establishing a baseline for the affordable care act: how accessible and affordable has health care...

How Accessible and Affordable has Health Care been in Minnesota

previous to the ACA?

Giovann Alarcón

MN Health Services Research Conference

March 4th, 2014

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Provide an up-to-date and State specific overview of two

important outcomes to monitor under the ACA: health

care access and affordability.

• How accessible is care in MN?

• How affordable is care in MN?

• How do the Uninsured compare to other groups?

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• MNHA 2007, 2009, 2011, and 2013

• Non-elderly population

• Sample size

• 2007: 7,316

• 2009: 9,749

• 2011: 9,499

• 2013: 9,935

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Access indicators that the ACA is expected to impact

include:

• reports of having a usual source of care (2007-2013),

• use of the emergency department (2009-2013),

• the ability -and confidence- in getting care when needed

(2011-2013), and

• provider supply issues where potential patients are told

by a doctor’s office or clinic that they do not accept their

health care coverage or they are not accepting new

patients (2013).

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• Most Minnesotans have a usual source of care and are

confident in getting care when needed, but only about half of

the uninsured report the same characteristics.

• Health Care Utilization is high for most (around 80% for

doctor’s visits) but the uninsured (47%).

• One out of ten Minnesotans could not get a doctor’s

appointment as soon as needed, with those enrolled in public

programs doubling the rates of others.

• Minnesotans with public coverage were more likely to face

problems with providers than people with other types of

insurance or the uninsured.

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90.4%

83.6%^*

88.5%

54.6%^

86.3%

50%

60%

70%

80%

90%

100%

Group Coverage IndividualCoverage

Public Coverage Uninsured Total

2007 2009 2011 2013

* Indicates statistically significant difference (p≤.05) from previous year shown

^ Indicates statistically significant difference (p≤.05) from Group within year

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* Indicates statistically significant difference (p≤.05) from previous year shown

^ Indicates statistically significant difference (p≤.05) from Group within year

96.1%

89.8%^ 90.6%^

58.4%^

91.1%

50%

60%

70%

80%

90%

100%

Group Coverage IndividualCoverage

Public Coverage Uninsured Total

2007 2009 2011 2013

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^ Indicates statistically significant difference (p≤.05) from Group within year

Total

Very confident 83.4% 73.1% ^ 67.5% ^ 30.0% ^ 74.5%

Somewhat confident 12.8% 16.7% 23.1% ^ 28.3% ^ 16.6%

A little confident 2.5% 5.4% ^ 5.0% ^ 23.0% ^ 5.1%

Not confident at all 1.4% 4.8% ^ 4.4% ^ 18.6% ^ 3.8%

PublicGroup Individual Uninsured

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^ Indicates statistically significant difference (p≤.05) from Group within year

83.0%

76.2%^

82.4%

47.3%^

79.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Group Coverage IndividualCoverage

Public Coverage Uninsured Total

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* Indicates statistically significant difference (p≤.05) from previous year shown

^ Indicates statistically significant difference (p≤.05) from Group within year

13.5%

11.7%

27.2%^

18.0%

16.7%

0%

5%

10%

15%

20%

25%

30%

35%

Group Coverage IndividualCoverage

Public Coverage Uninsured Total

2009 2011 2013

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^ Indicates statistically significant difference (p≤.05) from Group within year

8.9%

5.7%^

15.9%^

7.9%

10.1%

0%

3%

6%

9%

12%

15%

18%

Group Coverage IndividualCoverage

Public Coverage Uninsured Total

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^ Indicates statistically significant difference (p≤.05) from Group within year

1.3%

2.2%

7.2%^

5.2%^

2.9%

2.2% 2.1%

6.1%^

4.0%

3.2%

0%

2%

4%

6%

8%

Group Coverage IndividualCoverage

Public Coverage Uninsured Total

Doctor did not accept their health care coverage

Doctor was not accepting new patients

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Affordability indicators that the ACA is expected to impact

include:

• forgone and delayed care due to costs (2011 & 2013),

• problems paying medical bills (2013),

• needing to establish a payment plan with a hospital or

doctor’s office (2013), or

• having trouble paying other basic bills (e.g. food, heat, or

rent) due to care costs (2013).

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• Although, in 2013 Minnesotans were less likely to forgo

care due to costs than in 2011, about one out of five

people faced this situation.

• One out of four Minnesotans who used some form of

care reported having financial burdens related to these

services.

• Almost one out of two uninsured Minnesotans had

problems paying medical bills, and for 32% of the

uninsured these affected their ability to pay other basic

bills

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* Indicates statistically significant difference (p≤.05) from previous year shown

^ Indicates statistically significant difference (p≤.05) from Group within year

9.2%

17.4%

9.8% 9.2%

7.3%*

12.4%*

6.9%*

4.1% 4.9%*

0%

3%

6%

9%

12%

15%

18%

21%

Prescription Dental Care Routine Care Mental HealthCare

Specialist Care

2011 2013

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* Indicates statistically significant difference (p≤.05) from previous year shown

^ Indicates statistically significant difference (p≤.05) from Group within year

Group Coverage 4.5% * 8.3% * 3.7% * 2.4% 3.2% *

Individual Coverage 7.5% 15.1% ^ 7.8% ^ * 3.6% 4.4% *

Public Coverage 11.1% ^ 15.2% ^ * 5.5% ^ * 4.1% ^ 4.9% ^ *

Uninsured 17.7% ^ 32.4% ^ * 32.2% ^ 17.1% ^ 17.6% ^ *

Total 7.3% * 12.4% * 6.9% * 4.1% 4.9% *

Prescription Dental Care

Routine

Care

Mental

Health

Specialist

Care

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^ Indicates statistically significant difference (p≤.05) from Group within year

19.3% 19.3%

25.3%^

40.0%^

22.5% 21.3% 22.1%

28.1%^

60.6%^

25.1%

0%

10%

20%

30%

40%

50%

60%

70%

Group Coverage IndividualCoverage

Public Coverage Uninsured Total

Overall population Those who used health care

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^ Indicates statistically significant difference (p≤.05) from Group within year

12% 16%

20%^

48%^

16% 17% 16% 18%

46%^

19%

6% 7%

14%^

32%^

10%

0%

10%

20%

30%

40%

50%

60%

Group Coverage Individual Coverage Public Coverage Uninsured Total

Problems paying medical bills Set up a payment plan for medical bills

Had trouble with basic bills due to medical costs

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^ Indicates statistically significant difference (p≤.05) from comparison group (Insured) within year

83.0%

76.2% 82.4%

60.1%^ 54.9%^

40.6%^

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Group coverage Individual coverage Public coverage

Insured Uninsured

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^ Indicates statistically significant difference (p≤.05) from comparison group (Insured) within year

8.9%

5.7%

15.9%

7.6%

10.4%

7.2%^

0%

10%

20%

Group coverage Individual coverage Public coverage

Insured Uninsured

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^ Indicates statistically significant difference (p≤.05) from comparison group (Insured) within year

13.4%

22.3% 23.3%

44.0%^

49.7%^

43.6%^

0%

10%

20%

30%

40%

50%

60%

Group coverage Individual coverage Public coverage

Insured Uninsured

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^ Indicates statistically significant difference (p≤.05) from comparison group (Insured) within year

19.3% 19.3%

25.3%

43.2%^

34.7%^

43.0%^

0%

10%

20%

30%

40%

50%

Group coverage Individual coverage Public coverage

Insured Uninsured

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• Despite high insurance rates, some measures of

health care access and affordability are low.

• This especially affects Minnesotans with public

coverage and the uninsured.

• Under ACA, most changes are expected to occur in

the individual market and public programs.

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www.shadac.org

@shadac

Giovann Alarcón

alar0013@umn.edu