2017 Minnesota Health Access Survey. Alisha Simon & Stefan Gildemeister Health Economics Program March 14, 2018

Transcription

1 2017 Minnesota Health Access Survey Alisha Simon & Stefan Gildemeister Health Economics Program March 14, 2018

2 Agenda Brief overview of the MNHA 2017 Results in Context Covering the uninsured 2017 and beyond 2

3 Brief overview of the Minnesota Health Access Survey General Population Telephone Survey Comparable data back to 2001, conducted biennially since Stats: 12,436 completed interviews Fielding period: June through early October 2017 Sample design: 75% cell phone/25% landline Screening for age Oversampled pre-paid cell phones Response rate: Overall: 28.8% Weighted to MN population using 2016 American Community Survey (ACS) 3

4 Other Uninsurance Estimates Much activity in this space: National surveys and polling on national data Some estimates for large states are possible For Minnesota, MNHA is the richest source of information Survey specifically aligned to Minnesota (uses Minnesota-specific terms) Asks multiple questions to determine health insurance coverage Sample is designed based on state geography and demographics Timely and can be aligned with changing policy questions 4

5 2017 Results in Context 3/14/2018 5

6 What changed in Minnesota Between 2015 and 2017? 2015 Unemployment Rate: 3.8% Average Weekly Wages State Economy: $328.4B 0.2 pp No change 7.2% 2017 Unemployment Rate: 3.6% Average Weekly Wages State Economy: $352.0B 0 to 65 Population Growth 1.2% 0 to 65 Population Growth 65+ Population Growth 4.6% 65+ Population Growth

7 Minnesota Uninsurance Rate Rose Significantly in % 8% 6% 4% 2% 0% 6.1% Recession 7.7%* Lagged Increase in Uninsurance Rate Percent Uninsured in Minnesota, 2001 to % Recession 9.0%* 9.0% Lagged Increase in Uninsurance Rate % Major ACA Reforms 4.3%* 6.3%*? * Indicates statistically significant difference from previous year shown at the 95% level Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013, 2015 and 2017 Minnesota Health Access Survey. 7

8 Coverage Through Individual Market and Employers Fell 70% 60% 68.1% Private Coverage in Minnesota, 2001 to %* 62.5% 57.6%* 56.6% 55.2% 55.9% 52.9%* Fewer people connected to employers offering coverage 50% 40% Declining take-up among children 30% 20% High costs (both group and individual markets) 10% 0% 4.8% 4.6% 5.1% 5.1% 5.2% 5.4% 6.2% 4.4%* Uncertainty around coverage Group Individual * Indicates statistically significant difference from previous year shown at the 95% level Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013, 2015 and 2017 Minnesota Health Access Survey. 8

9 Public Coverage increases did not make up for private coverage decreases 70% 60% 50% 40% 30% 20% 10% 0% 68.1% 21.1% Sources of Insurance Coverage, 2001 to %* 62.5% 25.1%* 25.2% 57.6%* 56.6% 28.3%* 29.2% 55.2% 55.9% 31.1%* 33.6%* 4.8% 4.6% 5.1% 5.1% 5.2% 5.4% 6.2% 52.9%* 36.5%* 4.4%* Group Individual Public More people aging into Medicare (responsible for 40% of the increase) Fewer people losing public coverage and becoming uninsured Eligible people have more options to enroll, better support than in the past and more exposure to the issue * Indicates statistically significant difference from previous year shown at the 95% level Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013, 2015 and 2017 Minnesota Health Access Survey. 9

10 Volatility and Uncertainty in the Health Policy Space Uncertainty throughout the year Will the ACA be repealed after election? Wait for state response to high individual market premiums ACA repeal votes in Congress Ending CSR subsidies Individual Mandate penalty set to $0 for 2019 Continued increasing health care costs (premiums/cost sharing) for private insurance 10

11 Individual Coverage Most sensitive to uncertainty and debate surrounding health insurance Significant changes occurred in the market in Minnesota in 2017 Approximately 2 percent decline in enrollment, which corresponds with a documented enrollee decrease as of June 2017 Demographic profile of the individual market did not change Over one-fourth are over age 55 (average age is still increasing) Nearly half of all enrollees have incomes over 400 percent FPG Of those who lost individual coverage, about 1/3 (36%) became uninsured, while the rest went to other coverage 11

12 Rural Minnesota Saw a Steeper Decline in Individual Coverage from

13 The MNsure Good News Enrollment through MNsure has kept growing, despite the shrinking market Over half of individual market enrollees purchased coverage through MNsure; in 2015, that number was about 16 percent Indirect evidence: greater stability in public program enrollment Based on income, most people enrolled in individual market coverage who are eligible are getting premium subsidies. There are still 75,000 uninsured Minnesotans who could potentially benefit from premium subsidies Other studies tell us access to navigators helps enrollment More Minnesotans are enrolling in and maintaining public program coverage. MNsure provides another option to enroll aside from counties and brokers 13

14 Covering the Uninsured: 2017 and Beyond 3/14/

15 Potential Sources of Coverage for the Uninsured 80% 67.4% 60% 59.4% 51.1%~ 40% 36.7% 33.4% 30.8% 20% 19.6% 23.1% 18.6% 23.5% 22.7% 17.7% 7.8%~ 12.5%~* 0% Connection to Employer that offers coverage Eligible for employer coverage Potentially eligible for public coverage Potentially eligible for APTC Not eligible for employer coverage, public coverage or APTC (2013 does not include APTC eligibility) * Statistically significant difference from 2015 at the 95% level ~ Statistically significant difference from 2013 at the 95% level Source: Minnesota Department of Health, Health Economics Program, 2013, 2015 and 2017 Minnesota Health Access Survey. 15

16 People with the lowest incomes maintained coverage gains Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013, 2015 and 2017 Minnesota Health Access Survey. 16

17 Most adults saw a return to 2013 coverage levels Source: Minnesota Department of Health, Health Economics Program, 2001, 2004, 2007, 2009, 2011, 2013, 2015 and 2017 Minnesota Health Access Survey. 17

18 Individual Market Premiums Have Changed A Lot Annual Single Premium, 40 year old, Morris, MN $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 $3,351 $3,351 Individual, $51,000 Income Subsidized Coverage Comparison - Individual Market, 2016 through 2018 Individual, $42,000 Income $871 $2,481 Individual, $30,000 Income $1,396 $1,513 $3,094 $4,187 $4,070 $2,490 Individual, $51,000 Income Individual Individual, $42,000 Income Sponsor Individual, $30,000 Income $5,178 Individual, $51,000 Income $1,163 $4,015 Individual, $42,000 Income $2,722 $2,456 Individual, $30,000 Income Notes: Premiums are for benchmark silver plan in Morris, MN. In 2017, state premium rebate of 25% is included for individuals over 400% of poverty ($51,000 income); 2018 premium decreases are due to a new state reinsurance program. Morris, MN was selected because its premiums were close to the statewide average in 2016 and Source: Minnesota Department of Health, Health Economics Program Analysis of Individual market premiums. 18

19 But Costs are Going up for Everyone Annual Premiums (40-year old, Morris, MN) $18,000 $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 $6, % 23.7% $4,993 $2,722 $5,178 $1,497 $2,456 Employer Sponsored Coverage Payments Made by Individuals and Sponsors of Coverage (2018) $5,178 $5,178 Individual/ no subsidy ($51,000 income) Individual/ subsidy ($30,000 Income) -1.3% Personal Cost Subsidized Cost Change from Previous Year $16,385 $10,327 $6, % High Risk Pool Coverage (projected) 25% 20% 15% 10% 5% 0% -5% Change in Individual Cost from 2017 Notes: Employer sponsored coverage based on average single premiums for Minnesota in 2016; premiums were estimated for 2018 using the average growth between 2014 and Morris Minnesota was selected as it has premiums close to the state average. High risk pool coverage is estimated by using 2012 monthly premiums and assessment amounts, and then using the average growth from 2011 through 2013 to estimate costs in Source: Minnesota Department of Health, Health Economics Program Analysis of Medical Expenditure Panel Survey Insurance Component results(meps-ic), Individual market premiums, and Minnesota Comprehensive Health Association (MCHA, Minnesota s high risk pool that ended in 2014) Writing Carrier reports. 19

20 Closing Thoughts The ongoing decline in employer-sponsored coverage is of concern that it happens in strong economic times is even more worrisome Public program coverage is not currently designed to accommodate people without ESI Affordability and stability of individual market coverage is uncertain Health care costs are still going up, regardless of how many people have insurance coverage. Need a deeper understanding: What drives people to drop, maintain, or enroll in coverage Why public coverage eligible Minnesotans don t enroll 20

21 Questions? Alisha Simon & Stefan Gildemeister