assistance (Minnesota’s Medicaid program); Overall, the majority of Minnesotans in 2013 were Establishment of MNsure, the state’s health very confident in their ability to get needed health insurance marketplace, through which eligible care. Specifically, 74.6% of non-elderly Minnesotans can obtain premium and cost Minnesotans said they were very confident in their sharing subsidies and comparison-shop for ability to get needed health care, and 91.1% said health insurance products; they were very or somewhat confident (data not Establishment of guaranteed issue, under which shown). As shown in Figure 1, confidence varied pre-existing conditions will not act as a barrier greatly by type of insurance coverage. People with to coverage; group coverage (coverage through an employer or Reform in standards of available insurance union) showed higher confidence in their ability to products to include coverage of preventive get needed care than those who held other types of services free of cost-sharing and remove annual insurance coverage.5 People who were uninsured and life-time benefit limits; and were less than half as likely as other groups to be Requirement that all Minnesotans hold health very confident they could get the care they needed insurance coverage.1 (30.0%). In an effort to establish a baseline against which to measure the effects of federal health reform (also called the Affordable Care Act, or ACA) 100% implementation in Minnesota, this issue brief 83.4% presents data from the 2013 MNHA on metrics of 80% 73.1%* access to health care.2 The issue brief also presents 67.5%* information on how well Minnesotans understood 60% the health care market changes planned for 2014, at 40% the time the survey was conducted (between August 30.0%* and November of 2013). Given high rates of 20% coverage among Minnesotans age 65 and older, this 3 brief focuses on the non-elderly population. 0% Group Individual Public Uninsured Coverage Coverage Coverage Minnesota Department of Health Health Care Access in Minnesota, Baseline Analysis for Assessing the Impact of the Health Reform in the State health care providers. Through future research, MDH will monitor whether increased coverage leads to greater linkages between patients and 100% providers, and to what extent minimum standards 90.4%* 83.6%* 88.5%* around preventive care and other delivery system 80% reforms, such as the Health Care Home effort and movement towards payment systems with greater 54.6% 60% financial accountability for health care providers, contribute towards that change. 40% 20% Even with insurance coverage, obtaining health care 0% services can be costly for some. Two indicators Group Individual Public Uninsured Coverage Coverage Coverage were analyzed for this research to understand whether in 2013, prior to federal health reform implementation, Minnesotans experienced financial strain related to health care. One indicator assessed Results from actuarial and economic modeling 8 indicate coverage options are most likely to change financial burden due to medical bills, a second one determined whether Minnesotans ever felt they had for the uninsured and people with individual 9 coverage.6 As such, monitoring the perception of to forgo needed care because of the associated cost. the remaining uninsured and people with individual coverage around access to care will be important. Using these metrics, nearly one-third of non-elderly In addition, as the composition of public program Minnesotans (30.8%) experienced some financial enrollees has the potential of changing as well, strain (financial burden, forgone health care, or continued monitoring of that population’s sense of both) in 2013 due to health care costs. Specifically, their confidence in getting needed care is equally in the past year, 22.4% of non-elderly Minnesotans important. experienced financial burden associated with health care services they consumed; 18.9% decided to Having a usual source of care increases the forgo some type care because of the costs. likelihood of timely preventive care and health care access.7 In 2013, the vast majority of Minnesotans As shown in Figure 3, health insurance remains an had a usual source of health care – a typical place to important factor in reducing financial strain go when sick, such a physician’s office or health associated with health care costs –it does not, care clinic. Overall, 86.3% of non-elderly however, eliminate it. Minnesotans with group Minnesotans had a usual source of care (data not coverage were the least likely to experience shown). Differences in the availability of a usual financial strain associated with using medical care, source of care by insurance coverage are as and of those with group coverage who did prevalent as Minnesotans’ confidence in getting experience issues, they appeared more likely to needed care. While the vast majority of the insured struggle with paying medical bills rather than population had a usual source of care (Figure 2), having to decide to forgo care. only about half of the uninsured (54.6%) reported People with individual and public program coverage having that level of connection to a health care also experienced financial strain, albeit at levels provider. significantly below those for the uninsured. Although insurance coverage on its own doesn’t Overall, nearly six in ten uninsured people (57.8%, guarantee access to health care providers, this and data not shown) experienced some health care other research suggests that there is an association related financial strain; 40.1% reported struggling between insurance coverage and connectedness to with financial burden due to health care bills, 44.7% decided to forgo some care due to cost. 2 Health Care Access in Minnesota, Baseline Analysis for Assessing the Impact of the Health Reform in the State 50% 44.7%^ 40.1%^ 40% 30% 24.9%* 22.3%* 23.3%*^ 22.4% 19.4%* 18.9% 20% 19.4%*^ 13.4%*^ 10% 0% Group Individual Public Uninsured Overall Financial Burden Forgone Care Previous research indicates that insurance coverage has the potential to decrease the percent of people who experience financial burden, but not to completely eliminate it. For example, a The vast majority of Minnesotans will have the Massachusetts study found significant financial option of maintaining their insurance coverage burden among people with unsubsidized plans in under federal health reform, either through their the individual market; those with the equivalent of current employer coverage, Medicare, Medical 12 an ACA “bronze” plan, and incomes below 400% Assistance (Medicaid) or Minnesota Care. The of the Federal Poverty Guidelines were more likely groups most likely affected by changes in the to experience financial burden than people with insurance market are people currently covered “Gold” or “Silver” plans, or higher incomes.10 A under MinnesotaCare with incomes above 200% study in Oregon, which looked at what happened to Federal Poverty Guidelines, those covered by the the uninsured who became eligible for Medicaid, Minnesota Comprehensive Health Association found that Medicaid reduced financial strain after (MCHA, Minnesota’s high-risk pool), people who two years on the program.11 currently purchase health insurance on the individual market and Minnesotans who lack The changes in the health insurance market that insurance coverage. extend beyond greater availability of affordable coverage have the potential to decrease financial Figure 4 shows projected coverage options available strain of Minnesotans in the future. The magnitude in 2014 for those who were uninsured in 2013 or of the decrease will depend on the mix of metal tiers held individual insurance; these projections are among enrollees, the volume of care use, the extent based on estimates of income and current eligibility 13 to which people qualify for premium subsidies, and for employer coverage reported in the MNHA. the level of health insurance literacy, which would The coverage estimates are likely somewhat allow enrollees to better understand the available overstated, because the survey does not identify benefits, as well as the implications of service use. immigration status, thereby removing the possibility to exclude non-documented residents from eligibility estimates.14 3 Health Care Access in Minnesota, Baseline Analysis for Assessing the Impact of the Health Reform in the State 60% 51.3% 50% 40% 28.8% 30% 22.8% 24.1% 19.7% 19.3% 20% 11.3% 9.5% 8.3% 10% 5.1% 0% Eligible for Medical Eligible for Eligible for Access to coverage Not Eligible for Assistance MinnesotaCare premium subsidies through employer ACA Assistance1 on MNsure Uninsured Individual
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